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Afterlife

Bulimia Prognostic Factors

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I shall be posting nearly all stations of Spring one by one followed by autumn 2008 and so on one by one. Any discussion is more than welcome. Feedback from the passers is highly appreciated who can tell us what were the loopholes and what is the significance of each part of the scenario.

Bulimia Prognostic Factors

A 24yr old woman, works at horse race stable, referred by gp, was previously seeing a therapist privately but found it unhelpful. take hx to assess for bullimia and prognostic factors.

Time allowed: 7 minutes

What will be the helpful points in history?

What will be the important prognostic factors and how will that be covered?

Is there any significance of horse race stable here in this scenario?

What are the risk issues here and how will those be covered?

What kind of therapist she was seeing privately? Is this of significance?

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that is great, we need to discuss the college feedback as well

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i was plagued by the horse thing afterwards because it was only after i left the station that I realised I had forgotten to ask about horse racing as exercise... and periods. Still passed the station somehow.

I also thought part of the station was something about considering a diagnosis or a differential? Can't remember exactly, what do others remember?

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I havent done this station but may be they were trying to rule out anorexia nervosa as jockeys can suffer from anorexia since they have to maintain a very low weight to win the race

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Bulimia Prognostic Factors

A 24yr old woman, works at horse race stable, referred by gp, was previously seeing a therapist privately but found it unhelpful. take hx to assess for bullimia and prognostic factors.

Time allowed: 7 minutes

[highlight]What will be the helpful points in history?

What will be the important prognostic factors and how will that be covered?

What are the risk issues here and how will those be covered?[/highlight]

What kind of therapist she was seeing privately? Is this of significance?

Can somebody answer above mentioned questions especially first 3.

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Afterlife - You are a star. Thanks for posting all the stations

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I want to discuss more stations too. Please somebody answer that so we can move on.

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There are some poor prognostic factors in bullimia

1. Low self esteem

2.sever personality disorder

You have to take bullimia history differentiate from anorexia and also focus on prognostic factors, rule out depression and personality disorder.

Risk could be physical complications, suicide due to co-morbid depression ,drugs and alcohol misuse.

Generally prognosis is good for bullimia as compare to anorexia.

Any suggestions

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I have not done this station but can offer pointers all the same:

1. What will be the helpful points in history?

a) Introduction, Remit, Rapport

B) Open questions as to what brings her here, how she is doing now, how is work, what are her main problems in her perception

c) Explore about previous therapy, what she found beneficial and what didn't work

d) Gently explore her previous relationships and coping mechanisms

e) Look for alcohol/substance use and compliance with treatment

2. What will be the important prognostic factors and how will that be covered?

a) Build upon thee previously gained info., especially w.r.t. past experience of therapy, working in horse stable, relationship history and coping mechanisms.

B) Presence of other co-morbid conditions: You don't have to look for depression/PD/OCD etc. by phenomenological questions, but try to cut the chase with asking for previous diagnoses including anorexia.

c) baseline weight, current weight, target weight, body image

d) pre-morbid level of functioning

Prognostic factors:

a. Age of onset (earlier, the worse)

b. Type of purging behaviours

c. Presence of co-morbidities (the more co-morbidities, the worse the prognosis)

d. Length of periods of remission (longer the period of remission, the better)

e. Duration of illness (the longer, the worse)

f. Level of motivation and insight

g. Pre-morbid level of functioning

h. Level of coping skills

3. What are the risk issues here and how will those be covered?

I don't think you are asked to assess risk in this station, but if asked, look into medical complications, history of self-harm and suicidal behaviour, level of self-neglect, presence of diabetes,etc.

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Many thanks Nocturnal for answering my query.

Kamran

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Many thanks Nocturnal for answering my query.

Kamran

Kamran mian, what I have done is trivial when compared to what you have contributed to others! :silly:

This time around, we'll show 'em who's the BOSS! ;) [smiley=thanks.gif]

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I passed this station I remember it vividly.

For prognositc factors you need to know when symptoms first started, previous none response to treatment, coexisting binging in alcohol etc etc - google prognosis in bulimia.

One key aspect which made me worry I had failed- at the final moment just as the bell went she said 'I just feel like ending it all'- so she was clearly suicidal you must do a risk assessment.

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