Background: We will focus on the value of a biopsychosocial conceptualization and a multidisciplinary approach to developing a "Prescription for Healing". Particular emphasis will be placed on the use of psychotropic medications during the course of eating disorder treatment. Risks and benefits of common medications will be reviewed. A "script" for talking to clients and families about their fears and beliefs of medications will be presented. We will also discuss the value of psychoeducation and techniques for enhancing motivation and compliance. The audience members will gain tools and language to utilize in the practice of supporting clients in the healing process.
Objectives: 1) List at least 3 common fears patients express about medications and effective responses. 2) Describe at least 3 risks and 3 benefits of psychiatric medications in the ED population. 3) Describe 3 methods to enhancing motivation for treatment compliance.
- The biopsychosocial model is a broad view that attributes disease outcome to the intricate, variable interaction of biological factors (genetic, biochemical, etc), psychological factors (mood, personality, behavior, etc.), and social factors (cultural, familial, socioeconomic, medical, etc.).
❖Multidisciplinary Team for ED Treatment
- ED Therapist
- ED Psychiatrist
- ED Nutritionist
- +/- ED Primary Care Physician
- +/- Family Therapist
- +/- Addiction Counselor
- +/- Sponsor
❖Benefits of the multidisciplinary team
- Working with the team
- Avoiding splitting
- Consistent messaging
- Managing family expectations
❖Psychiatrist’s role in the team
- Approach the symptoms from a neuro-biologic framework
- Determine and refine the psychiatric diagnoses
- Assess for “brewing” symptoms (prodromal psychosis, suicidality)
- Manage acute or emergency situations
- Reinforce the messages from the team
- Provide motivational interviewing
- Work closely with therapist to understand symptoms to treat with medications
- Prescribe weight neutral medications
❖Treatment from the Psychiatric Framework
❖Understanding Neurobiology
- Mental Disorders are Brain Disorders
- Dysregulation of neurotransmitters and reward system
♦ Psychiatric Medications
- Anti-depressants
- Anxiolytics
- Mood stabilizers
- Antipsychotics
- Stimulants
- Insomnia mediations
❖Considerations for Various Eating Disorders
- Anorexia Nervosa: Effectiveness of medications in severely malnourished
- Bulimia Nervosa: Risks in clients who are actively purging
- Binge Eating Disorder: Consider weight neutral medications
- Orthorexia Nervosa: Hyperfocus on ingredients in medications
❖Considerations for Co-Occurring Issues
- Substance Use Disorders
- Trauma
- Personality Disorders
♦The Value of Psychoeducation
- Informs client of treatment options and the risks and benefits associated with various options
- Can help assess client’s insight and motivation to change
- Fosters trust and sense of understanding which will promote collaborative therapeutic relationship
❖Psychiatric Medications as a Tool
- Addressing medication concerns (working with resistance)
- Fear of weight gain
- Fear “meds will change my personality”
- Fear of “relying on medication”
- “Unnatural”, “I’m strong enough to do this on my own”
- Mental health stigma
- Cost of medications (“financial anorexia”)
- “Meds don’t work” (explore adherence)
- Consider herbal medication options
❖Engaging Client’s Family is Discussion and Decision Medications
❖When Compliance Matters – Techniques for Enhancing Motivation and Compliance
Particular emphasis will be placed on the use of psychotropic medications during the course of treatment and how the use of medication can be complicated and nuanced. Common medications prescribed for the treatment of eating disorders and co-occurring disorders will be reviewed, as well as medications that can be harmful to patients with certain diagnoses. The presentation will highlight how proper assessment and effective introduction of medication may enhance overall engagement in treatment and prognosis. And alternatively, we describe how inappropriate prescribing or patient misuse of medication may blunt treatment effects therefore rendering treatment ineffective. We will discuss the importance of consultation and communication in the shaping of the “medication script”. Frequent discussions between the therapist and psychiatrist allows for refining of the diagnoses and treatment recommendations, including medications and dosages.
Attendees will gain an understanding of the importance of providing psychoeducation to the client and family about diagnoses and the effective treatment options. Clients often resist starting psychiatric medications for a variety of reasons including: fear of weight gain, belief that “I will have to rely on a mediation forever”, fear that “the medication will change my personality”, history of experiencing side effects or no effect from medications, belief that “I want to fight this on my own”, family beliefs about medication and the financial cost. We will provide a “script” for exploring these concerns and responding in a productive way. Practical tools will be provided for enhancing motivation and addressing common fears that impact compliance with treatment recommendations.
Molly McShane, MD, MPH is a board certified psychiatrist and serves as the Medical Director / Chief of Psychiatry at Oliver-Pyatt Centers and East Coast Medical Director at Monte Nido and Affiliates. She is expert in managing complex psychiatric illnesses including co-occurring substance use and eating disorders. She graduated from Duke University and the University of Miami, and trained in psychoanalytic psychotherapy. Dr. McShane is the recipient of the prestigious Laughlin and Ginsberg Fellowships, is a Fellow of the American Psychiatric Association, and is a member of the Alpha Omega Alpha Medical Honors Society. She is on the Board of Directors of the Eating Disorders Coalition.
Jamie Blosser Morris, LMHC serves as the Director of Clinical Programming at Oliver-Pyatt Centers. Ms. Morris received her bachelor’s degree from Boston College, and her master’s degree from the University of Miami. Ms. Morris’s previous work experience includes the role of Clinical Director at Oliver-Pyatt Centers and Prevention Program Coordinator at the Hanley Center. In addition to being a Licensed Mental Health Counselor, Ms. Morris holds her Eye Movement Desensitization and Reprocessing Therapy (EMDR) Certification and is a Certified Eating Disorder Specialist (CEDS). Ms. Morris is Vice Chair of the Board of Directors for The Alliance for Eating Disorders Awareness.
