Monday, 31 December 2012

Mental Health

Griffon Vulture on the lawn
Cotswold Falconry Centre, July 2012
A study day on 'The role of the Dietitian in Mental Health' was set up for all the students in the region, and I was allowed to tag along. It covered depression, obsessive compulsive disorder, schizophrenia, bipolar disorder, dementia, eating disorders, and touched on phobias, personality disorders and forensic psychiatry. There was also a bit about Huntington's Disease, Chronic Fatigue Syndrome/ME and epilepsy, although I'm not sure why, because these don't seem to be about mental health, they're more like diseases that have their origins in the brain.

The role of the Dietitian in every condition was described as supporting other health professionals who prescribe medications or provide therapy, because although diet is often a part of the whole picture, it is rarely the key to recovery. It is often a matter of making the best of a situation - someone who fears that they will choke on food or has to clean every utensil in the kitchen before eating anything is not going to be cured by a Dietitian, but we can try to find ways to ensure that the diet is as nutritionally balanced as possible within the constraints of the condition.

Another factor is that many of the anti-psychotic medications result in weight gain, and sometimes to a very large degree. Other side-effects include constipation, insulin resistance, disordered blood lipids (e.g. high cholesterol or triglycerides), lowered metabolic rate, or they affect appetite or satiety centres in the brain (and these are just some of the diet-related side effects). Dietitians can offer suggestions on minimising these effects, or try to work around them.

The eating disorder Specialist Dietitian was a very good speaker, with long experience in the profession, and some really useful and practical suggestions that I can use in clinics. Firstly, according to NICE guidelines, Dietitians should not be treating anorexia nervosa without support from other health professionals. This seems sensible, and I have been lucky so far because we have a specialist eating disorder service that we can refer patients to. I have only referred one girl so far, but I received a letter a while later to say that she'd DNA'd two appointments and been discharged.

For bulimia or binge eating disorder, there could be a role for the Dietitian in an outpatient clinic, but it would depend on being able to identify the individual as having one of these conditions. The main message was that these disorders are not about the food; the disordered eating is usually the manifestation of some other issue. Again, it's not the Dietitian's job to fix everything nicely; all we can do is try to minimise the effect on health, perhaps by providing facts or evidence about food, eating and physiology, perhaps by suggesting different options within a disordered eating pattern.

What was clear was that eating disorders are pretty unpleasant to endure, difficult to treat, and the longer they last the less likely it is that they will resolve. Maintaining a stable weight may be the best outcome possible, for both underweight and overweight patients.

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