MEDS 2148 Clinical Presentations- Therapeutic Interventions

Answer 

Therapeutic Interventions for Mr. Versace

Introduction

Orthorexia is a pathological disease that occurs when an individual is obsessed with a specific nutrition characterized by defined patterns of eating and avoidance of some types of foods due to preference or allergy (Baer, 2015). Moreover, the WHO reports that in light to fulfill health desires, Orthorexia leads to malnutrition and poor quality of life (Kessler et al., 2013). However, the NHS indicates that less attention has been paid to the topic. Hence, there is a heated debate on whether to classify the condition as a nutrition disease or a psychiatric disorder (Caudle et al., 2015). Notably, assessment of the current literature on neuropsychology suggests that orthorexic signs and symptom are associated with the multifaceted diagnosis of anorexia nervosa, bulimia nervosa, and Orthorexia (Fisher et al., 2014). As such, the ideas in this paper seek to illustrate the aged physiological and psychosocial factors contributing to the risk of Orthorexia on Mr. James Versace. Furthermore, the article will outline the therapeutic regime that could be put in place to reduce the risk of the condition. Also, the paper will set a discussion on the benefits evidence-based adjunctive therapies for Mr. Versace. Notably, a letter to the GP will be provided as an appendix. Finally, the paper will sum up the ideas regarding the thesis statement as shown below.  

Pathophysiology and psychosocial factors contributing to risk of disease

Biological factors determine the type of Orthorexia in people; males have been reported to show increased cases of anorexia nervosa while females ascribe to bulimia nervosa. Additionally, the NHS reports that most patients with Orthorexia have higher rates of substance abuse, alcoholism, and fear of obesity (Herpertz-Dahlmann et al., 2014). Moreover, endogenous opioids contribute to the denial of hunger as they believe dieting increases the risk of Orthorexia (Koven and Abry, 2015). Further, a case of Mr. James Versace presents a case of increased endorphins levels that induce a feel of well-being yet his body mass as a sportsperson is not related to the age. As such, there is a growing need for patients such Mr. Versace to be given antidepressants which support the pathophysiologic function of norepinephrine and serotonin. Another key thing to remember is that starvation leads to several biochemical modifications in the body such as suppression of thyroid function. Therefore, it is possible to discern that obese people eat to increase body activities; as such, Mr. Versace falls a victim. Also, self-starvation is a tool t gain validation amid the eyes of the society. To that end, it is important to recognize the physical factors that contribute to the risk of Orthorexia. Also, there is need to understand that physical factors do relate with emotional and psychosocial factors. The factors include but are not limited to losing interest in activities previously enjoyed, spending a lot of time in meal planning, and reduced exertion on activities.

Therapeutic interventions for combating the condition

According to Kristeller et al., 2014 is of the opinion that due to limited research regarding Orthorexia, there are limited treatment models to combat the condition effectively. However, the works of Micali et al., 2015 propose that alternative suggestions have been offered as reduce and manage the adverse effects. Such interventions include but are not limited to multifaceted group approach made up of psychotherapists, physicians, and dieticians; who advocate for implementation of cognitive-behavior therapy and psychoeducation awareness to asses and monitor the condition of patients such as Mr. Versace. Furthermore, Shanwal and Dasgapata, 2014 is of the opinion that in the case of a severe orthorexic condition characterized by drastic weight loss and malnourishment, it is advisable to refer the patient to an inpatient system; with qualified physicians re-feeding syndrome. Importantly, the interventions need to be individualized-centered and recognize not only the signs and symptoms but also on their economic status and their preference to the mode of medication. Regarding psychotropic medication, serotonin synthesis is of significance value in treating Orthorexia and OCD. Besides, cognitive-behavior therapy is likely to reduce the stress associated with Orthorexia through creating a platform for engaging the nurses and patients. What is more is that body relaxation sessions can be of significant role in managing anxiety health for Mr. Versace. Notably, it is important for health professionals to implement strategies that seek to socially involve the patients and allow them room to interact with other people and share ideas on matters health and diet. Finally, it is considered wise to have a psychoeducation on experimental-validated dietetic science to change the biased belief on orthorexia food beliefs. As such, the works of Stice et al., 2013 find meaning in explaining the need for establishing a patient-centered platform for promoting recovery from Orthorexia. It is to such information that one can realize that Orthorexia is a dread disease if assumed.

Treating Mr. Versace calls for the implementation of a treatment plan that integrates nutritional rehabilitation, medication, and psychotherapy. Mr. Versace's weight and cardiac metabolic status determine the acuteness of the disorder and the type of hospital facility to be accessed. Moreover, the American Psychiatric Association offers guidelines that aim towards restoring Mr. Versace's nutritional status and establish healthy patterns  (Thompson-Brenrer et al., 2013). Besides, the clinician in charge of the client should focus on treating medical complications, restore Mr. Versace's dysfunctional thoughts concerning Orthorexia, and involve the family in supporting the healthy eating habits. The National Collaborating Centre for Mental Health in liaison with the NICE advocates for evidence-based care needs for Orthorexia patients; that it is important for nurses within the acute nutrition setting to have the knowledge about eating disorders to address and provide care for vulnerable patients who usually go undiagnosed (Treasure and Schmidt, 2013). Therefore, the model promotes recovery and well-being of patients through theory evidence-based interventions; such as the CFIR.

Nutritional rehabilitation

The standard controlled weight gain for Mr. Versace as per his pathology findings should be 2 pounds per week (Baer, 2015). Also, his intake levels should be 30 Kcal/kg per day. The pathological findings of Mr. Versace indicate that oral feeding cannot work effectively in his nutritional rehabilitation program hence need for the inclusion of nocturnal nasogastric feeding pattern to lessen the distress. As a nurse in charge of Mr. Versace, one needs to pay attention to matters weigh, fluid intake, and vital signs and symptoms on a daily routine. Notably, frequent physical examinations should be done to assess the availability of circulatory overload, re-feeding edema, and monitor cases of bloat due to the change of diet (Dunn and Bratman, 2016). In the inpatient care unit, Mr. Versace needs to be checked for serum electrolyte levels. In the case of constipation, the physician in charge needs to induce a stool softener to the diet supplemented with minerals and vitamins. Positively, Mr. Versace needs to be praised on the good habits he adopts during the rehabilitation program. Further, keeping a close monitor on the patient entails supervision after eating and restriction on accessing washrooms two hours after eating. Another key thing to remember is that at the early phase of the program no exertion on activity should be prescribed for the patient. However, after restoring his weight; three weeks after the program has commenced, the patient can be gradually introduced to a training program starting with stretching then jogging and finally a vigorous aerobic program can be established.

Medication

Medication serves a significant role in restoring and maintaining the body weight of Mr. Versace. Also, it helps in restoring normal eating habits through treating specific psychiatric symptoms. For instance, tricyclic antidepressants are important in treating the treating disorder of the patient (Caudle et al., 2015). However, care should be upheld when allocating the drugs since abuse results in cardiac complications such as hypotension.  In case Mr. Versace still shows signs of poor eating habits it is considered wise induce low dosage of antipsychotics to increase his appetite. Subsequently, benzodiazepines can be used for the cases of anxiety. Alternatively, for matters bloating metoclopramide is recommended to reduce abdominal discomforts. To that end, it is important to note that screening also helps in preventing adverse Orthorexia conditions among aged related psychosocial and physiological factors.

Conclusion

The technological advancement in the health sector has seen significant results regarding awareness on the benefits and disadvantages associated with eating. As such, it is evident that increased rates of Orthorexia are prevalent amid old teenage. For instance, Mr. Versace aged seventeen years old. Moreover, from the discussion above it is possible to discern that Orthorexia is more of a social construct where environmental factors do influence the eating habits of a person. For instance, Mr. Versace is obsessed with football and aspires to be a great sportsperson yet he is not willing to have a balanced diet in his meals. Also, the patient is reported to having a poor eating habit; that which is contrary to what most of the mentors in his field of sports do. Additionally, as much as there are increased cases of Orthorexia amid the old teenagers, health professionals are committed to reducing the threat through establishing patient-centered intervention within related clinical settings. Further, it is also of significant value to having the correct medication prescribed for patients suffering from Orthorexia so as to improve their appetite and restore back to normal their weight. Therefore, to that end, it is possible to discern that severe Orthorexia is a dread condition but early identification of the signs and symptoms saves a big deal in combating the situation.

Reference

Baer, R. A. (Ed.). (2015). Mindfulness-based treatment approaches: Clinician's guide to evidence base and applications. Academic Press.

Caudle, H., Pang, C., Mancuso, S., Castle, D., & Newton, R. (2015). A retrospective study of the impact of DSM-5 on the diagnosis of eating disorders in Victoria, Australia. Journal of eating disorders, 3(1), 35.

Couturier, J., Kimber, M., & Szatmari, P. (2013). Efficacy of family?based treatment for adolescents with eating disorders: A systematic review and meta?analysis. International Journal of Eating Disorders, 46(1), 3-11.

Dunn, T. M., & Bratman, S. (2016). On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eating behaviors, 21, 11-17.

Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., ... & Walsh, B. T. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. Journal of Adolescent Health, 55(1), 49-52.

Herpertz-Dahlmann, B., Schwarte, R., Krei, M., Egberts, K., Warnke, A., Wewetzer, C., ... & Hagenah, U. (2014). Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial. The Lancet, 383(9924), 1222-1229.

Kessler, R. C., Berglund, P. A., Chiu, W. T., Deitz, A. C., Hudson, J. I., Shahly, V., ... & Bruffaerts, R. (2013). The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biological psychiatry, 73(9), 904-914.

Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric disease and treatment, 11, 385.

Kristeller, J., Wolever, R. Q., & Sheets, V. (2014). Mindfulness-based eating awareness training (MB-EAT) for binge eating: A randomized clinical trial. Mindfulness, 5(3), 282-297.

Micali, N., De Stavola, B., Ploubidis, G., Simonoff, E., Treasure, J., & Field, A. E. (2015). Adolescent eating disorder behaviours and cognitions: gender-specific effects of child, maternal and family risk factors. The British journal of psychiatry, 207(4), 320-327.

Shanwal, V. K., & Dasgupta, P. (2014). Emotional intelligence: A management tool for orthorexia nervosa. Indian Journal of Health and Wellbeing, 5(6), 738.

Stice, E., Marti, C. N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of abnormal psychology, 122(2), 445.

Thompson-Brenner, H., Franko, D. L., Thompson, D. R., Grilo, C. M., Boisseau, C. L., Roehrig, J. P., ... & Devlin, M. J. (2013). Race/ethnicity, education, and treatment parameters as moderators and predictors of outcome in binge eating disorder. Journal of consulting and clinical psychology, 81(4), 710.

Treasure, J., & Schmidt, U. (2013). The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. Journal of eating disorders, 1(1), 13.