AJ a 17 year-old is referred to a psychiatrist after her mother become concerned about her behavior. Patient mother spoke with the psychiatrist at length describing to him the alarming behaviors AJ have exhibited for the past 2 years. AJ’s mother was asked to wait in the waiting room while AJ speaks to the psychiatrist alone/private. The patient tells the psychiatrist that for the past 2 years, she has been making herself vomit by sticking her fingers down her throat. This behavior occurs regularly, as many as three to four times a week, and worsens when she is stressed out at school. The patient admits that she gorges herself with food and is worried that she will become overweight if she does not vomit it up. She describes her gorging as
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The patient states that she is ashamed of this behavior and goes to great length to hide how much she eats. A physical examination shows a young woman, 5ft 6in tall and weighing 135lb. Her vital signs are BP 106/65, RR 12, TEMP 98.2, HR 72 and her neurologic, musculoskeletal, and genitourinary exams within normal limits. The psychiatrist told the patient that her physical exam are normal and normal weight, but he was concerned about bulimia nervosa. The patient was worried and begged the doctor to not disclose such to her mother because her mother is in a lot of stress due to pending divorce. The patient promised the psychiatrist that she is willing to work with him, adhere to all treatment regimens, and stop her behavior as long as the psychiatrist did not tell her mother. Although the psychiatrist was concerned about the patient but he agreed to keep it a secret so as long as AJ adhere to the following: nutrition rehabilitation, cognitive behavioral therapy, and treatment with an antidepressant Fluoxetine 20mg po daily. I was shocked and feel strongly that the decision to keep it a secret was not …show more content…
Combined treatment as seen in many studies has demonstrated efficacy in the management of bulimia nervosa. Nutritional rehabilitation helps patient with regular nutritional balanced meal to replace pattern of fasting then binging with vomiting. Cognitive behavioral therapy helps the patient deal with underlying cognitive patterns that drive bulimia. Treatment with antidepressant (SSRI) helps to decrease vomiting and binging behavior. SSRIs are considered first line therapy because they provide the most evidence for efficacy with least adverse effects (Trunko & Kaye, 2008). The recommended SSRI in the treatment of bulimia nervosa (BN) is Fluoxetine. Fluoxetine is the only drug approved by the Food and Drug Administration (FDA) for the treatment of BN and starting dose, fluoxetine 60mg po daily; titrating downwards once goal is achieved (Tusaie & Firzpatrick, 2013; Trunko & Kaye,
The patient states that she is ashamed of this behavior and goes to great length to hide how much she eats. A physical examination shows a young woman, 5ft 6in tall and weighing 135lb. Her vital signs are BP 106/65, RR 12, TEMP 98.2, HR 72 and her neurologic, musculoskeletal, and genitourinary exams within normal limits. The psychiatrist told the patient that her physical exam are normal and normal weight, but he was concerned about bulimia nervosa. The patient was worried and begged the doctor to not disclose such to her mother because her mother is in a lot of stress due to pending divorce. The patient promised the psychiatrist that she is willing to work with him, adhere to all treatment regimens, and stop her behavior as long as the psychiatrist did not tell her mother. Although the psychiatrist was concerned about the patient but he agreed to keep it a secret so as long as AJ adhere to the following: nutrition rehabilitation, cognitive behavioral therapy, and treatment with an antidepressant Fluoxetine 20mg po daily. I was shocked and feel strongly that the decision to keep it a secret was not …show more content…
Combined treatment as seen in many studies has demonstrated efficacy in the management of bulimia nervosa. Nutritional rehabilitation helps patient with regular nutritional balanced meal to replace pattern of fasting then binging with vomiting. Cognitive behavioral therapy helps the patient deal with underlying cognitive patterns that drive bulimia. Treatment with antidepressant (SSRI) helps to decrease vomiting and binging behavior. SSRIs are considered first line therapy because they provide the most evidence for efficacy with least adverse effects (Trunko & Kaye, 2008). The recommended SSRI in the treatment of bulimia nervosa (BN) is Fluoxetine. Fluoxetine is the only drug approved by the Food and Drug Administration (FDA) for the treatment of BN and starting dose, fluoxetine 60mg po daily; titrating downwards once goal is achieved (Tusaie & Firzpatrick, 2013; Trunko & Kaye,