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Psychiatry > 3: Eating Disorders and Obesity > Flashcards

3: Eating Disorders and Obesity Flashcards

1
Q

What are 3 main eating disorders

A
  • Anorexia Nervosa
  • Bulimia Nervosa
  • Other specific feeding and eating disorder (OSFED)
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2
Q

What does other specific feeding and eating disorder include

A

Binge-eating disorder

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3
Q

Define anorexia nervosa

A

Condition characterised by deliberate weight-loss induced and sustained by the patient

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4
Q

What is a way to remember DSM-V criteria for anorexia

A

RID

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5
Q

What is the DSM-V criteria for anorexia

A

Reduced energy intake

Intense fear of gaining weight, despite being underweight

Disturbance in how they perceive their body image, shape or size

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6
Q

What gender is more common to have anorexia

A

Female (90%)

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7
Q

What age is anorexia more common

A

Just after puberty (12-13 years-old)

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8
Q

What is the most common cause of admission to paediatric mental health inpatient wards

A

Anorexia nervosa

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9
Q

What model is used to describe aetiology of anorexia

A

Biopyschosocial

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10
Q

What biological factors correlate to anorexia

A
  • Genetics: 50-80% concordance

- NT disturbance

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11
Q

What conditions is anorexia associated with

A
  • Anorexia

- OCD

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12
Q

What social factors lead to anorexia

A
  • High parental pressure
  • Difficultly establishing autonomy
  • Childhood adversity
  • Poor ability to resolve conflicts
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13
Q

What are symptoms of anorexia nervosa

A
  • BMI <17.5
  • Hypothermia

(Other symptoms relate to specific symptoms)

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14
Q

What endocrine anomalies are seen in anorexia nervosa

A
  • Secondary amenorrhoea
  • Hypokalaemia
  • Impaired glucose tolerance
  • Raised cortisol
  • Raised GH
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15
Q

What causes hypokalaemia in anorexia

A

Laxative abuse

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16
Q

What is problem with hypokalaemia

A

Lead to arrhythmias and seizures

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17
Q

What are cardiac symptoms of anorexia

A

Hypotension

Bradycardia

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18
Q

What are MSK symptoms of anorexia

A

Osteoporosis, fractures

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19
Q

What are skin symptoms of anorexia

A
  • Lanugo
  • Dry skin
  • Russell sign
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20
Q

What is russell sign

A

Calluses over knuckles - from when they brush over the molars on inducing vomiting

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21
Q

What are two oral signs of anorexia nervosa

A
  • Enlarged salivary glands

- Loss of tooth enamel

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22
Q

What is there a loss of tooth enamel

A

Due to stomach acid causing loss

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23
Q

What behaviours may an anorexia person use to induce weight loss

A
  • Reduced food intake
  • Excessive exercise
  • Vomiting
  • Laxative mis-use
  • Diuretic mis-use
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24
Q

What pathology is present in anorexia

A

Fear of normal body weight

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25
Q

What does a fear of normal body weight lead to in anorexia

A
  • Excessive activity

- Restrict intake

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26
Q

What can endocrine disturbance lead to in anorexia

A
  • Secondary amenorrhoea
  • Emotional immaturity
  • Decrease libido
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27
Q

What should all people with an eating disorder receive

A

Physical and psychiatry assessment

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28
Q

What does physical assessment involve

A
  • BMI
  • BP
  • Glucose, TFT, U+E
  • ECG (Look for bradycardia, arrhythmias)
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29
Q

How often should individuals with anorexia be assessed

A

Annually

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30
Q

What are indications for bone mineral density scan in anorexia

A
  • Adult: 2 years underweight, bone pain or fractures

- Child/Young-Person: 1-year underweight, bone pain or fractures

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31
Q

What are the main principles of managing anorexia

A
  • Monitor body weight

- Psychoeducation

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32
Q

What is a key-goal of managing anorexia

A

Help individuals achieve a normal BMI

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33
Q

What ‘medical’’ treatment is offered for anorexia nervosa

A

Dietician counselling

- Mineral supplementation and multi-vitamins

34
Q

If a low bone-mineral density and 13-17 years what is given

A

Oestradiol

35
Q

If a low bone-mineral density and over 18-years what is given

A

Bisphosphonates

36
Q

For adults, what psychological interventions are recommended

A

CBT-ED
MANTRA: maudsley anorexia treatment for adults
SSCM: special supportive clinical management

37
Q

What is first line for managing anorexia in children

A

Anorexia-Focused Family Therapy

38
Q

What is second line for managing anorexia in children

A

CBT-ED

39
Q

Where are patients with anorexia normally managed

A

Day care

40
Q

What is the criteria for admission of patient to psychiatric ward with anorexia

A
  • Bradycardia <40
  • ECG: Prolong QT
  • Weight-loss >1Kg in one week
  • Physical risk
  • Parent’s cannot keep them from harm
  • Acute mental health risk
41
Q

When may patient’s be admitted to hospital

A

Require medical stabilisation

42
Q

What should all anorexia patients in hospital receive

A

Liaison psychiatry

43
Q

What is the usual prognosis of anorexia

A

Treated in 4-5 years

44
Q

If anorexia persists beyond 7-years what is it called

A

Severe enduring anorexia

45
Q

What are the three features of severe enduring anorexia

A
  • Resistant
  • Persistent
  • Severe
46
Q

What is persistent

A

There are no periods of remission

47
Q

What is resistant

A

Resistant to psychotherapy, despite multiple psychotherapists

48
Q

What is severe

A

Individuals become ego-synchronically attached to their low body-weight. They see any intervention as trying to change their personality

49
Q

What is re-feeding syndrome

A

Feeding a person after a prolonged period of starvation

50
Q

What are 3 electrolyte abnormalities seen in re-feeding syndrome

A

Hypokalaemia
Hypomagnesaemia
Hypophosphataemia

51
Q

What are the following criteria patient needs one of to be at risk of re-feeding syndrome

A
  • BMI <16
  • Weight loss 15% in 3-6 months
  • Poor nutrition for 10d
  • Low K+, Low Mg2+, Low Phosphate
52
Q

What are the following criteria a patient needs two of to be at risk of re-feeding

A
  • BMI <18.5
  • Weight loss 10% in 3-6 months
  • Poor nutrition for 5d
  • History alcohol abuse, drug therapy
53
Q

Explain re-feeding a patient if they have not eaten for 5-days

A

Aim to re-feed at no more than 50% for 2-days

54
Q

Define bulimia

A

Disorder characterised by binge eating followed by intentional purgative behaviours including vomiting, exercise, laxatives and diuretics

55
Q

What is the DSM-V criteria for bulimia

A
  • 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
56
Q

What demographic does bulimia tend to occur in

A

Young females (90%)

57
Q

Explain onset of bulimia nervosa compared to anorexia nervosa

A

Bulimia onsets later in early 20’s

58
Q

Explain onset of bulimia nervosa

A
  • Bing eating starts at 18-years
  • Vomiting starts at 21-years
  • Present to services at 23-years
59
Q

What condition is associated with higher incidence of bulimia nervosa

A

PCOS

60
Q

Explain weight in bulimia nervosa

A

Often patients are normal or over-weight. Weight fluctuates according to starving-purging behaviour.

Weight unduly influences self-esteem

61
Q

Explain behaviour in bulimia nervosa

A

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
62
Q

What are mouth features of bulimia

A

Parotitis

63
Q

What are 3 GI symptoms of bulimia nervosa

A

Gastritis
Oesophagitis
Parotitis

64
Q

What are endocrine symptoms of bulimia nervosa

A

Hypokalaemia (Can be due to laxative abuse)

65
Q

What are skin symptoms of bulimia nervosa

A

Russell sign - calluses of the knuckles

66
Q

What are cardiovascular symptoms of bulimia nervosa

A

Hypotension

67
Q

What are CNS symptoms of bulimia nervosa

A

Seizures (secondary to hypokalaemia)

68
Q

Explain how pathophysiology of bulimia is different to anorexia

A

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

69
Q

Explain assessment in bulimia

A

All individuals should have physical and psychiatric assessment as soon as possible

70
Q

What physical examinations should individuals with bulimia recieve

A

BMI
BP
TFT, Glucose, U+E
ECG

71
Q

What is first-line for bulimia

A

Bulimia focused guided self-help

72
Q

What is second-line for bulimia

A

CBT-ED

73
Q

When is CBT-ED offered

A

If no improvement after 4W with bulimia focused guided self-help

74
Q

How is bulimia managed in children

A

Bulimia nervosa focused self-help

75
Q

What BMI defines overweight

A

25-30

76
Q

What is BMI 25-30

A

Overweight

77
Q

What BMI defines obese type I

A

30-35

78
Q

What does BMI 30 - 35 indicate

A

Obese type I

79
Q

What does BMI: 35-40 indicate

A

Obese type II

80
Q

What dose BMI above 40 indicate

A

Obese type 3

Psychiatry (13 decks)

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