Dr. holemon- Medical Management of ED


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Dr. Holemon, M.D. spoke at the Castlewood Preferred Provider Conference on the medical aspects of the treatment of Eating Disorder.

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  • Diagnosis of ED; anorexia, bulimia or ED, nos Concurrent psychiatric diagnosis, history of prior treatment, medications, onset of illness Medical; preadmission labs, EKG, bone density; ROS, past medical history, FH Cardiac arrhythmia is the most common medical cause of death in AN
  • Chest pain, dysrhythmias, syncope
  • Strength of association of substance use disorders varies by diagnosis, strongest in bulimia, weaker in ED of AN, purging type, not significant in AN, restricting Substance use increased suicide risk across the board, all psychiatric diagnoses
  • Refeeding at low energy replacement and monitor electrolytes, weight, cardiac status Rapid weight loss and/or profound weight loss; abnormal EKG; low phosphorus levels Symptoms; swelling, SOB, altered mental status
  • SNRI examples TCA uses MAOI issues and complications Other antidepressant examples TMM example; deplin or methylfolate as booster
  • Dr. holemon- Medical Management of ED

    1. 1. Medical Management of Eating Disorder Dr. Dawn Holemon
    2. 2. Diagnostic Assessment• Psychiatric • Anorexia nervosa • Bulimia nervosa • ED, nos• Medical • Risk increased with rapid weight change, purging, onset of binges, non compliance with medication
    3. 3. AN, BN or ED, nos• Refer for inpatient or residential care Pregnancy Diabetes mellitus Abnormal EKG Deficiencies of potassium, magnesium or phosphorus Suicidal ideation
    4. 4. EKG
    5. 5. Associated disorders• MedicalPANDASPCOS
    6. 6. Associated disorders• PsychiatricMajor depressionAnxiety disorderBipolar disorderAlcohol and/or drug dependence or abuseBody dysmorphic disorder
    7. 7. Laboratory tests commonly indicated in eating disorderLiver enzymes RBC FolateBlood count Magnesium,Serum creatinine, Phosphorus, Amylase, ferritin, vitamin B12 Potassium, Sodium TSH
    8. 8. Laboratory tests commonly indicated in eating disorderUrinalysisUrine drug screenEKGBone density
    9. 9. Medical complications of eating disorderEdemaWeaknessShortness of breathCardiac arrhythmiasChest painConfusionLoss of consciousness
    10. 10. Medical complications of eating disorderRefeeding syndrome -imbalance of electrolytes and fluid -risk factors -symptoms to monitor
    11. 11. Psychotropic medications used to treat eating disorder SSRI Other antidepressant SNRI Trimonoamine TCA modulator MAOI
    12. 12. Psychotropic medications used to treat eating disorderMood stabilizersAntipsychotics, 1st generationAntipsychotics, 2nd generation
    13. 13. Psychotropic medications used to treat eating disorderAnxiolytics, non benzodiazepineBenzodiazepines, short-actingBenzodiazepines, mid-actingBenzodiazepines, long-acting
    14. 14. Psychotropic medications used to treat eating disorderInsomniaADHDDependence, opioidDependence, nicotine
    15. 15. Common side effects of medications used to treat eating disorderLightheadedness HeadacheSedation Acid refluxDry mouth nauseaConstipation
    16. 16. Less common side effects ofmedication used to treat eating disorder Parasthesia EPSE Weight gain/loss Galactorrhea
    17. 17. Recent research in neuropsychiatry