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3: Psych Y3 - Mental Health [10] > [17] Anorexia Nervosa > Flashcards

[17] Anorexia Nervosa Flashcards

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1
Q

What is anorexia nervosa characterised by?

A
  • Deliberate weight loss
  • Intense fear of fatness
  • Distorted body image
  • Endocrine disturbances
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2
Q

What are the biological predisposing risk factors for anorexia nervosa?

A
  • Genetics
  • Family history
  • Female
  • Early menarche
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3
Q

What are the biological precipitating risk factors for anorexia nervosa?

A

Adolesence and puberty

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4
Q

What are the biological perpetuating risk factors for anorexia nervosa?

A

Starvation leads to neuroendocrine changes that perpetuate anorexia

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5
Q

What are the psychological predisposing risk factors for anorexia nervosa?

A
  • Sexual abuse
  • Preoccupation with slimness
  • Dieting behaviours starting in adolesence
  • Low self-esteem
  • Premorbid anxiety or depressive disorder
  • Perfectionism, obsessional/anankastic personality
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6
Q

What are the psychological precipitating risk factors for anorexia nervosa?

A

Criticism regarding eating, body shape, or weight

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7
Q

What are the psychological perpetuating risk factors of anorexia nervosa?

A
  • Perfectionism
  • Obsessional/anakastic personality
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8
Q

What are the social predisposing risk factors for anorexia nervosa?

A
  • Western society - pressure to diet in a society that emphasises being thin is beauty
  • Bullying at school revolving around weight
  • Stressful life events
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9
Q

What are the social precipitating risk factors for anorexia nervosa?

A

Occupational or recreational pressure to be slim, e.g. ballet dancers, models

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10
Q

What are the social perpetuating factors for anorexia nervosa?

A
  • Occupation
  • Western society
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11
Q

What is the typical age of onset of anorexia nervosa?

A

Mid-adolescence

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12
Q

What are the ICD-10 diagnostic criteria for anorexia nervosa?

A
  • Fear of weight gain
  • Endocrine disturbances leading to amenorrhoea and loss of sexual interest and potency in males
  • Emaciated (abnormally low body weight) - >15% below expected weight, or BMI <17.5kg/m2
  • Deliberate weight loss with decreased food intake and increased exercise
  • Distorted body image

The above features must be present for at least 3 months, and there must be the absence of recurrent episodes of binge eating, and preoccupation with eating/craving to eat

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13
Q

Other than those mentioned in ICD-10, what are the features of anorexia?

A
  • Physical features
  • Preoccupation with food
  • Social isolated
  • Symptoms of depression and obsessions
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14
Q

What are the physical features of anorexia nervosa?

A
  • Fatigue
  • Hypothermia
  • Arrhythmias
  • Peripheral oedema (due to hypoalbuminaemia)
  • Headaches
  • Lanugo hair
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15
Q

How might preoccupation with food manifest in anorexia nervosa?

A
  • Dieting
  • Preparing elaborate meals for others
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16
Q

How is anorexia nervosa investigated?

A
  • History
  • MSE
  • Blood tests
  • VBG
  • DEXA scan
  • ECG
  • Questionnaires, e.g. eating attitudes test (EAT)
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17
Q

What blood tests should be done in anorexia?

A
  • FBC
  • U&Es
  • TFTs
  • LFTs
  • Lipids
  • Cortisol
  • Sex hormones
  • Glucose
    Amylase
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18
Q

What may be found on FBC in anorexia nervosa?

A
  • Anaemia
  • Thrombocytopenia
  • Leukopenia
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19
Q

What may be found on U&Es in anorexia nervosa?

A
  • Increased urea and creatinine if dehydrated
  • Decreased potassium, phosphate, magnesium, and chloride
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20
Q

What may be found on TFTs in anorexia nervosa?

A

Decreased T3 and T4

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21
Q

What may be found on LFTs in anorexia nervosa?

A

Decreased albumin

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22
Q

What changes may occur to lipids in anorexia nervosa?

A

Increased cholesterol

23
Q

What changes may occur to sex hormones in anorexia nervosa?

A

Decreased LH, FSH, oestrogens and progesterones

24
Q

What changes may occur to glucose in anorexia nervosa?

A

Decreased glucose

25
Q

Why is amylase tested in anorexia nervosa?

A

Pancreatitis is a complications

26
Q

Why is VBG done in anorexia nervosa?

A
  • Metabolic alkalosis may be present if there is vomiting
  • Metabolic acidosis may be present if there is abuse of laxatives
27
Q

Why is a DEXA scan done in anorexia nervosa?

A

To rule out osteoporosis if suspected

28
Q

Why is an ECG done in anorexia nervosa?

A

Arrhythmias such as sinus bradycardia and prolonged QT are associated with AN patients

29
Q

What are the differential diagnoses of anorexia nervosa?

A
  • Bulimia nervosa.
  • Eating disorder not otherwise specified (EDNOS)
  • Depression.
  • Obsessive–compulsive disorder.
  • Schizophrenia with delusions about food.
  • Organic causes of low weight - diabetes, hyperthyroidism, malignancy.
  • Alcohol or substance misuse.
30
Q

What are the metabolic complications of anorexia nervosa?

A
  • Hypokalaemia
  • Hypercholesteroaemia
  • Hypoglycaemia
  • Impaired glucose tolerance
  • Deranged LFTs
  • Increased urea and creatinine
  • Decreased potassium, phosphate, magnesium, albumin, and chloride
31
Q

What are the endocrine complications of anorexia nervosa?

A
  • Increased cortisol
  • Increased growth hormone
  • Decreased T3 and T4
  • Decreased LH, FSH, oestrogens and progesterones leading to amenorrhoea
  • Decreased testosterone in men
32
Q

What are the gastrointestinal complications of anorexia nervosa?

A
  • Enlarged salivary glands
  • Pancreatitis
  • Constipation
  • Peptic ulcers
  • Hepatitis
33
Q

What are the cardiovascular complications of anorexia nervosa?

A
  • Cardiac failure
  • ECG abnormalities
  • Arrhythmias
  • Decreased BP
  • Bradycardia
  • Peripheral oedema
34
Q

What are the renal complications of anorexia nervosa?

A
  • Renal failure
  • Renal stones
35
Q

What are the neurological complications of anorexia nervosa?

A
  • Seizures
  • Peripheral neuropathy
  • Autonomic dysfunction
36
Q

What are the haematological complications of anorexia nervosa?

A
  • Iron deficiency anaemia
  • Thrombocytopenia
  • Leucopenia
37
Q

What are the musculoskeletal complications of anorexia nervosa?

A
  • Proximal myopathy
  • Osteoporosis
38
Q

What are the other complications of anorexia nervosa?

A
  • Hypothermia
  • Dry skin
  • Brittle nails
  • Lanugo hair
  • Infections
  • Suicide
39
Q

What needs to be considered in the risk assessment in anorexia nervosa?

A
  • Risk of suicide
  • Risk of medical complications
40
Q

What is involved in the biological management of anorexia nervosa?

A
  • Treatment of medical complications
  • SSRIs for co-morbid depression or OCD
41
Q

What is involved in the psychological management of anorexia nervosa?

A
  • Psychoeducation about nutrition
  • Cognitive behavioural therapy
  • Cognitive analytic therapy
  • Interpersonal psychotherapy
  • Family therapy
42
Q

What duration should psychological treatments be for in anorexia nervosa?

A

At least 6 months

43
Q

What is involved in the social management of anorexia nervosa?

A
  • Voluntary organisations
  • Self-help groups
44
Q

What weight gain is aimed for in inpatient treatment of anorexia nervosa?

A

0.5-1kg/week

45
Q

What weight gain is aimed for in outpatient treatment of anorexia nervosa?

A

0.5kg/week

46
Q

Why should weight gain be carefully controlled when treating anorexia nervosa?

A

Because patients are at risk of refeeding syndrome

47
Q

What is refeeding syndrome?

A

A potentially life-threatening syndrome that results from food intake (parenteral or enteral) after prolonged starvation or malnourishent, due to changes in phosphate, magnesium, and potassium

48
Q

What is the pathophysiological process in refeeding syndrome?

A

It occurs due to an insulin surge following increased foot intake

49
Q

What are the biochemical features of refeeding syndrome?

A
  • Fluid balance abnomalities
  • Hypokalaemia
  • Hypomagnesia
  • Hypophosphataemia
  • Abnormal glucose metabolism
50
Q

What effect can phosphate depletion in refeeding syndrome have?

A

Can cause a reduction in cardiac muscle activity, which can lead to cardiac failure

51
Q

How is refeeding syndrome prevented?

A

Measure serum electrolytes prior to feeding, and monitor refeeding bloods daily, starting at 1200kcal/day and gradually increase every 5 days, monitoring for signs such as tachycardia and oedema

52
Q

What is done if electrolytes are found to be low when refeeding in anorexia nervosa?

A

They should be replaced orally or intravenously, depending on the severity of the eletrolyte depletion

53
Q

When might hospitalisation be necessary in anorexia nervosa?

A

Either for medical reasons (severe anorexia with BMI <14, or severe electrolte abnormalities) or psychiatric reasons (suicidal ideation)

3: Psych Y3 - Mental Health [10] (21 decks)

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