Please reply to the following discussion with one or more references. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of vie

Niurka Blanco discussion

Information provided in the scenario indicates that the 16-year-old female patient is having difficulty concentrating in school and has a frail and thin appearance. The initial areas of concern include the nutritional status of this patient. Nutrition plays a vital role in disease prevention and health promotion since it is a basic need. Nutritional intake has different controlling mechanisms, such as satiety and appetite. These are significantly complex body processes. These mechanisms have an effect on an individual's nutritional status, which is impacted fluid intake, nutritional intake and the supply of nutrients (Reber et al., 2019). The client in the scenario is asking for diet pills regardless of her frail and thin appearance. This indicates that she may be experiencing an eating disorder which in turn predisposes her to malnutrition.

            The second area of concern is the patient’s body image distortion. The patient asking to be given diet pills indicates that she may be overestimating her body size, which indicates a distortion in the perception of her body image. She may be severely underweight and restricting food intake, which may be contributing to her inability to concentrate in school. Such detrimental dietary behaviours are contributed to by negative appraisals and feelings toward her body and overestimation of her body size, which is a sign of anorexia nervosa (Dalhoff et al., 2019). The perceptive component of the patient's body image can be measured by metrics and body size estimation methods.

            Screening tools that may help lead closer to making a diagnosis include using the SCOFF questionnaire, taking a comprehensive medical history, and performing a physical examination and laboratory tests. The medical history will involve a comprehensive review of the medications the patient is taking, including the nonprescribed, review of systems, social and family history, previous drug and substance abuse and psychiatric and medical history. A physical examination is aimed at determining any complications arising from the information gathered in the medical history. Basic laboratory workups that can be performed for this patient encompass a coagulation panel, metabolic profile, urine testing for beta-hCG, drugs, 25-hydroxyvitamin D, thyroid stimulating hormone and a complete blood count (Moore & Bokor, 2019). Additional studies may be required if the patient has a BMI of 14 kg/m or amenorrhea exceeding 9 months.    

             Most patients diagnosed with anorexia nervosa are successfully managed on an outpatient basis; thus, their assessment should result in the determination of the safety of outpatient management. Risk assessment requires a clinical interview. Determining the duration that the patient has had their eating disorder and its severity will aid in the identification of possible complications. The patient’s physical capacity should be compared to that of her agemates to determine a deviation of her nutritional status from the expected. The interview should also assess if the patient is excessively vomiting and exercising or using medications and laxatives to enhance diuretic effects and increase metabolism (Frostad & Bentz, 2022). This will guide both the pharmacological and non-pharmacological management of the patient.

            The mainstay of anorexia nervosa management is outpatient psychotherapy since it is less disruptive and costly compared to other intensive modes of treatment. This condition is difficult to manage because patients are difficult to engage, and most patients have poor outcomes even when they agree to undergo treatment. Since the patient in this scenario is an adolescent, the most appropriate form of non-pharmacological therapy is family-based treatment. Family-based treatment aims to empower the adolescent’s parents to help their child in overcoming the disease. It integrates strategies from psychotherapy. Family therapy for this patient will consist of 18 to 20 sessions that are done in a year. The patient's needs will be reviewed after four weeks of commencing treatment and every three months afterwards to determine how often the sessions should be scheduled and how long their treatment should last. Emphasis is put on the family's role in enhancing the patient's recovery (NICE, 2020). Psychosocial education is provided during these sessions, including the effects of malnutrition.

            Pharmacological management of this patient is considered to prevent relapse. The patient will be given antidepressants to successfully maintain weight gain following treatment. Since the patient has anorexia nervosa, anxiolytics can be given when she is experiencing anxiety before eating. Olanzapine will be used to stimulate weight gain and appetite, thus enhancing food consumption. Ondansetron is an antiemetic used to reduce self-induced vomiting and thus will be used in the management of this patient (Crow, 2019). Client teaching involves offering dietary counselling. The patient will be encouraged to take age-appropriate multi-mineral and multi-vitamin supplements until they start taking diets that meet their dietary needs. The family members will be involved in meal planning and dietary education, especially if the patient is alone when having therapy. Offering dietary advice to this patient and their family will be necessary to meet their nutritional needs for development and growth. Referral and follow-up of the patient are essential in ensuring the successful implementation of strategies to manage anorexia nervosa; thus, the patient will be referred immediately to an age-appropriate community-based service. The patient should be followed-up for at least a year (NICE, 2020). This will enhance mediation and moderation of factors influencing the effectiveness of treatment, addressing treatment barriers and promoting positive factors.

References

Crow, S. J. (2019). Pharmacologic Treatment of Eating Disorders.  Psychiatric Clinics of North America,  42(2), 253–262. https://doi.org/10.1016/j.psc.2019.01.007

Dalhoff, A. W., Romero Frausto, H., Romer, G., & Wessing, I. (2019). Perceptive Body Image Distortion in Adolescent Anorexia Nervosa: Changes After Treatment.  Frontiers in Psychiatry,  10. https://doi.org/10.3389/fpsyt.2019.00748

Frostad, S., & Bentz, M. (2022). Anorexia nervosa: Outpatient treatment and medical management.  World Journal of Psychiatry,  12(4), 558–579. https://doi.org/10.5498/wjp.v12.i4.558

Moore, C. A., & Bokor, B. R. (2019, May 14).  Anorexia Nervosa. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459148/

National Institute for Health and Care Excellence (NICE). (2020, December 16).  Eating disorders: recognition and treatment. Nih.gov; National Institute for Health and Care Excellence (NICE). https://www.ncbi.nlm.nih.gov/books/NBK568394/

Reber, E., Gomes, F., Vasiloglou, M. F., Schuetz, P., & Stanga, Z. (2019). Nutritional Risk Screening and Assessment.  Journal of Clinical Medicine,  8(7), 1065. https://doi.org/10.3390/jcm8071065

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