1: Eating Disorders Flashcards
epidemiology of eating disorders
- anorexia: 1% of women
- bulimia: 1-3% of women
- binge-eating: 2% of women, 1% of men
female to male ratio 10:1 for anorexics
factors in the multifactorial pathogenesis
- genetic: higher in monozygotic twins
- psych: means of coping
- biological: chemical changes occur w/ starvation
- family: higher incidence in 1st degree relatives
- env’t: higher in cultures that value thinness
- social: teasing
7 risk factors for developing an eating disorders
- female gender
- early pubertal development
- perfectionist
- low self-esteem
- sense of personal ineffectiveness
- difficulties w/ communication, conflict resolution, and separation from family
- drive to excel in sports
diagnostic criteria for anorexia
- restriction of energy intake -> significantly low body weight
- intense fear of gaining weight/becoming fat
- disturbance in the way in which one’s body weight or shape is experiences/lack of recognition of the seriousness of the problem
weight usually below 85% of normal for age/gender
restricting subtype of anorexia
weight loss achieved by dieting, fasting, and/or excessive exercise
binge eating/purging subtype of anorexia
weight loss achieved by self-induced vomiting, misuse of laxatives/diuretics/enemas, diet pills, stimulants
anorexia levels of severity: mild, moderate, severe, extreme
mild: BMI 17-18.5kg/m2
moderate: BMI 16-16.99 kg/m2
severe: BMI 15-15.99 kg/m2
extreme: BMI
diagnostic criteria for bulimia
- recurrent episodes of binge eating (eating in a discrete period a larger than normal amt or sense of lack of control over eating during episode)
- recurrent inappropriate compensatory behaviors to prevent weight gain at least 1/week for 3 mo.
- self eval is unduly influenced by body shape/weight
- disturbance doesn’t occur during anorexic episodes
bulimia levels of severity: mild, moderate, severe, extreme
mild: 1-3 episodes/week
moderate: 4-7 episodes/week
severe: 8-13 episodes/week
extreme: 14 or more episodes/week
diagnostic criteria for binge-eating disorder
- recurrent episodes of binge eating
- episodes associated with 3 or more of the following:
- eating too rapidly
- eating until feeling uncomfortably full
- eating large amts of food when not feeling hungry
- eating alone b/c of embarrassment
- feeling disgusted w/ oneself, depressed, or guilty after
- marked distress regarding binge eating
- at least 1/week for 3 mo
- not associated with inappropriate compensatory behavior
binge-eating levels of severity: mild, moderate, severe, extreme
mild: 1-3 episodes/week
moderate: 4-7 episodes/week
severe: 8-13 episodes/week
extreme: 14 or more episodes/week
presenting symptoms of eating disorders
- amenorrhea or menstrual irregularities
- abdominal pain and bloating
- cold intolerance
- constipation
- dizziness
- dry skin
- fatigue
- GERD (from vomiting)
- palpitations
- syncope
physical findings in anorexia
- acrocyanosis (blue fingers/toes)
- bradycardia
- emaciation
- hypotension (especially orthostatic hypotension)
- lanugo (fine hair)
- cold extremities
- hypothermia
- atrophic breasts
- edema of extremities
- flat affect
- alopecia (lose hair)
- salivary gland enlargement (from starvation)
physical findings in bulimia
- salivary gland enlargement (from vomiting), inflammation of parotid duct
- calluses on knuckles (Russell’s sign)
- mouth sores
- dental enamel erosions
- hypotension (especially orthostatic)
- edema of extremities (more due to compensatory methods, like diuretics)
- Mallory-Weiss tear (vomit forcefully and tear esophageal mucosa - usually present w/ bloody vomit)
lab abnormalities in anorexia
- mild normochromic, normocytic anemia with moderate leukopenia
- low blood sugar
- elevated serum cholesterol
- hyponatremia may be present from water loading
- elevated liver enzymes from refeeding or apoptosis from starvation
lab abnormalities in bulimia
- hypokalemia, hypochloremia with metabolic acidosis secondary to vomiting
- hypokalemia with metabolic acidosis from laxative abuse
- elevated serum amylase (from salivary gland)
important questions to ask
- weight: highest, lowest, desired?
- feelings about current weight?
- has anyone commented on weight?
- type of diet? vegetarian common
- rituals such as chewing certain number of times?
- restricting foods they used to eat?
- any purging of food?
- any binging of food?
- medications taken ?
- menstrual history?
suicide risk for eating disorders
-elevated in both anorexia and bulimia
co-morbidities with bulimia
- sexual promiscuity
- substance abuse
lab tests for a suspected eating disorder
- CBC and ESR
- comprehensive metabolic profile (K+, Cl-)
- magnesium
- UA (specific gravity to see if water loaded)
- EKG
- thyroid function tests
- bone densitometry (osteopenic)
additional labs to consider based on H&P
- urine B-hCG
- serum amylase (to confirm purging)
- FSH, LH, estradiol, testosterone, prolactin (for menorrheal issues)
- stool for blood
- GI endoscopy, CXR, head CT
- PPD
differential diagnosis options for weight loss (9)
- anorexia
- intentional dieting and exercise
- CNS tumors (hypothalamic, pituitary)
- endocrine disorders (hyperthyroid, T1DM, addison’s)
- GI disorders (IBS)
- chronic infection (AIDS, TB)
- CT disorders (SLE)
- malignancy (lymphoma)
- other psych disorders (MDD)
4 principles of successful care of eating disorders
- early restoration of normal state
- establishment of trust
- involvement of family in treatment
- team approach - medical, nutritional, psychological
levels of care for eating disorders
-hospital inpatient
-outpatient
-partial hospitalization (12 h for 5d/week)
-intensive outpatient program (IOP) - 8h for 3d/week
-residential - one or two month stay
-regular visits with health care provider, psychotherapist
and nutritionist while maintaining activities of daily life
medical criteria for hospitalization
severe metabolic disturbances
-HR
psychiatric criteria for hospitalization
- severe depression
- psychosis
- family crises
- failure to comply with eating disorder contract
what drug is approved for bulimia treatment?
fluoxetine/prozac
-in higher doses than for depression -> 60 mg/day
pharm treatment for anorexia
- olanzapine/zyprexa may be helpful: promotes weight gain, decreases obsessive thinking
- avoid meds that prolong QT interval
what drug is contraindicated in treating eating disorders and why?
buproprion/wellbutrin/zyban - b/c increased incidence of seizures
definition of refeeding syndrome
clinical complications that occur as a result of fluid and electrolyte shifts during nutritional rehab of malnourished patients
- stores of phosphate depleted during AN/starvation
- feeding -> release insulin -> cell uptake of phosphate, K+, Mg2+ and increase production of ATP
- lack of phosphorylated intermediates causes tissue hypoxia and resultant myocardial dysfunction and resp failure
clinical components of refeeding syndrome (6)
- hypophosphatemia
- hypokalemia
- hypomagnesemia
- vitamin and trace mineral deficiencies
- volume overload
- edema
