Anorexia Nervosa

INTRODUCTION 1 THE NATURE OF THE PSYCHOPATHOLOGY 3 Differential diagnosis 6 II APPROACH TO THE ASSESSMENT 9 PSYCHOPATHOLOGY 9 Level 1 Behavioural 9 Level 2 The phobic avoidance mechanism 12 Level 3 The avoided phobic 'object' - the maturational conflict 12 PHYSICAL FINDINGS 17 General appearance 17 Gastrointestinal system 19 Cardiovascular system 19 Renal system 19 Musculo-skeletal system 20 Endocrine system 20 Central nervous system 21 Anorexia nervosa with comorbidity 21 Additional complications resulting from vomiting/laxative abuse 22 INVESTIGATIONS 24 Blood tests 24 ECG rhythm strip 25 Chest X-ray 25 Urine analysis 25 PREGNANCY AND MOTHERHOOD IN ANOREXIA NERVOSA III TREATMENT 27 Assessment 31 What are the aims of the intervention? 31 Identification of target weight 33 INTERVENTION 1 Assessment interview 36 INTERVENTIONS 2-13 The initial intensive psychotherapy 37 Interventions 2-5 Engagement of the patient and family Intervention 2 - Patient 38 Intervention 3 - Patient 41 Intervention 4 - Patient 42 Intervention 5 - First family meeting 45 Interventions 6-9 Every two or three weeks Intervention 6 - Patient 46 Intervention 7 - Patient 47 Intervention 8 - Patient 48 Intervention 9 - Second family meeting 50 Interventions 10-13 Every 3-4 weeks Intervention 10 - Patient 51 Intervention 11 - Patient 52 Intervention 12 - Third family meeting 53 Intervention 13 - Patient - ending acute phase of intervention 53 Planning follow-up 55 When to admit to hospital 56 Use of the Mental Health Act 57 Physical treatments 58 IV TERTIARY REFERRAL 60 Relationship to specialist centres 60 Indications for referral