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Anorexia Second-Line Treatment — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatryAnorexia Second-Line TreatmentMRCPsych Paper B

A 16-year-old girl with anorexia nervosa has completed a properly delivered and regularly reviewed course of anorexia-nervosa-focused family therapy (FT-AN). Her specialist eating-disorder team judges FT-AN to have been ineffective because significant eating-disorder psychopathology and inadequate weight restoration persist. She is medically stable, can be managed safely as an outpatient and wishes to continue treatment. Which of the following is a NICE-recommended individual psychological treatment to consider now?

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Correct answer: A — Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)

The correct answer is A. NICE recommends considering individual CBT-ED when anorexia-nervosa-focused family therapy is unacceptable, contraindicated or ineffective in a child or young person. Adolescent-focused psychotherapy for anorexia nervosa is another NICE-supported alternative, but it is not listed here; NICE does not establish CBT-ED as uniquely preferable to it. Routine inpatient admission is not indicated solely because psychological treatment has been ineffective: admission depends on physical or acute psychiatric risk and whether stabilisation can occur safely outside hospital. Olanzapine should not be used as sole treatment for anorexia nervosa. Generic family therapy lacking an eating-disorder focus is not the recommended substitute for ineffective FT-AN. Discharge is inappropriate because she wants further treatment and remains symptomatic.

Reference: National Institute for Health and Care Excellence. Eating disorders: recognition and treatment (NG69), recommendations 1.3.15, 1.3.24 and 1.11.1–1.11.4. Published 2017; updated 2020. https://www.nice.org.uk/guidance/NG69/chapter/recommendations