Transcript Presentation - The Care Forum

Mental Health Network
-Eating Disorders
• Introduction to STEPs
• Motivational Work
• Eating Disorders
• Questions
Lydia Pym - Occupational Therapist
Nadia Freyther – Community Nurse
STEPs Eating Disorder Service
STEPs Eating Disorder Service
• Adult Service offering specialist service interventions and
consulting to a wide geographical area
• Commissioned to work with people with a diagnosis of Anorexia,
Bulimia and EDNOS, excluding Binge Eating Disorder
• 10 Bed In-patient unit, 8 place Day Therapy programme* Outpatient and Community services
• Multidisciplinary Team
• Variety of treatments
• Supporting Carers
Prochaska & DiClemente’s Six Stages of Change
• How and why did we develop our
current model of working?
Motivational Work
• Listen
• Step back
• Learn
• Be curious
• Invest less
Is it any good?
• Benefits Staff, team and Clients
Non-Negotiable
1. Clearly defined from the outset – no surprises
2. Agreed by staff & clients if possible
3. Not arbitrary, but with good justification
4. Consistently applied by all staff
Anorexia nervosa (F50)
• Weight loss leading to body weight at least 15% below
normal weight for age & height (BMI below 17.5)
• Weight-loss is self-induced by avoidance of ‘fattening
foods’
• Self-perception of being too fat & intrusive dread of
fatness
• Widespread endocrine disorder involving hypothalamicpituitary-gonadal axis
- amenorrhea in female
- loss of sexual interest in males
• Restricting type & Purging type (DSMIV)
Bulimia Nervosa (F50.2)
• Recurrent episodes of overeating (at least twice a
week over a period of 3 months) in which large
amounts of food are consumed in short periods of
time
• Persistent preoccupation with eating, & strong
compulsion to eat
• Self-perception of being too fat with an intrusive dread
of fatness
• Attempts to counteract the fattening effects of food by
one or more of:
– Self-induced vomiting
– Self-induced purging
– Alternating periods of starvation
– Use of drugs (appetite suppressants, thyroid
preparations or diuretics, failure to take insulin)
Atypical eating disorder
• Do not meet criteria for AN or BN but are clinically
severe (atypical anorexia nervosa (F50.1) & atypical
bulimia nervosa (F50.3))
• Sub-group – binge-eating disorder (DSM IV)
Recurrent bulimic episodes in absence of other
diagnostic features of BN, particularly counterregulatory features such as vomiting
May be evidence of depression, unhappiness with
weight but less significant vs BN
Higher spontaneous remission rate, txt CBT
Epidemiology
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Prevalence – 0.7% (school & college girls)
Incidence range from 0.37 – 4.06 per 100 000
Female-to-male ratio of 10:1
Primarily white (>95%) & adolescent (>75%)
High concordance rates for monozygotic twins
(55%)
Causes
Complex condition - biological, psychological, and social
factors
– Developmental condition
• Predisposing - Female sex, family history of eating
disorders, character (low self-esteem & perfectionism)
& family dynamics
• Precipitating – cultural & peer group group pressure,
peer acceptance for dieting & weight loss, autonomy
conflicts
• Perpetuating – secondary gain (attention), biological
factors (starvation)
– Certain groups increased at risk - dancers, longdistance runners, skaters, models, actors, wrestlers,
gymnasts
Symptoms - AN
Symptoms - BN
Prognosis
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Full recovery more common in those with a short history
Some may be left with atypical ED or BN
20% make a full recovery
60% fluctuating course
20% remain severely ill
Most severe cases – 15% mortality (suicide & cardiac
complications)
• BN – COMORBIDITY WITH DEPRESSION AND
ALCOHOL USE
• Assessing and Managing risks – bloods, weight, Squat
tests, driving, cognitive function, mood, DSH, suicidal
ideation.
Referring to STEPs
• BANES
• If already in secondary mental health services the
referral is direct to STEPs.
• GP refers to PCLS.
• PCLS and STEPs offer a joint assessment.
• Decision about treatment is usually made at
assessment.
• What we can offer, treatment, joint working,
supervision, teaching.
Thank you for listening
Any questions?
Please contact us at:
STEPs Eating Disorder Service
Clifton Building
Southmead Hospital
Westbury-on-Trym
Bristol
BS10 5NB
Tel: 0117 3236113