In this episode, Helen West, RD, discusses the challenges of inpatient treatment for eating disorders, including ethical considerations of nasogastric feeding and autonomy. She explores advancements in treatment strategies, the complexities of defining recovery, and disparities in care. Helen also addresses barriers in treatment, parallels with obesity care, and the importance of individualized interventions for effective outcomes.
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Quality-Improvement Reduced Force-Feeding
Helen described joining a CAMHS tier-4 eating disorder unit that routinely used NG feeds under restraint as protocol-driven care.
Her simple QI change to require MDT decisions dramatically reduced restraints and shifted focus to meal support.
insights INSIGHT
Research Hasn't Fully Reached Clinical Practice
Research on genetics and neurobiology broadened understanding but hasn't fully translated into routine clinical practice.
CBT-E and family therapy remain mainstays despite variable outcomes and poor results for a significant minority.
insights INSIGHT
Therapy Manuals Don’t Fit Many Patients
Eating disorders present heterogeneously and often don't fit neat diagnostic boxes, so manuals may fail some patients.
Practitioners need to individualize care and value relational, supportive work alongside manualized therapies.
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CAMHS eating disorder unit - Child & Adolescent Mental Health Service
Tier 4 Services - CAMHS services are organized through a tiered system. Tier 4 is the highest on the hierarchy and relates to highly specialized or inpatient services.
NG Feed - nasogastric (NG) tubes
MDT decision - multidisciplinary team (MDT) decision-making
CBT-E - Enhanced Cognitive Behaviour Therapy - a "transdiagnostic" treatment for all forms of eating disorder including anorexia nervosa, bulimia nervosa, binge eating disorder and other similar states.
ARFID - Avoidant/restrictive food intake disorder (ARFID) is a feeding or eating disorder in which people avoid eating certain foods, or restrict their diets to the point it ultimately results in nutritional deficiencies.
SSCM - Specialist Supportive Clinical Management (SSCM) is a psychotherapy comprising a clinical management focus addressing anorexia nervosa (AN) symptoms and a supportive therapy component.
About This Episode: When exploring the landscape of eating disorder treatment and research, several crucial topics emerge, each shedding light on different aspects of this complex field. Firstly, the practice of nasogastric feeding under restraint raises ethical questions and considerations. How do healthcare professionals navigate the balance between ensuring adequate nutrition and respecting the autonomy and dignity of patients? What are the potential implications and risks associated with this practice? Progress in understanding and treating eating disorders has evolved significantly over the years, yet challenges persist in translating research findings into effective clinical practice. How can advancements in genetics, neurobiology, and psychology inform more personalized and holistic treatment approaches? What barriers hinder the implementation of evidence-based practices within healthcare settings? An essential aspect of eating disorder treatment is understanding what "recovery" truly means. Beyond weight restoration, what factors contribute to a meaningful and sustainable recovery journey? How can healthcare professionals support individuals in achieving their unique goals and aspirations for recovery? Improving services and introducing better treatment options requires a nuanced understanding of the complexities inherent in eating disorders. How can healthcare systems prioritize patient-centered care and tailor interventions to meet the diverse needs of individuals affected by eating disorders? What strategies can be employed to address systemic challenges and foster positive change within healthcare settings? In addressing these questions and navigating the complexities of eating disorder treatment and research, expertise and insights from seasoned professionals are invaluable. In this episode Helen West, an Advanced Specialist Eating Disorders Dietitian with over 12 years of clinical experience, discusses her experience and understanding of these areas. With her extensive background and expertise, Helen offers valuable perspectives in tackling these critical topics within the realm of eating disorder treatment and research.
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