NEDA TOOLKIT for Parents
Antianxiety agents used selectively before meals may
be useful to reduce patients’ anticipatory anxiety
before eating [III], but because eating disorder
patients may have a high propensity to become
dependent on benzodiazepines, these medications
should be used routinely only with considerable
caution [I]. Pro-motility agents such as
metoclopramide may be useful for bloating and
abdominal pains that occur during refeeding in some
patients [II]. Electroconvulsive therapy (ECT) has
generally not been useful except in treating severe co-
occurring disorders for which ECT is otherwise
indicated [I].
Although no specific hormone treatments or vitamin
supplements have been shown to be helpful [I],
supplemental calcium and vitamin D are often
recommended [III]. Zinc supplements have been
reported to foster weight gain in some patients, and
patients may benefit from daily zinc-containing
multivitamin tablets [II].
ii. Relapse Prevention
Some data suggest that fluoxetine in dosages of up to
60 mg/day may help prevent relapse [II]. For patients
receiving cognitive-behavioral therapy (CBT) after
weight restoration, adding fluoxetine does not appear
to confer additional benefits with respect to
preventing relapse [II]. Antidepressants and other
psychiatric medications may be used to treat specific,
ongoing psychiatric symptoms of depressive, anxiety,
obsessive-compulsive, and other comorbid disorders
[I]. Clinicians should attend to the black box warnings
in the package inserts relating to antidepressants and
discuss the potential benefits and risks of
antidepressant treatment with patients and families if
such medications are to be prescribed [I].
iii. Chronic Anorexia Nervosa
Although hormone replacement therapy (HRT) is
frequently prescribed to improve bone mineral density
in female patients, no good supporting evidence exists
either in adults or in adolescents to demonstrate its
efficacy [II].
Hormone therapy usually induces monthly menstrual
bleeding, which may contribute to the patient’s denial
of the need to gain further weight [II]. Before estrogen
is offered, it is recommended that efforts be made to
increase weight and achieve resumption of normal
menses [I]. There is no indication for the use of
bisphosphonates such as alendronate in patients with
anorexia nervosa [II]. Although there is no evidence
that calcium or vitamin
D supplementation reverses decreased bone mineral
density, when calcium dietary intake is inadequate for
growth and maintenance, calcium supplementation
should be considered [I], and when the individual is
not exposed to daily sunlight, vitamin D
supplementation may be used [I]. However, large
supplemental doses of vitamin D may be hazardous [I].
4. Choice of Specific Treatments for Bulimia Nervosa
The aims of treatment for patients with bulimia
nervosa are to 1) reduce and, where possible,
eliminate binge eating and purging; 2) treat physical
complications of bulimia nervosa; 3) enhance patients’
motivation to cooperate in the restoration of healthy
eating patterns and participate in treatment; 4)
provide education regarding healthy nutrition and
eating patterns; 5) help patients reassess and change
core dysfunctional thoughts, attitudes, motives,
conflicts, and feelings related to the eating disorder; 6)
treat associated psychiatric conditions, including
deficits in mood and impulse regulation, self-esteem,
and behavior; 7) enlist family support and provide
family counseling and therapy where appropriate; and
8) prevent relapse.
a. Nutritional Rehabilitation Counseling
A primary focus for nutritional rehabilitation is to help
the patient develop a structured meal plan as a means
of reducing the episodes of dietary restriction and the
urges to binge and purge [I]. Adequate nutritional
intake can prevent craving and promote satiety [I]. It is
important to assess nutritional intake for all patients,
even those with a normal body weight (or normal
BMI), as normal weight does not ensure appropriate
nutritional intake or normal body composition [I].
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