From the Guidelines
Assessment of anorexia requires a comprehensive evaluation including a complete blood count, comprehensive metabolic panel, and electrocardiogram, as well as a documented, comprehensive, culturally appropriate, and person-centered treatment plan. The American Psychiatric Association recommends 1 that the laboratory assessment of a patient with a possible eating disorder include a complete blood count and a comprehensive metabolic panel, including electrolytes, liver enzymes, and renal function tests. This approach is crucial for identifying potential complications associated with anorexia, such as malnutrition or purging behaviors 1.
When assessing anorexia, it is essential to consider the following key components:
- A detailed medical history, including weight changes, eating patterns, and any compensatory behaviors
- Physical examination to assess vital signs, body mass index (BMI), signs of malnutrition, and cardiovascular status
- Laboratory tests, including complete blood count, comprehensive metabolic panel, thyroid function tests, and electrolytes
- Psychological assessment using validated tools to evaluate the severity of disordered eating thoughts and behaviors
- Differential diagnosis to rule out other causes of weight loss
The APA also recommends 1 that patients with anorexia nervosa who require nutritional rehabilitation and weight restoration have individualized goals set for weekly weight gain and target weight. Furthermore, adults with anorexia nervosa should be treated with an eating disorder-focused psychotherapy 1, while adolescents and emerging adults with anorexia nervosa who have an involved caregiver should be treated with eating disorder-focused family-based treatment 1.
Given the high mortality rate associated with anorexia, primarily due to medical complications and suicide risk, early identification and a multidisciplinary approach involving primary care physicians, psychiatrists, psychologists, and nutritionists are crucial for providing the most comprehensive assessment and treatment 1.
From the FDA Drug Label
In US placebo–controlled clinical trials for major depressive disorder, 11% of patients treated with Prozac and 2% of patients treated with placebo reported anorexia (decreased appetite). In US placebo–controlled clinical trials for OCD, 17% of patients treated with Prozac and 10% of patients treated with placebo reported anorexia (decreased appetite) In US placebo–controlled clinical trials for bulimia nervosa, 8% of patients treated with Prozac 60 mg and 4% of patients treated with placebo reported anorexia (decreased appetite).
Assessment of anorexia can be done by monitoring the patient's appetite, as anorexia (decreased appetite) was reported in clinical trials.
- The incidence of anorexia varied across different indications:
- 11% in major depressive disorder
- 17% in OCD
- 8% in bulimia nervosa 2
From the Research
Assessment of Anorexia
- The assessment of anorexia nervosa is crucial in both research and clinical practice, as it can significantly enhance treatment outcomes 3.
- Laboratory tests can be useful in diagnosing anorexia nervosa, but their results should be interpreted with caution, as they may be normal even in patients with severe malnutrition 4.
- Liver function tests can be abnormal in patients with anorexia nervosa, but these abnormalities can resolve with refeeding and weight restoration 5.
Laboratory Evaluation
- Laboratory tests, including liver function tests, can be used to evaluate the severity of malnutrition in patients with anorexia nervosa 4.
- However, laboratory tests may not always be abnormal in patients with anorexia nervosa, and their use without a multi-dimensional evaluation may be misleading 4.
- Liver enzymes may increase during the refeeding process due to hepatic steatosis, but this can be distinguished from starvation hepatitis by the finding of a fatty liver on ultrasonography 6.
Diagnosis and Treatment
- The diagnosis of anorexia nervosa should be based on a comprehensive evaluation, including physical and psychological assessments 7.
- Treatment of anorexia nervosa typically involves a multidisciplinary approach, including medical, nutritional, and psychological interventions 7.
- Family-based treatment is often effective for adolescents with anorexia nervosa, while cognitive behavior therapy may be beneficial for patients with bulimia nervosa 7.