3: Eating Disorders and Obesity Flashcards
What are 3 main eating disorders
- Anorexia Nervosa
- Bulimia Nervosa
- Other specific feeding and eating disorder (OSFED)
What does other specific feeding and eating disorder include
Binge-eating disorder
Define anorexia nervosa
Condition characterised by deliberate weight-loss induced and sustained by the patient
What is a way to remember DSM-V criteria for anorexia
RID
What is the DSM-V criteria for anorexia
Reduced energy intake
Intense fear of gaining weight, despite being underweight
Disturbance in how they perceive their body image, shape or size
What gender is more common to have anorexia
Female (90%)
What age is anorexia more common
Just after puberty (12-13 years-old)
What is the most common cause of admission to paediatric mental health inpatient wards
Anorexia nervosa
What model is used to describe aetiology of anorexia
Biopyschosocial
What biological factors correlate to anorexia
- Genetics: 50-80% concordance
- NT disturbance
What conditions is anorexia associated with
- Anorexia
- OCD
What social factors lead to anorexia
- High parental pressure
- Difficultly establishing autonomy
- Childhood adversity
- Poor ability to resolve conflicts
What are symptoms of anorexia nervosa
- BMI <17.5
- Hypothermia
(Other symptoms relate to specific symptoms)
What endocrine anomalies are seen in anorexia nervosa
- Secondary amenorrhoea
- Hypokalaemia
- Impaired glucose tolerance
- Raised cortisol
- Raised GH
What causes hypokalaemia in anorexia
Laxative abuse
What is problem with hypokalaemia
Lead to arrhythmias and seizures
What are cardiac symptoms of anorexia
Hypotension
Bradycardia
What are MSK symptoms of anorexia
Osteoporosis, fractures
What are skin symptoms of anorexia
- Lanugo
- Dry skin
- Russell sign
What is russell sign
Calluses over knuckles - from when they brush over the molars on inducing vomiting
What are two oral signs of anorexia nervosa
- Enlarged salivary glands
- Loss of tooth enamel
What is there a loss of tooth enamel
Due to stomach acid causing loss
What behaviours may an anorexia person use to induce weight loss
- Reduced food intake
- Excessive exercise
- Vomiting
- Laxative mis-use
- Diuretic mis-use
What pathology is present in anorexia
Fear of normal body weight
What does a fear of normal body weight lead to in anorexia
- Excessive activity
- Restrict intake
What can endocrine disturbance lead to in anorexia
- Secondary amenorrhoea
- Emotional immaturity
- Decrease libido
What should all people with an eating disorder receive
Physical and psychiatry assessment
What does physical assessment involve
- BMI
- BP
- Glucose, TFT, U+E
- ECG (Look for bradycardia, arrhythmias)
How often should individuals with anorexia be assessed
Annually
What are indications for bone mineral density scan in anorexia
- Adult: 2 years underweight, bone pain or fractures
- Child/Young-Person: 1-year underweight, bone pain or fractures
What are the main principles of managing anorexia
- Monitor body weight
- Psychoeducation
What is a key-goal of managing anorexia
Help individuals achieve a normal BMI
What ‘medical’’ treatment is offered for anorexia nervosa
Dietician counselling
- Mineral supplementation and multi-vitamins
If a low bone-mineral density and 13-17 years what is given
Oestradiol
If a low bone-mineral density and over 18-years what is given
Bisphosphonates
For adults, what psychological interventions are recommended
CBT-ED
MANTRA: maudsley anorexia treatment for adults
SSCM: special supportive clinical management
What is first line for managing anorexia in children
Anorexia-Focused Family Therapy
What is second line for managing anorexia in children
CBT-ED
Where are patients with anorexia normally managed
Day care
What is the criteria for admission of patient to psychiatric ward with anorexia
- Bradycardia <40
- ECG: Prolong QT
- Weight-loss >1Kg in one week
- Physical risk
- Parent’s cannot keep them from harm
- Acute mental health risk
When may patient’s be admitted to hospital
Require medical stabilisation
What should all anorexia patients in hospital receive
Liaison psychiatry
What is the usual prognosis of anorexia
Treated in 4-5 years
If anorexia persists beyond 7-years what is it called
Severe enduring anorexia
What are the three features of severe enduring anorexia
- Resistant
- Persistent
- Severe
What is persistent
There are no periods of remission
What is resistant
Resistant to psychotherapy, despite multiple psychotherapists
What is severe
Individuals become ego-synchronically attached to their low body-weight. They see any intervention as trying to change their personality
What is re-feeding syndrome
Feeding a person after a prolonged period of starvation
What are 3 electrolyte abnormalities seen in re-feeding syndrome
Hypokalaemia
Hypomagnesaemia
Hypophosphataemia
What are the following criteria patient needs one of to be at risk of re-feeding syndrome
- BMI <16
- Weight loss 15% in 3-6 months
- Poor nutrition for 10d
- Low K+, Low Mg2+, Low Phosphate
What are the following criteria a patient needs two of to be at risk of re-feeding
- BMI <18.5
- Weight loss 10% in 3-6 months
- Poor nutrition for 5d
- History alcohol abuse, drug therapy
Explain re-feeding a patient if they have not eaten for 5-days
Aim to re-feed at no more than 50% for 2-days
Define bulimia
Disorder characterised by binge eating followed by intentional purgative behaviours including vomiting, exercise, laxatives and diuretics
What is the DSM-V criteria for bulimia
- Recurrent episodes of binge eating
- Loss of control over eating
- Occurs at least once a week for 3 months
- Purgative behaviours
- Self-esteem unduly influenced by body image
- Disturbance does not occur exclusively during episode anorexia
What demographic does bulimia tend to occur in
Young females (90%)
Explain onset of bulimia nervosa compared to anorexia nervosa
Bulimia onsets later in early 20’s
Explain onset of bulimia nervosa
- Bing eating starts at 18-years
- Vomiting starts at 21-years
- Present to services at 23-years
What condition is associated with higher incidence of bulimia nervosa
PCOS
Explain weight in bulimia nervosa
Often patients are normal or over-weight. Weight fluctuates according to starving-purging behaviour.
Weight unduly influences self-esteem
Explain behaviour in bulimia nervosa
Individual looses control during periods of binge eating.
Purgative behaviours include:
- Recurrent bing eating
- Compensatory behaviours
- Low self-esteem
- Lack of control leads to depression, anxiety and anger
What are mouth features of bulimia
Parotitis
What are 3 GI symptoms of bulimia nervosa
Gastritis
Oesophagitis
Parotitis
What are endocrine symptoms of bulimia nervosa
Hypokalaemia (Can be due to laxative abuse)
What are skin symptoms of bulimia nervosa
Russell sign - calluses of the knuckles
What are cardiovascular symptoms of bulimia nervosa
Hypotension
What are CNS symptoms of bulimia nervosa
Seizures (secondary to hypokalaemia)
Explain how pathophysiology of bulimia is different to anorexia
Anorexia - there is a fear of normal weight
Bulimia - there is NO fear of normal weight. individuals just see themselves as inadequate body weight - image
Explain assessment in bulimia
All individuals should have physical and psychiatric assessment as soon as possible
What physical examinations should individuals with bulimia recieve
BMI
BP
TFT, Glucose, U+E
ECG
What is first-line for bulimia
Bulimia focused guided self-help
What is second-line for bulimia
CBT-ED
When is CBT-ED offered
If no improvement after 4W with bulimia focused guided self-help
How is bulimia managed in children
Bulimia nervosa focused self-help
What BMI defines overweight
25-30
What is BMI 25-30
Overweight
What BMI defines obese type I
30-35
What does BMI 30 - 35 indicate
Obese type I
What does BMI: 35-40 indicate
Obese type II
What dose BMI above 40 indicate
Obese type 3
