Anorexia nervosa — structured clinical viva

This is adult binge-purge AN with medical risk (bradycardia, QTc concern, purging, chronic course). “Olanzapine at home only” is inadequate: medication is at best an adjunct with modest BMI effect in adult RCT evidence and does not replace medical monitoring, nutritional rehabilitation, or specialist psychotherapy.[1][4]

Medical plan. Same-day senior medical review; likely admission for monitoring, electrolytes (phosphate/K/Mg especially if refeeding), ECG observation, and supervised nutrition under MEED/MARSIPAN-type principles. Purging adds electrolyte risk.[4][6]

Psychotherapy. Adult options with trial lineage include CBT-E, MANTRA, and SSCM; SWAN and earlier three-psychotherapy trials support structured specialist approaches. Prior “therapy never works” needs fidelity check (was it ED-specific? was weight restoration attempted?).[2][3]

Olanzapine. Attia 2019: modest BMI advantage vs placebo in outpatients; psychological symptom superiority not the main story; counsel sedation/metabolic effects; start low if used, never as sole plan while unstable.[1]

Capacity/compulsory care. Decision-specific assessment for admission/NG feeding. If incapacity and life-threatening risk, jurisdiction-specific compulsory frameworks with least restrictive means, second opinion, ethics — partner cannot alone authorise adult compulsory treatment without legal process.[5]