Adolescent eating disorders — structured clinical viva

BN first-line package. Psychological care is core — CBT or family-based treatment adapted for adolescent BN. le Grange RCT showed FBT superior to supportive psychotherapy for adolescent BN binge–purge outcomes. Supportive counselling alone is not an adequate prior trial.[2][6]

Fluoxetine in BN. Multicentre placebo-controlled evidence supports fluoxetine; classic teaching dose with clearest efficacy signal is 60 mg oral daily, titrated with monitoring for activation, suicidality in youth, GI and sexual side-effects. Combine with therapy; correct electrolytes and assess ECG risk from purging before assuming tablet-only safety.[1][4]

Fluoxetine in weight-restored AN. Walsh RCT: fluoxetine did not reduce relapse versus placebo after weight restoration — do not promise this to the GP as AN relapse prophylaxis.[3]

ARFID vs AN. ARFID lacks weight/shape overvaluation; drivers are sensory, fear of aversive consequences, or low interest. Epidemiology of youth ARFID presentations differs from classic AN and needs different therapy targets.[5]

Medical risk of purging at normal BMI. Hypokalaemia, metabolic alkalosis, arrhythmia, dental erosion, Mallory-Weiss — BMI normal is not reassurance.[4]

Capacity and NG refusal when bradycardic. Decision-specific capacity; medical emergency first; parental authority and local compulsory pathways if incapacitous and life at risk; name jurisdiction; document best-interests reasoning.[6]