Transcript Is it an eating disorder? - Irish Student Health Association

Eating disorders
UCC Student Health Service
Ardpatrick, College Road
021-4902311
Are you suffering with an
eating disorder?
Are you worried about a
friend?
Help is
available
here!!
What is an Eating Disorder?
 The term ‘eating disorder’ refers to a complex,
potentially life-threatening condition,
characterised by severe disturbances in eating
behaviours.
 Eating disorders are serious mental illnesses.
They are treatable, and the sooner someone gets
the treatment he or she needs, the better the
chance of a good recovery
 Eating disorders are NOT choices, passing fads or
phases. Eating disorders are severe, have serious
consequences and can even be fatal.
(source – Bodywhys 2013 and ProYouth 2013)
Who can be affected?

Anyone can be affected by an eating disorder. They
can be found in both sexes, all age groups, and
across a wide variety of races and ethnic
backgrounds around the globe.

Eating disorders most frequently appear during
adolescence or young adulthood, but they can also
develop during childhood or later in adulthood.

Women and girls are much more likely than males
to develop an eating disorder, but boys and men
can be affected from any kind of eating disorder in
the same way as girls and women
Is it an eating disorder?
The SCOFF questionnaire is a quick way of confirming an
ongoing Eating Disorder
1.
Do you make yourself Sick because you feel uncomfortably full?
2.
Do you worry you have lost Control over how much you eat?
3.
Have you recently lost more than One stone in a 3 month
period?
4.
Do you believe yourself to be Fat when others say you are too
thin?
5.
Would you say that Food dominated your life?
Are you noticing warning signs?
 Some warning signs are related to food,
and some are not.
 Some are present before an eating
disorder comes into the picture, and
some increase in intensity as the illness
progresses.
Warning signs around food.

Excessive dieting

Avoiding a widening range of foods

Avoiding situations where communal eating is expected

New interest in "healthy," "low-fat," "low-carb" or "vegetarian“
diets

Inflexibility about what or when or how much to eat

Unnatural focus on what others are eating

Need to know calorie content of all foods
Warning Signs around food continued

Never available for family/group meals

New interest in cooking and recipes but avoiding eating
the food

Foods, especially carbohydrates, disappearing quickly
from the house (secret bingeing)

Secretive or ritualistic eating

Avoiding food until certain hours

Anger at others if pressed to eat something

Fear of over-eating, or gaining weight from a particular
meal or type of food
Warning signs around physical activity
 Exercising intensely but without pleasure

Exercising to compensate for eating and
panicking if you are unable or feel you have not
done enough to restore a feeling of calmness or
control
Medical warning signs
 Failure to gain weight or height according to
growth curve
 Weight loss at any time during childhood or
adolescence
Thinking warning signs
 A conviction that one is too large

Unnatural focus on the flaws of a particular
body part or aspect of the body
 Repetitive requests for reassurance about
appearance
Social warning signs
 Social withdrawal
 Reports others are newly judgmental or "not
connecting"
 The person has an inability to describe
emotions
Noticed these warning signs?

If a friend or loved one shows only a few of the symptoms
of an eating disorder, or denies that anything is wrong,
this is not reason to put the issue aside.

Denying and concealing symptoms are a common
symptom of brain changes associated with eating
disorders and resulting malnutrition, and many patients
are unable to accurately report their thoughts or feelings.

Early detection and assertive treatment are the best way
to prevent chronic illness and death.
What can you do?

If you feel that any of this applies to you, then please don't be frightened
to come and see us here at the Student Health Centre. When you attend
the clinic we will listen to your problems and give you the choice to begin
treatment when you are ready.

You can book in advance, by telephone 021 4902311, or by calling into
the surgery.

You will be seen and assessed by a GP and referred to a counselor (unless
you are already attending counseling) and also referred to a dietitian.
Appointments are available
Monday –Friday 9.15-12.15 and 2.30 – 4.15


You can either be referred to the Eating Disorders clinic by your Doctor or
you can refer yourself directly

If needed you will be referred to Dr. Mary Buckley, Consultant Psychiatrist
Development of the Eating
Disorder Service UCC
 In
2011/2012 Eating Disorders were
identified as a difficult consultation for
GP’s in Student Health and we decided to
work on a management pathway.
 At that point there were no Irish guidelines
for primary care – NICE Guidelines used as
well as UK Universities
 Multidisciplinary – GP’s/psychiatry
/counselling within UCC, dietitian in Bons
First Steps
 Development
of a Care Pathway – to
incorporate all existing support services
and to encourage us all to work together
 Identified missing services (dietitian) and
recruit their help
 Acknowledge that some students were
“shopping” between services and
manipulating their care.
Draft Care Pathway for Patient Presenting with Possible Eating Disorder
Support Groups
Overeater’s Anon
BodyWhys
External Agencies
Counsellor
Refer if
needed
Student Health Physician
Baseline and 3 mthly
See Over For Details
Follow up 1-2 Weekly
History
Examination
Family
Stable on Programme
Eating Disorder Diagnosed
Dietitan
Complex Needs
Medically Ill
Refer
Student Health Physician
Psychiatrist
Interval Weighing and Interval Blood Tests
See over
UCC INTEGRATED CARE FOR STUDENTS WITH POSSIBLE EATING DISORDER
Admit Medical
Eating Disorders Programme
Student Health Physician Baseline and 3 monthly
Interval Checks (or as requested)
History
Vomiting/Laxatives; Collapse/LOC; Weakness (e.g. climbing stairs); Chest
pain/palpitations; recent weight loss; medications; menstruation (LMP)
Examination
Self care/hygiene/clothes/Rapport/hydration
Dental Erosion
Parotid/submandibular gland enlargement
Height/weight/BMI
BP sitting and standing
HR and heart sounds
Temperature
Musculoskeletal
- Stand from squatting w/o using arms
- Sit from lying w/o using arms
Investigations
FBC Haematinics Bioprofile TFT’s Glucose
ECG
Eating Disorder Risk Table
System
Nutrition
Dietician Referral
Karen Macken, Bons 021 4941930, fax 021 4941950
€75 new1 hour; €50 return 1 hour. Referral letter &Inv results. VHI covers €25
Eating Disorder Units (Private only, no state services for ED)
St John of God, Stillorgan; Admissions 01 2771400, fax 01 2771455
St Patricks, James St; Referral 01 2493535, fax 01 2493609
Tabor Lodge, Belgooly; 021 4887110. 28 day residential programme
Arbour House, St Finbarr’s Hospital; 021 4968933. Drug and Alcohol Addiction
Rutland Centre, Templeogue Dublin; 01 4946358 Day/Residential Programme
Body mass index
(adults)
Moderate
risk
Circulation
< 2
< 1.0 kg
Purpuric rash
Systolic BP
—
Present
< 90 mmHg < 80 mmHg
Diastolic BP
< 60 mmHg < 50 mmHg
Postural drop
> 10 mmHg > 20 mmHg
Pulse rate
< 50 bpm
Extremities
—
Musculoskeletal (sit- Unable to stand
+
up/squat test)
up from a
squatting position
without using
arms for balance
Temperature
Investigations
High risk
< 15 kg/m2 < 13 kg/m2
Body mass index < 3
centiles
Weight loss/week < 0.5 kg
Complex Needs (Psychiatrist Review/Referral)
Underlying Psychiatric Disorder (e.g. Depression)
Drug or Alcohol Addiction
Risk of Suicide or Deliberate Self Harm
Laxative/diuretic Abuse
Worsening BMI; Moderate risk BMI <15 High risk BMI<13
Medically Ill/May need Referral or Admission See Table Opposite
Diabetes
(Dr Antoinette Tuthill, CUH)
Pregnancy
(CUMH)
Medications that prolong the QT interval – Antihistamines Terbinafine;
Macrolides; Antipsychotics; Antidepressants Erythromycin; Serevent;
Sumatriptan; Anti-arrhythmic
Severe Deterioration, very low body weight or rapid weight loss; no
improvement with appropriate therapy (Eating Disorders Unit, only private
available)
Medical Complications such as severe oedema, electrolyte imbalance,
hypoglycaemia, infection.
Examination
< 40 bpm
Dark blue/cold
—
Unable to stand
—
up from a
squatting position
without using
arms as leverage
+
Unable to sit up
+
from lying
without using
arms as leverage
—
Unable to sit up
from lying at all
—
+
—
Full blood count,
urea, electrolytes
(including PO4),
liver function
tests, albumin,
creatinine kinase,
glucose
< 35°C
Concern if
outside
normal
limits
< 34.5°C
K < 2.5 mmol/L
Na < 130
mmol/L
PO4 < 0.5
mmol/L
ECG
Rate
< 50 bpm
Rate < 40 bpm.
Prolonged
QT interval
Computer Template
 Next
step.. Developing a template care
screen for recording of consultations using
Helix Practice Manager.(Dr Byrne)
 To be used in consultations to prompt all
staff to have a consistent approach in
assesment, management and recording
in each consultation
 Prompts/reminders/structure – audit!
Example of Care Screen
Example of Care Screen BN
Audit
 Care
screen enabled yearly auditing
 Care screen has been modified over time
e.g adding coeliac screen, ECG in house
 2012 – 14, 2013 – 17, 2014 -14, mostly
female, few males
 Overall good outcomes e.g. 12/14 this
year have BMI’s that are stable or
improving
 We all focus on the students who don’t do
so well.
Fitness to Study
 New
process in UCC , based on Fitness to
Practice
 Can be used for any student, not limited
to ED
 Has been used for ED students who
haven’t responded to treatement in UCC
to facilitate their further care with the help
of their families and facilitate structured
return to college when they have
recovered
Referral To Tertiary Care
 Traditionally
difficult unless the patient has
private insurance (Dublin)
 Recent development of public system in
Cork – still not easy to liase with
 CAMH’s offer a good service for <18
Feedback from
staff/students in UCC
 Less
psychiatry referrals
 Better co-operation between services
 Dietitian referrals a success
 Easier to identify those who are struggling
and need extra help
 Structured consult easier for GP’s and
students find it helpful
Other supports available
 UCC Student Counselling and Development
www.ucc.ie/en/studentcounselling//
 Bodywhys – www.bodywhys.ie
 Eating Disorder Centre, Cork -
http://www.eatingdisordercentrecork.ie/
 Overeaters Anonymous
– www.corkoa.ie
 ProYouth - www.proyouth.eu/
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