Psych Station 7

Setting:

You are a junior doctor in a family medicine / GP clinic. Your next patient is a 19 year old girl, who has been brought in by her parents due to concerns about her weight loss and eating habits over the past 6 months.

Name: Anna Novak

Tasks:

1. Take a patient history.

2. Explore the patient concerns.

2. List the appropriate management to the examiner.

You are not required to examine the patient or explain the diagnosis.

Briefing

Diagnosis: Anorexia Nervosa
You are Anna Novak, age 18
You have been brought to the GP by your mother due to her concerns over weight and eating habits. You believe you’re just trying to be healthy and don’t think there’s anything wrong, but you’re starting to feel more pressure around food and your body image.

Appearance and Behaviour

You have low BMI. You’re defensive about your weight loss, but not outright confrontational. You’re hesitant and somewhat reluctant to discuss your eating habits, but you’ll open up if the doctor is empathetic and non-judgmental. You avoid making direct eye contact when talking about your body and tend to look down or fidget with your hands. You’re anxious when the topic of mental health or hospitalization is brought up, as you fear losing control over your eating habits.

Opening statement

“Hi... my mom wanted me to come in because she's been worried about me lately. I've lost some weight, but I really don’t think there’s anything wrong. I’m just trying to eat healthier and take better care of myself.”

Information to Give Freely

Only give the below information when specifically asked.

Presenting Complaint

Recent weight loss - I’ve lost 8kg in 2 months, but I think it’s just because I’m eating healthier.
Diet - I mostly eat salads, and have cut out all carbs including fruit and potato. I track calories and aim <1000/day. I often skip meals. I believe these changes are part of a healthier lifestyle and don't view them as restrictive.
Binge / Purge - some self induced vomiting but usually only after binging which is infrequent
Binge / Purge - never tried medication but considered ordering ozempic online once
Exercise - I’ve been working out more, mostly cardio of up to 4 hours per day, to stay fit.
Anxiety - you've been feeling very anxious about university course work recently
Mood - mood has been okay recently
Psychomotor - nil
Psychosis - No visual/auditory hallucinations.
Obsessions/compulsions - nil
Risk Assessment - No thoughts of suicide or self harm.

Past Medical History

Previous similar episodes - this has been going on for 6 months only
Other medical conditions - periods stopped 6 months ago, IBS, anxiety

Forensic History

None

Drug History

Prescribed - None
Over the counter - Paracetamol PRN for headaches
Allergies - None

Family History

Father - Alcohol Excess

Mother - Anxiety

Social History

Smoking - none
Alcohol - social use but only vodka as it's lower calories
Drugs - never used drugs
Job - uni student
Home - I live with my parents and younger sibling in a suburban area. My parents are supportive but are somewhat controlling or overly concerned about me, especially my mother, who has noticed my recent weight loss.

Systems Review

You have experiences all of the following:
No period for months
General symptoms - faitgue, weight loss, sleep disturbance
Cardio - palpitations
GI - constipation
MSK - muscle aches
Endo - cold intollerance, dry skin, hair loss

Ideas / Concerns / Expectation

Ideas - "I think I’m just being healthy and taking care of myself by eating better and exercising. There are no problems here."
Concerns - "I’m really worried that if I stop, I’ll lose control and gain all the weight back."
Expectations - I just want to hear that everything is fine and that I don’t need to make any big changes.

Discussion / Questions

The doctor will explore your concerns. You should be receptive but deny having an eating disorder (no insight).