20. EATING DISORDERS Flashcards
Who has highest prevelence rates for eating disorders?
- Women
- Adolescents
Which eating disorders are often associated with a high rate of suicidality?
How should we handle?
- Bullimia
- Anorexia Nervosa
- If a specific, lethal plan is made => hospitalize!
Anorexia Nervosa
- Restrict NRG intake compared to requirement => leading to low weight for age, sex and develoment
- Fear WG, even though underweight or persistant behaviors to prevent WG
- Disorted perception of body weight/shape or deny seriousness of weight
Screening questions for eating disorders
- Are you happy with your weight?
- Do you ever eat in secret
- Does your weight affect how you feel about yourself?
- Have any family members suffered from eating disorder?
- Do you currently suffer/ever suffered with eating disorder?
Types of Anorexia Nervosa
- Restricting type: 3 months of no binging or purging, use of lacatives; exercise alot, fast, diet
- Binge-purge type: 3 months of binging and purging (vomiting, laxatives, diuretics, enemas)
But, crossover is common!
Pts with ____ are often u_nderweight/overweight/NL_
- Anorexia Nervosa are often ________
- Bullemia are often ________
- Binge-eating are often _______
- Underweight
- NL weight
- Overweight
Will a Anorexic pt admit to being hungry, despite looking underwight?
No, deny starvations
- How do ppl with anorexia view WL?
- What are common behaviors?
- Form of control
- Excessive viewing in mirror, weighing self/body parts
As anorexic patient loses more weight, how does their fear of gaining weight change?
Fear of WG and other psychological comorbidities get worse
What are common medical complications with Anorexia Nervosa?
- CV: bradycardia, hypotension, QT dispersion, cardiac atropgy, mitral valve prolapse
- Electrolyte: dehydration, hypokalemia/hypophosphatemia/hypomagnesia
- Amenorrhia, decreased sex frive
Pulmonary, hematologic and neurologic, and derm medical complications in ppl with anorexia Nervosa?
- Pulm: respiratory muscles atrophy and dyspnea
- Heme: anemia, thrombocytopenia, leukopenia
- Neuro: brain atrophy
- Derm: lanugo
MC psychological comorbidity in Anorexia Nervosa?
- OCD (Anxiety disorder)
- Mood disorder: depression/dysthmia
- Personality disorder
1st line treatment for Anorexia Nervosa
- 1st line = multidisciplinary aprroach
- Nutritional rehabilitation = with registered dietician, focusing on how to gain weight and may include supervised meals; main goal is to bring pt back to NL body weight and teach good eating habits for long-term acre.
- Psychotherapy (CBT or family therapy)= help pt confront disorder and change eating habits, thoughts about gaining weight
- If needed, hospitilize until NL weight is needed to prevent relapse and rehospitilzation
Initial choice of psychotherapy for Anorexia Nervosa patients
Family therapy
Is pharmacotherapy used for Anorexia nervosa?
- Disordrer and psych comorbidites are usually resistiant to drugs bc pt is so sick.
- Only use when depression/anxiety is a barrier to care or pts are resistant to care
What drugs should be avoided in Anorexia nervosa pts and why?
- Bupropion = seizures
- TCAs = cardiotoxicity
- Antipsychotics and antidepressants that cause QT prolongation
If drugs ARE used in Anorexia, what are good examples?
- 2.5 - 10 mg Olanzapine/day to help WG
- 0.5 mg of Lorazapam to reduce anxiety with confronting meals
- SSRI if anxiety/depression is a barrrier to care. IF unresponsive, add 2nd gen antipsychotic.
Bullimeia Nervosa Dx Criteria
- Recurrent epides of binge eating (uncontrollable eating alot of food in short pt of time) + compensatory behavior to prevent WG
- Occur 2x/week for 3 months
- Pts self-eval is based on weight and shape
- Does not occur during episode of anorexia nervosa
What WL tactics do those with Bullimemia use?
same as AN
How do patients who are bullemia feel after binging?
Dysphoric, shitty
Do Bullemic patients want to be thin?
No, they dont want to be fat. They fear WG
Medical Complications with Bullemia (electrolte, CV, GI, dental)
- Electrolytw: dehydration, hypokalemia/hypocholoremia, metabolic alkalosis
- CV: hypotension, orthostasis, tacycardia, ECG changes
- GI: Mallory weis syndrome or esophageal rupture
- Dental: tooth eroion, dental carriers, callus on hand
1st line of treatment for Bullemia Nervosa
- Nutritional rebab + CBT psychotherapy (to stop binging/purging)+ drugs (Fluoxetine 60mg/day, but start with 20mg and increase each week)
What is the 1st line drug used for bullemia?
- 60mg of Fluoxetine (Start at 20mg then move up)
2nd line: SSRIS (sertraline or fluvoxamine)
3rd line: TCAs > topiramate > trazodone > MAOIs
Binge Eating Disorder (BED)
- Binge eating (uncontrollably eating a large amount of food in a short time period: 2 hours) at least 1x a week for 3 months
-
At least 3 of the following:
- Eating alot of food w_hen not hungry_
- Eats fast
- Feels umcomfortably full after eating
- Eating alone bc embarrased over shit ton of food eaten
- Feel guilty, depressed, disgusted after binging.
- No regular compensatory behaviors.
Do ppl with binge eating disorder (BED) engage in compensatory behaviors?
NO
1st line of therapy for BED (binge-eating disorder)
- Psychotherapy (CBT and IPT: interpersonal therapy are equally helpful)
Meds are less effective, but less expensive and time consuming. Taking both together is not more affective than CBT alone
FDA approved meds for Binge-Eating Disorder
Vyvanse: moderate - severe binge eating
What should therapy for BED focus on?
1. Binge eating
2. WG
3. Psychiatric comobidities
4. Concerns about body
What SSRIs can be effective in Binge Eating Disoder (BED)?
- Citalopram, escitalopram, fluoxetine, fluvoxamine and sertraline
