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Mental Health Network -Eating Disorders

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

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Mental Health Network -Eating Disorders

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  1. 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

  2. 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* Out-patient and Community services • Multidisciplinary Team • Variety of treatments • Supporting Carers

  3. Prochaska & DiClemente’s Six Stages of Change • How and why did we develop our current model of working?

  4. Motivational Work • Listen • Step back • Learn • Be curious • Invest less Is it any good? • Benefits Staff, team and Clients

  5. Non-Negotiable

  6. 1. Clearly defined from the outset – no surprises2. Agreed by staff & clients if possible 3. Not arbitrary, but with good justification4. Consistently applied by all staff

  7. 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 hypothalamic-pituitary-gonadal axis - amenorrhea in female - loss of sexual interest in males • Restricting type & Purging type (DSMIV)

  8. 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)

  9. 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 counter-regulatory features such as vomiting May be evidence of depression, unhappiness with weight but less significant vs BN Higher spontaneous remission rate, txt CBT

  10. Epidemiology • 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%)

  11. 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, long-distance runners, skaters, models, actors, wrestlers, gymnasts

  12. Symptoms - AN

  13. Symptoms - BN

  14. Prognosis • 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.

  15. 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.

  16. Thank you for listeningAny questions? Please contact us at: STEPs Eating Disorder Service Clifton Building Southmead Hospital Westbury-on-Trym Bristol BS10 5NB Tel: 0117 3236113

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