17 - Eating Disorders Flashcards
What is anorexia nervosa and the epidemiology of this?
Eating disorder characterised by restriction of energy intake resulting in low body weight and an intense fear of weight gain
More common in females
0.1-0.3% prevalence at any time
What are some risk factors for developing anorexia nervosa?
- Female
- Age (young)
- FHx of eating disorders, depression, or substance abuse
- Previous criticism of eating habits and weight
- Increased pressures to be slim (e.g. ballet dancers, models, athletes)
- History of sexual abuse
- Low self-esteem
- Obsessive personality
- Emotionally unstable personality disorder
What are some clinical features of anorexia nervosa?
- Restriction of energy intake
- Low body weight
- Features of body dysmorphia
- Intense fear of weight gain
- Rapid weight loss
- Aggressive weight-loss techniques (laxatives, diuretics, vomiting)
- Often a lack of insight or denial
- Withdrawal from social settings
- Loss of libido
What are some signs you might see of someone with anorexia nervosa?
- Amenorrhea
- Lanugo
- Hypothyroidism
- Hypotension
- Hypokalaemia
- Hypothermia
What are some cardiac complications with anorexia nervosa?
- Arrhythmia
- Cardiac atrophy
- Sudden cardiac death
What is a screening questionnaire you can use for anorexia?
Used in primary care to help refer on, score of 2 or more could mean anorexia or bulimia
SCOFF
- S – Do you make yourself Sick because you feel uncomfortably full?
- C – Do you worry you have lost Control over how much you eat?
- O – Have you recently lost more than One stone (6.35 kg) in a three-month period?
- F – Do you believe yourself to be Fat when others say you are too thin?
- F – Would you say Food dominates your life?
What is the ICD-10 diagnostic criteria for anorexia nervosa?
- Weight <85% expected or BMI<17.5
- Avoidance of fattening foods or compensatory behaviours
- Disordered body image
- Wide spread endocrine disorder e.g amenorrhea
What are some compensatory behaviours in anorexia nervosa?
- Calorie limits
- Avoiding food groups
- Food rules e.g timing, only when others eat
What management plan is used for eating disorders?
MARSIPAN
What examinations should you do if you suspect someone to have anorexia nervosa?
- Hydration status
- Height, weight and BMI. Centile chart if <18
- Vital signs: bradycardia, hypothermia and postural blood pressure drop
- Sit-up, Squat–stand test: tests the patient’s ability to sit up from lying and to squat down and stand back up
What investigations should you do for someone with anorexia?
- ECG: bradycardia, prolonged QT interval or arrhythmias
- Blood sugar: hypoglycaemia
- Blood tests: FBC, LFTs, U+Es, TFT, bone profile, magnesium
- Additional: pregnancy test and hormonal panels
How is anorexia nervosa managed in general terms?
- Talking therapies
- Supervised weight gain: weight gain of 0.5–1kg/week being wary of refeeding syndrome
- Inpatient: if bradycardia, ECG changes, electrolyte abnormalities, very low BMI, rapid weight loss, dehydration, organ failure, suicide risk)
What talking therapies are used in anorexia nervosa?
CBT-ED, MANTRA, SSCM
- CBT
- Interpersonal
- Supportive
- Family therapy - First line for children (FT-AN)
What is the prognosis with anorexia nervosa?
1⁄3 recover completely, 1⁄3 improve, and 1⁄3 develop a chronic eating disorder
Highest mortality of any mental health illness (5x general population)
Causes of death: cardiovascular complications, infections and suicide
Mortality is higher if: aged 20–29 at presentation, delayed access to treatment, bingeing, and vomiting
What is refeeding syndrome and the pathophysiology of this?
If nutritional intake is resumed too rapidly after a period of relatively low caloric intake
Rapidly increasing insulin levels lead to shifts of potassium, magnesium and phosphate from extracellular to intracellular spaces. Also utilisation of thiamine
This is potentially fatal