Key Feature 3: In a patient with an eating disorder, rule out co-existing psychiatric conditions (ex: depression, personality disorder, obsessive-compulsive disorder, anxiety disorder).
Skill: Clinical Reasoning
Phase: Hypothesis generation, History
Key Feature 4: When managing a patient with an eating disorder, use a multidisciplinary approach (ex: work with a psychiatrist, a psychologist, a dietitian).
Skill: Clinical Reasoning, Professionalism
Phase: Treatment, Referral
Key Feature 5: When assessing a patient presenting with a problem that has defied diagnosis (ex: arrhythmias without cardiac disease, an electrolyte imbalance without drug use or renal impairment, amenorrhea without pregnancy), include “complication of an eating disorder” in the differential diagnosis.
Skill: Clinical Reasoning
Phase: Hypothesis generation
Today I had the opportunity to spend time with the multidisciplinary* Eating Disorders Program at St Paul's Hospital, which included the opportunity to perform an initial consultation on a patient with an eating disorder. The attending psychiatrist let me lead the interview, and provided me with super useful feedback afterward, specifically regarding screening for comorbid psychiatric conditions. He suggested that rather than ask about typical symptoms of comorbid conditions, if I know specifically what diagnoses I'm trying to rule out, I can simply pick the "Criterion A" symptom to ask about per each of their DSM 5 diagnostic criteria; if they don't have the A criterion, they don't have the condition. Straightforward and obvious after having this pointed out, I will never forget it, and this will make my future screening for psychiatric conditions so much more efficient. Excellent!
What are the comorbid psychiatric conditions to rule out in a patient with an eating disorder? And what are their associated A criteria? (Note that in my blog posts, the A criteria are listed as the first criteria - the Weebly website creator I use doesn't give me the option to make lists with anything other than numbers or bullet points.)
I have yet to talk about OCD in previous blog posts. The DSM 5 diagnostic criteria for this diagnosis are as follows:
*The St Paul's Hospital Eating Disorders Program inpatient and outpatient clinical teams include Psychiatrists, Psychologists, and Dieticians. During my day spent with the Program, I interviewed and observed outpatient interviews with a Psychiatrist, I watched as a Psychologist delivered a Cognitive Behavioural Therapy session to inpatients, and I learned about how a team Dietician with experience in the management of eating disorders helps to create meal plans and coach around making tolerable dietary changes. Eating disorders are very often chronic, pervasive, and refractory to therapy, and so an intensive team approach is thought to provide the best possible chance for recovery.
The inpatient program at SPH is an intensive program that is capable of supporting people who suffer from complications associated with their eating disorder, of which there are many physical let alone psychological and emotional ones.
The UpToDate article, "Medical complications of anorexia nervosa" provides a succinct but long table of possible complications that can occur secondary to this disorder:
The medical complications associated with bulimia nervosa include:
Of the above complications, according to the UpToDate article, "Bulimia nervosa and binge eating disorder in adults: Medical complications and their management," "The most common medical symptoms of bulimia nervosa are lethargy, irregular menses, abdominal pain and bloating, and constipation."