BOOK REVIEWS: Medical Management of Eating Disorders
Reprinted from Eating Disorders Review
May/June 2005 Volume 16, Number 3
©2005 Gürze Books
(By C. Laird Birmingham and Pierre Beumont. Cambridge University Press. 289 pages, including 10 color plates, $55)
Before he died in late 2003, Dr. Beumont, the late and exceptionally distinguished Chairman of Psychiatry at the University of Sydney, was the driving force behind the successful completion and publication of the Australian and New Zealand clinical practice guidelines for the treatment of anorexia nervosa (Aust N Z J Psychiatry 2004; 38: 659).
In this welcome volume, Professor C. Laird Birmingham, an internist at the University of British Columbia, and Dr. Beumont expand on much of the excellent work that appeared more briefly in the guidelines, and offer a comprehensive approach to the medical assessment and treatment of eating disorders. Combining lifetimes of clinical experience at different centers, treating the most difficult and intractable patients with anorexia nervosa, and extensive scholarship, this book's focus on detailed medical management protocols will be particularly useful to those in inpatient and residential settings. Reading like a clearly written standard medical textbook, full of useful tables considering differential diagnoses of various symptoms and complications, lists of tests to order, and specific treatment algorithms, this volume offers more detail on a range of medical problems than anything I've previously seen.
For assessment, included are suggested schema for taking medical histories and conducting physical examinations; thorough considerations of diagnostic laboratory testing, including limitations and dangers of various tests; and detailed system-by-system reviews of complications affecting various organ systems. These include nursing implications as well as instructions for what patients should report to their physicians. All major organ systems are well covered. The dermatological discussion is the most complete I've seen in a text.
The sections on medical and nutritional therapy alone are worth the price of the book. Included are algorithms for distinguishing urgent from non-urgent conditions; a laxative-withdrawal protocol; suggested inpatient orders; a suggested protocol for preventing refeeding syndrome; and options for magnesium supplementation. Nasogastric feeding is briefly addressed.
Special problems considered include involuntary patients, geriatric patients, diabetics, and children and adolescents. Brief cases illustrate clinical problems requiring attention. Sections on how psychiatric problems with which these patients and families struggle interface with the medical problems and round out this book. Of special note, brief chapters addressed to primary care physicians, nurses, dietitians, family and friends add to the book's appeal and value.
I'd say that anyone treating serious cases of anorexia nervosa will want to have a copy of this book close by.