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 dominates your life?

*One point for every “yes”; a score of ≥2 indicates a likely case of anorexia nervosa or bulimia
Single measures such as just SCOFF or BMI should not be used to determine whether a disorder is present and if it should be treated. Need to take the whole picture into account.

·         Eating disorders are a complex mental health disorder that are often generated by multiple factors and associated with specific co-morbidities 

·         The most common mental health conditions that form comorbidities f patients suffering from Anorexia Nervosa includes:

o   Depression

o   Bipolar

o   Anxiety disorder

o   PTSD

o   OCD

o   Borderline PD

o   Insomnia 

o   Substance abuse 

·         The relevancy of these associated mental health disorders is that it aids in the overall understanding of the formation/development of an eating disorder. Features from a mental disorder can overlap with that of an eating disorder and in effect intensify/affect one or the other 

·         Clinically such comorbidities increase the risk of relapse and overall poorer recovery outcomes 

·         It is important that when treating an eating disorder, we must consider and address any related mental health comorbidities and treat them together 

·         This relates to the holistic approach of treating the whole person rather than a single eating disorder

15. Explain the laws associated with the mental health act and when to admit Rachel? (indications) Sarmad

·         The mental health act 1983 & 2007 contains a code of practise which details what can and cannot be done in regard to detention of mental health patients

·         ‘Detention’ is referred to as being ‘sectioned’ under the MHA

·         Key sections include: sections can be put in place by AMHP (approved MH professional)

o   Section 2, detained for assessment, 21 days

o   Section 3, detained for treatment, 6 months (needs to be treated, pose a risk, health &safety)

o   Section 4, emergency only required 1 doctor approval 

o   Section 5, holding power, doctors and nurses have the power to stop patients from leaving the hospital 

 

When the pancreas detects a decrease in blood glucose levels, it secretes glucagon. Glucagon is the main hormone in the fasted state. During the fasted state, glycogen is broken down by glucose into the liver and released into the blood to increase blood glucose levels to supply tissues and organs where it will be used to make energy at ATP and Co2 as a waste product.

Gluconeogenesis also occurs in the fasted state in the liver where liver proteins are broken down into amino acids, which are converted to ketoacids which can be used to make more glucose. (Urea is a by. product). During the fasted state in order for liver to keep up with the glucose demand by the body, adipose tissues begin to breakdown triglyceride stores, into free fatty acids and glycerol. Glycerol will enter the liver and enter gluconeogenesis, to make more glucose. The fatty acids can be utilised by the heart. Skeletal muscle has its own glycogen stores so during the fasted state, it can break it down to form glucose units which then are used to make ATP. However its glycogen stores are limited so muscle will then use free fatty acids as a source of energy. The free fatty acids in the bloodstream can also enter the liver where they are oxidised to produce  lots of acetyl CoA. During prolonged fasted state there is so much Acetyl CoA that it cant enter the Krebs cycle as normal. So therefore it must be converted to something else, so it participates in ketogenesis, the synthesis of ketone bodies. Ketone bodies are molecules which can be used as a source of energy during prolonged fasting. There are 3 types of ketone bodies produced by liver in fasting, 1. acetone, 2.acetoacetate and 3. B-hydroxy butamate. Ketone bodies are used mainly by the brain for energy as they can be broken down into acetyl CoA which can enter the Krebs cycle and be used to make ATP. During prolonged starvation the heart will also use ketone bodies. Eventually ketone bodies in the blood plasma, will be higher than blood glucose levels. After weeks of starvation skeletal muscle will start to breakdown muscle protein into amino acids for a source of energy. The amino acids will go to the liver to be made into glucose. Glucagon promotes glycogen breakdown, gluconeogenesis and lipolysis.

When treating anorexia nervosa, be aware that: 

Psychological treatment for anorexia nervosa in adults

 

Typically consist of 20 sessions, with: 

weekly sessions for the first 10 weeks, and a flexible schedule after this up to 10 extra sessions for people with complex problems, base treatment on the MANTRA workbook. Motivate the person and encourage them to work with the practitioner. Be flexible in how the modules of MANTRA are delivered and emphasised. When the person is ready, cover nutrition, symptom management, and behavior change. Encourage the person to develop a 'non‑anorexic identity'. Involve family members or carers to help the person:  understand their condition and the problems it causes and the link to the wider social context and change their behaviour.

 

Dehydration, hypoglycaemia, impaired glucose tolerance, hypoproteinaemia à fluid loss in to tissues from intravascular space, hypokalaemia, hyponatraemia, hypocalcaemia, vitamin deficiencies, hypercholesterolaemia

Amenorrhoea in women and loss of libido/impotence in men due to decrease gonadotropins, oestrogens and testosterone

Increased growth hormone, cortisol, sex hormone binding globulin

Decreased T3

Arrhythmias (hypocalcaemia) and ECG changes

Hypotension, bradycardia, peripheral oedema, congestive heart failure

Mitral valve prolapse

Parotid enlargement and tooth enamel erosion

Constipation, peptic ulceration, acute pancreatitis

Renal failure, partial diabetes insipidus, renal calculi

Seizures, peripheral neuropathy, enlarged ventricles

Iron-deficiency anaemia, leucopaenia, thrombocytopaenia

Osteoporosis, muscle cramps/tetany (hypocalcaemia and dehydration/hyponatraemia)

Hypothermia, infection, dry skin, brittle hair, lanugo, look out for Russell’s sign – callouses on dorsal aspect of knuckles cause by repeated self-induced vomiting

During a fast, body switches to fatty and amino acids as main fuel source. Electrolytes become depleted during time of fasting. Upon return to normal nutrition, blood sugar levels rise causing concomitant rise in insulin. The anabolic processes that follow (glycogen, fat and protein synthesis) require phosphate, magnesium and potassium. Serum electrolytes fall leading to cardiac arrhythmia and failure.