Master the board step 3

Psychiatry
Treatment
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Supportive psychotherapy is the treatment of choice.
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Do not confront or accuse the patient (the patient will become angry, more
guarded, and suspicious).
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Only provide the minimum amount of treatment and workup needed.
Aggressive management of the patient’s symptoms only reinforces the
behavior.
Eating Disorders and Other Impulse Control
Disorders
Eating Disorders
Following are the 3 main eating disorders that you need to distinguish on the
exam:
1. Anorexia nervosa
2. Bulimia nervosa
3. Body dysmorphic disorder
Anorexia Nervosa
The diagnosis is anorexia nervosa when the case describes a young female
who is underweight because of food restriction and excessive exercise. The
question may also include a history of purging (50 percent of anorexia nervosa
patients also purge), but the diagnosis will still be anorexia nervosa.
Bulimia Nervosa
The diagnosis is bulimia nervosa when the case describes a young female in
normal weight range with episodes of binge eating followed by guilt, anxiety,
and self-induced vomiting, laxative, diuretics, or enema use. These episodes
must occur at least once a week. Food restriction is not a feature of bulimia
nervosa. Look for painless parotid gland enlargement and dental enamel erosions.
Electrolyte disturbances are common (metabolic alkalosis, hypochloremia,
and hypokalemia caused by emesis; metabolic acidosis caused by laxative
abuse). There is a risk of cardiomyopathy with excessive syrup of ipecac use.
Treatment
Treat anorexia nervosa and bulimia nervosa as follows:
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Hospitalize for IV hydration if electrolyte disturbances are present
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Olanzapine in anorexia nervosa helps with weight gain
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SSRI antidepressants (especially fluoxetine) prevent relapses
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Prescribe behavioral psychotherapy
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