3 - PSY - Eating disorder Flashcards
Eating disorders have the highest ________ among other mental illness
mortality rate
M:F ratio
1:10
Aetiology of anorexia nervosa - psych
perfectionism low self esteem sexual development (early) Hx of abuse PD
Aetiology of bulimia nervosa - bio
changes in levels of serotonin
Aetiology of bulimia nervosa - psych
low self esteem Hx of abuse Hx of self harm impulsive personality PD high value placed on food and eating behaviour Hx of being overweight
Aetiology of bulimia nervosa - social
exposure to culture of dietin
family/socail culture of categorizing food as good/bad, healthy/naughty
Eating behaviour Hx points
methods of weight loss + control
typical day intake
relationship with body image (past and present)
any binge eating +/or compensatory behaviours
Psych common co-morbidities to screen for
anx dep + self harm
Areas of Sx of anorexia nervosa
Feet and ankles muscles reproductive failure osteopenia/porosis Heart function impaired Psychiatric hair and skin
Other complications of anorexia
hypothermia
infections
metabolic disturbance
haem disturbance
Bulimia nervosa Sx areas
head/CNS Mouth and teeth Heart (hypokalaemia) Abdomen Hand - russell sign on dorsum of long fingers feet and ankles
Other complications of bulimia
dehydration
E imbalance
muscle paralysis
Anorexia nervosa diagnostic criteria points
BMI <17.5
long term intake restriction
fear of getting fat/persistent behaviour stopping weight gain
skewed perception of ones body shape/weight (dont recognise seriousness of low body weight)
Bulimia nervosa diagnostic criteria points
recurrent binge eating episodes
recurrent inappropriate compensation – laxative misuse, diuretics, fasting, excess exercise, vomiting
on average once a week for 3 months
self evaluation unduly influenced by body shape and weight
DDx of eating disorders
hyperthyroidism depression OCD body dysmorphic disorder psychosis (food poisoned)
Co-morbidity with bulimia - reducing binge/purge behaviour can lead to …
increase in coping mechanisms - alcohol, illicit substances, self-harm
Anorexia bio Tx
key is weight restoration
specialist dietician to monitor intake and re-feeding syndrome
weight monitoring
blood monitoring
Dexa bone scan if indicated
ECG - QT prolongation, rate<50, arrhythmias
admission if deranged bloods
Psych Tc of anorexia
Family therapy commonly if pt <18
therapeutic relationship can be most important factor
specialist services
Social Tx of anorexia
advise to inform loved one for support
carer support
increased flexibility with social plans and life goals
Bio Tx of Bulimia
SSRI, commonly Fluoxetine
advise cessation of laxative use, alcohol use
weight and blood monitoring
Psych Tx of Bulimia
psych ed RE coping mechs
20 CBT sessions rec by NICE
therapeutic relationship can be most important factor
specialist dietician for psych ed on balanced eating
Social Tx of bulimia
advise to inform loved one for extra support
carer support
focus on regular intake - cessation of restrict binge purge cycle
increased involvement with social plans and lifestyle goals
