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Non-Intervention

By Warren Simmons,2014-11-13 18:28
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Non-Intervention

    The Anorexia Nervosa Care Pathway for Clinicians

    CONTENTS

     Go to Section Introduction 1

    Assessment For Anorexia Nervosa Module 2

    Self-Help Module 3

    Outpatient Therapy Module 4

    Intensive Treatment Module: Patient’s copy 5

    Intensive Treatment Module: Professional’s copy 6

    Acute Medical Admission Module 7

    Low Intensity Monitoring Module 8

    Active Non-Intervention Module 9

    Management of Self-Harm and Suicide Risk Module 10

    Recovery and Discharge Module 11

    Appendix 1: Rating Scales 12

    Appendix 2: Recording Charts 13

    Appendix 3: Healthy Eating Documents 14

    Appendix 4: Food Diary 15

    Appendix 5: Mental Health (Scotland) Act 16

     CAN-CP Clin Version 1.1 25.01.05 ? ANITT 2005 1

    Contents

INTRODUCTION ......................................................................................................................... 1

    What is a Care Pathway? ......................................................................................................... 2

    Aims and Objectives ............................................................................................................... 2

    Development of the Pathway ................................................................................................... 2

    Who is the Pathway for? .......................................................................................................... 2

    Using the Pathway ................................................................................................................... 2

    Clinicians‟ Contact Details ...................................................................................................... 3 ASSESSMENT FOR ANOREXIA NERVOSA MODULE ......................................................... 1

    Anorexia Nervosa Assessment Questions ................................................................................. 3 Probable Diagnosis of Anorexia Nervosa : .............................................................................. 4 Physical Assessment .................................................................................................................. 5 Investigations ........................................................................................................................... 10

    1. Blood Tests ....................................................................................................................... 10

    2. ECG .................................................................................................................................. 10

    3. DEXA Bone Density Scan ................................................................................................. 10 4. X-Ray ................................................................................................................................ 10

    Investigations Record Sheet .................................................................................................... 12

    Guidance on Levels of Risk ..................................................................................................... 13 Action Points ......................................................................................................................... 14

    Recommendations on the Frequency of Physical Monitoring for Outpatients ......................... 15 Eating Disorder Assessment Tool ........................................................................................... 16 A. Questions to make a provisional diagnosis of an Eating Disorder .................................... 16

    B. ‘At Risk’ Screening Questions ............................................................................................ 16 C. Examination key points ...................................................................................................... 17 D. Investigation key points ...................................................................................................... 17 SELF-HELP MODULE ................................................................................................................ 1 Introduction ............................................................................................................................... 2

    Using this Module ................................................................................................................... 2

    What is Self-Help? .................................................................................................................. 2

    How to Negotiate 'the System' .................................................................................................. 2 Preparing to See any Health Professional (Doctor, Nurse, Dietician etc) .................................. 2 What Could go Wrong? ........................................................................................................... 3

    Preparing to See a Therapist or Eating Disorder Specialist ....................................................... 3 What Could go Wrong? ........................................................................................................... 3

    Preparing to Attend a Self-Help Group .................................................................................... 3

     CAN-CP Clin Version 1.1 25.01.05 ? ANITT 2005 2

    What to do if you Collapse, Black out or Have a Fit and you have to go to A&E ..................... 4 Some facts about Anorexia Nervosa ......................................................................................... 4 How Common is Anorexia Nervosa? ....................................................................................... 4 What are the Common Symptoms of Anorexia Nervosa? ........................................................ 4 Am I Doing my Body any Harm? ............................................................................................ 4 What Causes Anorexia?........................................................................................................... 5

    Will I Ever Get Better? ............................................................................................................ 5

    Will my General Health be Okay Once I Get Better? ............................................................... 5 What is the Worst That Could Happen? ................................................................................... 5 What is the Best That Could Happen? ..................................................................................... 6 Which Health Professionals are Involved in Treatment for Anorexia? .................................. 6

    NHS Services in Lothian ........................................................................................................... 7 General Information ................................................................................................................ 7

    Cognitive Behavioural Therapy (CBT) .................................................................................... 7 Cognitive Analytical Therapy (CAT)....................................................................................... 7 Interpersonal Psychotherapy (IPT)........................................................................................... 7 Dialectical Behaviour Therapy (DBT) ..................................................................................... 8 Art Therapy ............................................................................................................................. 8

    Nutritional Support .................................................................................................................. 8

    Waiting List ............................................................................................................................ 8

    Private or Voluntary Services in Lothian................................................................................. 8 Self-Help Resources................................................................................................................. 11

    Self-Help and Support Groups ............................................................................................... 11

    Websites ................................................................................................................................ 11

    Telephone Information and Help Lines .................................................................................. 11 Books and Pamphlets ............................................................................................................ 12

    Resources for Friends and Family.......................................................................................... 14 OUTPATIENT THERAPY MODULE ........................................................................................ 1 Introduction ............................................................................................................................... 2

    Components of Care.................................................................................................................. 2

    1. Core Therapy ....................................................................................................................... 2

    2. Nutritional work .................................................................................................................. 2

    3. Weight Monitoring .............................................................................................................. 3

    4. Brief Risk Monitoring ......................................................................................................... 3

    5. Physical Health Monitoring ................................................................................................. 3

    6. Motivational Work .............................................................................................................. 3

    7. Interpersonal or Family Work .............................................................................................. 4

    Brief Risk Monitoring ............................................................................................................... 5 Therapy Review......................................................................................................................... 7

     CAN-CP Clin Version 1.1 25.01.05 ? ANITT 2005 3

INTENSIVE TREATMENT MODULE: Patient’s Copy ............................................................ 1

    Introduction ............................................................................................................................... 2

    The Anorexia Nervosa Intensive Treatment Team (ANITT) .................................................. 2 The Post-Discharge Service ..................................................................................................... 2

    The Intensive Treatment Program ............................................................................................ 3 Intensive Inpatient Programs for Anorexia Nervosa ............................................................... 4 The Priory Hospital Glasgow Eating Disorders Unit ................................................................ 4 The Huntercombe Edinburgh Hospital ..................................................................................... 4 The Young People‟s Unit ........................................................................................................ 5 The Retreat .............................................................................................................................. 5

    Bethlem Royal Hospital, The Gerald Russell Eating Disorders Unit ........................................ 6 St George‟s Eating Disorder Service........................................................................................ 6 Other Inpatient Services .......................................................................................................... 7

    Acute Medical Inpatient Treatment ......................................................................................... 7 INTENSIVE TREATMENT MODULE: Clinician’s Copy........................................................ 1

    Introduction ............................................................................................................................... 2

    The Anorexia Nervosa Intensive Treatment Team (ANITT) .................................................. 2 The Team ................................................................................................................................ 2

    Treatment Philosophy and Therapy ......................................................................................... 2 Evaluation ............................................................................................................................... 3

    The Post-Discharge Service ..................................................................................................... 3

    The Intensive Treatment Program ............................................................................................ 3 Primary Care Liaison Service .................................................................................................. 3

    Entry and Exit Criteria for The Anorexia Nervosa Intensive Treatment Team (ANITT)..... 4

    Entry criteria ............................................................................................................................. 4

    Exit criteria................................................................................................................................ 4

    Brief Risk Monitoring for ANITT ............................................................................................ 5 ANITT Evaluation Forms ......................................................................................................... 7

    Intensive Inpatient Care Admission Form ............................................................................... 9