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NEDA TOOLKIT for Parents c. Assessing and Monitoring the Patient’s General Medical Condition d. Assessing and Monitoring the Patient’s Safety and Psychiatric Status A full physical examination of the patient is strongly recommended and may be performed by a physician familiar with common findings in patients with eating disorders. The examination should give particular attention to vital signs, physical status (including height and weight), cardiovascular and peripheral vascular function, dermatological manifestations, and evidence of self-injurious behaviors [I]. Calculation of the patient’s body mass index (BMI) is also useful (see http://www.cdc.gov/nccdphp/dnpa/bmi/00binaries/bm i-tables.pdf [for ages 2-20] and http://www.cdc.gov/nccdphp/dnpa/bmi/00binaries/bm i-adults.pdf [for adults]) [I]. Early recognition of eating disorder symptoms and early intervention may prevent an eating disorder from becoming chronic [I]. During treatment, it is important to monitor the patient for shifts in weight, blood pressure, pulse, other cardiovascular parameters, and behaviors likely to provoke physiological decline and collapse [I]. Patients with a history of purging behaviors should also be referred for a dental examination [I]. Bone density examinations should be obtained for patients who have been amenorrheic for 6 months or more [I]. The patient’s safety will be enhanced when particular attention is given to suicidal ideation, plans, intentions, and attempts as well as to impulsive and compulsive self-harm behaviors [I]. Other aspects of the patient’s psychiatric status that greatly influence clinical course and outcome and that are important to assess include mood, anxiety, and substance use disorders, as well as motivational status, personality traits, and personality disorders [I]. Assessment for suicidality is of particular importance in patients with co-occurring alcohol and other substance use disorders [I]. In younger patients, examination should include growth pattern, sexual development (including sexual maturity rating), and general physical development [I]. The need for laboratory analyses should be determined on an individual basis depending on the patient’s condition or the laboratory tests’ relevance to making treatment decisions [I]. Services available for treating eating disorders can range from intensive inpatient programs (in which general medical care is readily available) to residential and partial hospitalization programs to varying levels of outpatient care (in which the patient receives general medical treatment, nutritional counseling, and/or individual, group, and family psychotherapy). Because specialized programs are not available in all geographic areas and their financial requirements are often significant, access to these programs may be limited; petition, explanation, and follow-up by the psychiatrist on behalf of patients and families may help procure access to these programs. Pretreatment evaluation of the patient is essential in choosing the appropriate treatment setting [I]. e. Providing Family Assessment and Treatment For children and adolescents with anorexia nervosa, family involvement and treatment are essential [I]. For older patients, family assessment and involvement may be useful and should be considered on a case-by- case basis [II]. Involving spouses and partners in treatment may be highly desirable [II]. 2. Choosing a Site of Treatment Page | 45