This is a new guideline from NICE on managing eating disorders. It is really targeted around anorexia nervosa and bulimia. Much of this is not new, but as we don’t see patients with these disorders too often, I’ll do a general summary, but concentrating on things I wasn’t aware of.
Presentation
This is not an exhaustive list, but these were some of the presentations I hadn’t considered:
- Problems managing chronic conditions involving weight (eg diabetes or coeliac).
- Menstrual or other endocrine disorders, or unexplained GI symptoms.
- Physical symptoms (eg dizziness or faintness).
Assessment of patients
- Mental health problems may coexist (eg anxiety, depression, suicidal thoughts, OCD).
- Alcohol or substance misuse may be present.
Physical health:
1. Obs (pulse / BP)
2. Bloods (including glucose, electrolytes, LFT)
3. ECG
4. Sit and squat stand test (First ask patient to lie prone, then go to sitting. Then ask them to stand, squat then stand again. Score each of these 2 elements separately. 0 = unable. 1 = need to use hands to help. 2 = with difficulty. 3 = able with no difficulty. A score of 2 or less is very concerning, as is a rapid decrease in ability).
