Assessment and management of anorexia nervosa during COVID-19

O Walsh,F Mcnicholas

doi:10.1017/ipm.2020.60

Abstract

Management of the high rates of medical and psychiatric complications, including self-harm and suicide, associated with anorexia nervosa requires regular clinical review. However, during the current pandemic, face-to-face clinical assessments carry the risk of infection and transmission in this vulnerable cohort already compromised by low weight and lowered immunity. This paper describes how one service has had to adapt usual care during the COVID-19 pandemic without contributing excessively to carer burden or compromising patient safety.

Highlights

Anorexia nervosa (AN) is the third most common chronic condition after obesity and asthma in adolescent females (Lucas et al 1991; Whitaker, 1992; Golden et al 2003) with prevalence rates for eating ‘problems’ amongst adolescents in Ireland at 10% (McNicholas et al 2010), with 3% reaching clinical thresholds (Merikangas et al 2010; CDC, 2013)
High levels of co-morbid anxiety and depression contribute to morbidity and mortality, such that is has the highest mortality risk of all mental health disorders, with deaths related to both suicide and medical complications (Arcelus et al 2011)
The increased stress caused by the COVID-19 pandemic and the collective sense of lack of personal control as we abide by government enforced restrictions is likely to affect us all

Summary

Introduction

Anorexia nervosa (AN) is the third most common chronic condition after obesity and asthma in adolescent females (Lucas et al 1991; Whitaker, 1992; Golden et al 2003) with prevalence rates for eating ‘problems’ amongst adolescents in Ireland at 10% (McNicholas et al 2010), with 3% reaching clinical thresholds (Merikangas et al 2010; CDC, 2013). Lucena Child and Adolescent Mental Health Services (CAMHS), not recognised as an ED hub, had recently established a dedicated clinic to assess and treat youth with AN using FBT.

Results

Conclusion