Poster Presentations Spring Conference May 2017
WINNER OF 1ST PRIZE
Body Dysmorphic Disorder: This is a Man’s World
Authors: Dr Esme O’Loughlin (FY1 Doctor, BSMHFT), Dr Sophie Emesih (CT1 Psychiatry Trainee, BSMHFT)
Introduction
Body dysmorphic disorder (BDD) is a distressing and often disabling condition with an uncertain prevalence. More data is available for eating disorders, where the number of cases in men has increased by 24% over the last decade. Studies have shown that men feel a lean and muscular shape represents the ideal male body type; exposure to media images may contribute to body dissatisfaction and BDD.
Objectives
To identify the amount of exposure to men of the ideal male body type by analysing the contents of articles in the bestselling UK "Men's Lifestyle" magazines.
Method
The bestselling "Men's Lifestyle" magazines for July-December 2015 were identified from the Audit Bureau of Circulation data: "Men's Health", "GQ", "Esquire", and "Men's Fitness". Data was collected from the March 2017 edition of each magazine. Firstly, articles with the following themes were identified: building muscle, “perfect” body, diet, supplements, fitness, grooming and cosmetic surgery. Secondly, the frequency of the words "build", "muscle", "diet", "abs", "fat", "strong", "improve", "big" and "better", were calculated.
Results
All four magazines contained articles on diet, supplements, fitness and grooming. 12.8% of pages in “Men’s Health”, contained articles relating to the “perfect” body whilst almost 1/5th of pages in "Men's Fitness" referenced supplements. The most commonly appearing words in all magazines included "strong" and "muscle".
Conclusion
The high density exposure of the ideal body image in these magazines could account for body dissatisfaction amongst men and the increase in the number of Eating Disorder cases. "Men's Health", being the bestselling magazine, reveals that fitness and health are a concern for men. Even fashion-orientated magazines frequently contained the words "strong" and "muscle" supporting the perceived expectation that men should be strong and muscular. This extensive exposure could contribute to BDD, and could account for the increase in men with diagnosed eating disorders.
WINNER OF 2ND PRIZE
“Teaching medical students about eating disorders using role-play”
Dr Jennifer Parker
Medical Education Fellow, East Sussex Healthcare NHS Trust
Introduction & Objectives
The objective of this teaching intervention was to assess if role-play is a useful tool for teaching medical students about assessment of patients with eating disorders.
Eating disorders have the highest mortality rate of any psychiatric disorder. Despite this, there appears to be limited teaching on the topic in both medical schools (Girz L, 2014) and postgraduate medical training programmes (Mahr F, 2015).
Role-play has been shown to be a useful strategy for enhancing communication skills and promoting learning amongst medical students (Mumtaz S, 2015), particularly when structured feedback is incorporated (Nestel D, 2007). The use of role-play to teach about eating disorders has not been published previously, although the use of standardised patients has received positive feedback (Brown R, 2005).
Methods
Final year medical students were invited to attend role-play workshop on the theme of eating disorders. The session consisted of 2 scripted scenarios (anorexia nervosa, bulimia nervosa). Students role-played in pairs. Formative feedback was provided by medical education fellows who observed the interactions.
The workshop was evaluated using anonymised paired pre- and post-workshop feedback forms with both quantitative and qualitative components to ascertain if medical student’s felt more confident assessing eating disorder patients after the role-play workshop.
Results
Students(n=17) were asked to rate their confidence in assessing patients with an eating disorder on a Likert scale (1-5). The mean rating was 2.76 pre-workshop and 4.24 post-workshop. A paired T test gave a p-value of 0.000000041.
Discussion
This intervention has shown that role-play increases student confidence around assessment of patients with eating disorders. Weaknesses include a self-selecting sample of students and a relatively small sample size. The focus of the encounter was around initial assessment rather than diagnosis and management.
Conclusion
Role-play is a novel way in which we could teach medical students to assess patients with eating disorders.
WINNER OF 3RD PRIZE
Is electroconvulsive therapy of value in the management of patients with anorexia nervosa? A review of published cases Miss Eleanor J C Reynolds - University of Liverpool Medical School
Aims
This clinical review of anorexia nervosa cases aims to establish, from existing literature:
- Whether there is evidence to suggest that ECT is safe to use in the management of comorbid depression in patients with a low BMI.
- If ECT is of therapeutic value in the treatment of anorexia nervosa.
Methods
A literature search was undertaken with the aim of finding published cases describing the use of ECT in patients with anorexia nervosa. Databases including Scopus, Medline and the University of Liverpool’s library catalogue were searched, identifying 4 reports detailing 6 cases for analysis.
Results
Of the 6 cases reviewed in this study, four reported a good response to ECT in which the report documented an improvement in both the patient’s mood and eating behaviours. In no case did the authors report observed side effects or complications following treatment. At the time of receiving ECT, all but one of the patients were still in the anorexic range, and therefore at a higher risk of complications regarding the use of general anaesthetic.
Conclusions
ECT is generally considered, and recommended by NICE, to be a suitable and effective treatment in life-threatening psychiatric conditions. Anorexia nervosa sufferers at critically low body weights fall into that category. The low uptake of, or referral for, ECT may be partly due to negative perceptions by patients but this study suggests that some anorexia nervosa patients may be being deprived of a treatment that is consistently beneficial and in some cases curative. Since no similar reviews have produced negative findings, the advice to refer for ECT should be considered more often and further reviews, using larger case series, are needed to confirm or contradict this position.
OTHER ENTRIES:
The patient experience of illness, treatment and change, during intensive community treatment for severe anorexia nervosa
Julia Hannona, Lindsey Eunsona and Dr Calum Munroa,b
aAnorexia Nervosa Intensive Treatment Team, NHS Lothian, Edinburgh, Scotland
bUniversity of Edinburgh, Department of Psychiatry, Edinburgh, Scotland.
Aims
This study explores experiences of intensive community treatment, illness, and change, among patients with severe Anorexia Nervosa, particularly seeking to understand the processes involved in change and inability to change.
Methods
A qualitative design with purposive semi-stratified sampling, using semi-structured interviews and interpretive phenomenological analysis, investigated in detail the experiences of five participants. Participants all had severe Anorexia Nervosa at the start of treatment and represented a spectrum of outcomes from deterioration to full recovery.
Results
Six super-ordinate themes emerged from the analysis: ‘treatment experience’; ‘function of anorexia’; ‘self-criticism versus self-acceptance’; ‘isolation versus connection’; ‘hopelessness versus hope’; and ‘stuckness versus change’. Examples of quotes from the data: “Everyone in the team was so compassionate, nobody judged me…... I think until you’ve built up trust with anyone it’s hard to make the changes.”; “…push and fight and fight and fight it all the time, and I would just go crumbling down with exhaustion and then I would get stuck for a wee bit, and then once the exhaustion passed I was ready to fight again!”; “It’s really, really frustrating to understand everything…but still not be able to do the right thing. It’s like, why do I still do the wrong things? But then I am still at the stage that I don’t want to change.” Results describe the valued function of the illness, barriers to change, the lengthy struggle for change and how this can be supported by intensive community-based treatment. Necessary ingredients in the process of change, arising from the analysis, are proposed.
Conclusions
The experiences of these patients reflect the particular functions of Anorexia Nervosa for each individual, and that both clinical deterioration and full recovery can occur with prolonged intensive community treatment.
Symptom and acceptability outcomes from the prolonged treatment of severe anorexia nervosa in the community
Dr Calum Munro1,2 , Lindsey Eunson1 , Aaron Herron1 and Claire Allott1 .
1 Eating Disorders Service, Royal Edinburgh Hospital, Edinburgh, UK.
2 Department of Psychiatry, University of Edinburgh, Edinburgh, UK.
Aims & Background
Patients with severe anorexia nervosa have traditionally been treated in costly inpatient settings. There is no available evidence of symptomatic or treatment acceptability outcomes from the prolonged treatment of this population. This study describes symptomatic and acceptability outcomes from prolonged community-based treatment among patients with severe anorexia nervosa.
Methods
In this naturalistic study, a multi-disciplinary treatment with periods of intensive psychological, social and dietetic treatment and long-term continuity of care, was delivered in a community setting. All patients completing outcome measures and remaining in the service for greater than 18 months, during a 5 year period, were included and assessed on a range of measures. The primary outcome measures were the Eating Attitudes Test (EAT-26) and Likert scales of patient satisfaction (1 = ‘not satisfied at all’ to 5 = ‘extremely satisfied’).
Results
A cohort of 28 patients with severe forms of anorexia nervosa, with a mean BMI at entry to the service of 13.0 kg/m2 and mean duration of illness of 9.2 years, received an average of 40 months of treatment. Eating disorder symptoms improved among 57% of the sample, with 18% achieving remission or recovery. The mean general satisfaction rating score was 4.4 (SD,0.3), showing a high level of acceptability. BMI increased on average by 3.9 to a mean BMI of 16.9 kg/m2, with 42% achieving a BMI >17.5.
Conclusions
This cohort represents a more severe population than any for whom psychological outcomes have previously been reported. Despite modest rates of recovery/remission, weight gain occurred among 89% and the treatment was highly acceptable. The outcomes from this study, combined with previously published evidence supporting cost-efficiency and medical safety, lead us to conclude this model should be considered to provide a tier of treatment between outpatient and inpatient care.
CAMHS Eating Disorders Pilot in Warrington CAMHS – “A success story”
Authors: Dr Irene Hadjioannou (CT2) and Dr Kiran Savarapu (Child & Adolescent Consultant Psychiatrist), 5 Borough Partnership NHS Trust, Warrington
Introduction
Eating Disorders have the highest mortality rate among mental health disorders. They can have a detrimental impact on the mental health as well as the physical health of the individuals affected, thus, early identification and prompt intervention can be crucial for their prognosis.
Aim
This was a joint pilot between Warrington Acute Trust and 5 Boroughs Partnership NHS Foundation Trust. The scheme aimed to improve the quality of service provision for young people with an Eating Disorder via developing a model of integrated shared care addressing both mental as well as physical health needs. The main objective was identification, intervention and prevention of Eating disorder cases at an early stage.
Methods
A retrospective case notes study of 24 adolescents referred to Warrington CAMHS Eating Disorders Team between the 1st of April 2016 to the 31st of December 2016 was carried out. The following parameters were used to evaluate the service provision for these young people: outcome, Care Programme Approach (CPA), individual Therapy, family Therapy, dietician, psychiatrist or paediatrician involvement, input from specialist eating disorder service and inpatient admission.
Results
The age range varied from 12-17 years old and the ratio of male to female was 1:11. 1 in 4 patients were discharged within 9 months of their referral. All patients who received treatment were managed on a Care Programme Approach (CPA) level and offered individual therapy sessions, with over half of the cases accepting family therapy as well. All patients received close physical health monitoring; with the ones at highest risk having paediatric in conjunction with dietetic input from the Acute Warrington Trust. There were no patients treated for their eating disorder in an inpatient setting.
Conclusion
Overall, the services provided through the pilot scheme were noted to be mostly in keeping with the current NICE Guidelines.