Bulimia, follow up

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Follow-up

Further Outpatient Care

The efficacy of cognitive-behavioral therapy in patients with bulimia nervosa has been convincingly demonstrated in randomized, controlled trials.9
Bright light therapy decreased winter binge frequency in one study of 34 women with bulimia nervosa.10
Daily potassium and magnesium supplements and regular monitoring of serum electrolyte levels in patients who cannot stop purging may be considered.

Deterrence/Prevention

Nutritional and general wellness education can help prevent unhealthy eating patterns and excess weight gain. Exercise, participation in school activities, and healthy family relationships are important.
Children should be warned against society's obsession with physical appearance. Body dissatisfaction, moodiness, and risk-taking behavior should be addressed openly rather than accepted as normal adolescent behavior.

Complications

Electrolyte abnormalities due to vomiting may be compounded by those due to laxative-induced diarrhea or diuretic use. Perioperative arrhythmias have occurred in 2 patients with unrecognized bulimia nervosa.11
Chronic laxative use may lead to dependence and constipation. Phenolphthalein poisoning due to laxative overdose has been reported.
Diet pills can cause hypertension and cerebral hemorrhage when taken in excess.
The rate of comorbid substance abuse seems to be higher among patients with bulimia who have a family history of alcoholism.
A subgroup of patients with eating disorders who display multiple impulsive disorders may exist. Among patients exhibiting symptoms of bulimia, increased experience with the use of different substances was related to increased incidence of attempted suicide, stealing, and promiscuity.
Deaths are believed to result from cardiac arrhythmias, although serious problems have resulted from gorging and vomiting (eg, gastric or esophageal rupture, acute gastric dilatation, Mallory-Weiss tear, pneumomediastinum, postbinge pancreatitis).
Ipecac-related deaths have been reported and probably are caused by emetine cardiotoxicity in conjunction with electrolyte imbalances.

Prognosis

Initial studies of patients with bulimia nervosa indicate that about one half recover, one fourth improve, and one fourth have no change after brief behavioral, interpersonal, and dietary treatments. Fewer than one third are doing well on 3-year follow-up.
The prognosis is expected to improve as further understanding of the neurohumoral mechanisms of bulimia is gained and the use of pharmacologic agents is improved.

Patient Education

Patients with severe eating disorders may mistrust physicians. They may believe that their physicians are only interested in feeding them or making them lose their will and become fat.
Education about body weight regulation and the effects of starvation, vomiting, and laxatives on bodily functions may be helpful.
For excellent patient education resources, visit eMedicine's?Eating Disorders Center. Also, see eMedicine's patient education article?Bulimia.

Bulimia, follow upOriginally from: http://www.nursinglink.monster.com/news/articles/15240-bulimia-follow-up

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