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
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