Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Term 5: Behavioral Science > 6/11- Eating Disorders > Flashcards

6/11- Eating Disorders Flashcards

You may prefer our related Brainscape-certified flashcards:
Biology 101 flashcards
1
Q

Case:

  • 16 yo female with weight loss as chief complaint
  • Hx of bullying, teased for weight, has had significant weight loss in the past 3 mo (lost 60 lb)
  • No suicidal ideation or substance use
  • Not involved in many extra-curricular activities
  • Often skipping breakfast and dinner with only a small lunch (~salad)
  • Weight: 100.6 lbs, height: 61.5 in (5’1”)
  • Growth curve (picture)

What is Mae’s diagnosis?

A. Anorexia Nervosa

B. Bulimia Nervosa

C. Neither

A

A. Anorexia Nerovsa (binge-purge subtype)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What percentage of people (high school) are trying NOT to lose weight?

A
  • 52% total
  • 37% girls
  • 67% boys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What percentage of people (high school) did not eat for 24 hours to try to lose weight?

A
  • 13% total
  • 19% girls
  • 7% boys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What percentage of people (high school) took diet pills, powders, liquids in past 30 days without doctor’s recommendation?

A
  • 5% total
  • 6.6% girls
  • 3.5% boys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What percentage of people (high school) took laxatives to lose weight or to keep from gaining weight in the past 30 days?

A
  • 4.4% total
  • 6.6% girls
  • 2.2% boys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Prevalence of eating disorders?

Average age for anorexia?

How many cases are male?

A

Growing number of people affected by eating disorders:

  • 2-5% have bulimia nervosa
  • 0.5-2% have anorexia nervosa (avg age 13.5)
  • 5% other specified eating disorder

Up to 10% of cases are male

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Individual risk factors for an eating disorder?

A
  • Adolescent female
  • Low self esteem
  • Conflicts about personal identity and autonomy
  • Negative attitude towards body at puberty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cultural risk factors for an eating disorder?

A
  • Thin ideal for beauty and happiness
  • Acculturation to Western value
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Family risk factors for an eating disorder?

A
  • Achievement oriented
  • Limited emotional support, nurturance or encouragement
  • Maternal preoccupation with appearance, diet, weight or physical fitness
  • Family history of eating disorders of mood disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Sports risk factors for an eating disorder?

A
  • Weight loss for performance
  • “Under-fueling” due to schedule and excessive practices
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does DSM 5 address eating disorders?

A
  • Included as mental disorders
  • Broadens AN and BN
  • Adds other feeding disorders into the category (pica-eating ice/dirt, rumination, avoidant feeling…)
  • Eliminating eating disorder NOS as a category but leaves an unspecified category
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Anorexia Nervosa?

Characteristics?

A
  • Restriction leading to clinically significant low weight
  • Intense fear of gaining weight OR behavior that interferes with gaining weight
  • Disturbance in how body weight or shape is experienced or persistent lack of recognition of seriousness of low body weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are two-subtypes of Anorexia Nervosa?

A

- Restricting type: does not binge or purge, typically use dieting, fasting, or excessive exercise

- Binge-eating/purging type: recurrent bingeing and purging over the last 3 mo, purging includes self-induced vomiting, misuse of laxatives/diuretics/enemas…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is severity given to cases of Anorexia Nervosa?

A

Severity is based on BMI

  • Mild: BMI > 17
  • Moderate: BMI 16-16.99
  • Severe: BMI 15-15.99
  • Extreme: BMI < 15
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Bulimia Nervosa? Characteristics?

A
  • Recurrent binge eating, includes both eating in a discrete period of time an amount more than most individuals, and having a sense of lack of control over this
  • Recurrent inappropriate compensatory behaviors to prevent weight gain (self-induced vomiting, misuse of laxatives, diuretics or other meds, fasting, excessive exercise)
  • Once a week for 3 mo (average)
  • Self-evaluation unduly influenced by body shape and weight
  • Disturbance not only during episodes of anorexia nervosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is severity given to Bulimia Nervosa?

A

Severity based on frequency of purging

  • Mild: 1-3 episodes/wk
  • Moderate: 4-7 episodes/wk
  • Severe: 8-13 episodes/wk
  • Extreme: 14+ episodes/wk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is BN different from the bingeing/purging subtype of AN?

A

AN involves chronic low weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How to calculate % ideal body weight (%IBW)

A

Determine using NHANES table, BMI, HAMWI method

% IBW = current body weight/ideal body weight x 100 OR

% IBW = current BMI/ideal BMI x 100

19
Q

What are the different categories for degree of malnutrition?

A

Determined by %IBW (ideal body weight)

  • Normal: 90-110%
  • Mild: 80-89.9%
  • Moderate: 70-79.9%
  • Severe: < 70%
20
Q

Common chief complaints for individuals with eating disorders?

A
  • Well child check
  • Weight loss
  • Fatigue
  • Amenorrhea
  • GI complaints
21
Q

What should you look for in vital signs?

A
  • Low weight (look at growth charts!)
  • Possibly stunted height
  • Hypotension
22
Q

What are some questions you can use for screening? Results?

A

SCOFF screening questions:

  • Do you make yourself SICK because you feel uncomfortably full?
  • Do you worry that you’ve lost CONTROL over how much you eat?
  • Have you recently lost more than ONE stone (14 lb) in a 3-mo period?
  • Do you believe yourself to be FAT when others say you are too thin?
  • Would you say that FOOD dominates your life?

Yes = 1 pt

Score > 2 suggests eating disorder

23
Q

What are some non-SCOFF (additional) screening questions?

A

Perception of weight:

  • “Do you fell you are too thin, too heavy, or just right?”
  • “Do you have a fear of gaining weight?”

Efforts to control weight (diet, exercise, vomiting, laxatives…)

24
Q

Physical findings with eating disorders?

A
  • Neurological
  • Psychiatric
  • Fluid and Electrolytes
  • Cardiovascular
  • Endocrine
  • Gastrointestinal
  • Dermatological
  • HEENT
25
Q

Physical findings: Neurologic?

A

Neurological

  • Cortical atrophy
  • Syncope
  • Cognitive impairment
26
Q

Physical findings: Psychiatric?

A

Psychiatric

  • Anxiety
  • Obsessive-compulsive symptoms
  • Depression
27
Q

Physical findings: Fluid and electrolytes?

A

Fluid and Electrolytes

  • Dehydration
  • Electrolyte abnormalities (decreased Ca, Na, PO4, K, Mg)
28
Q

Physical findings: Cardiovascular?

A

Cardiovascular

  • Bradycardia
  • Hypotension (especially orthostasis)
  • Prolonged QTc
29
Q

Physical findings: Dermatological?

A

Dermatological

  • Lanugo (fine hair)
  • Russell’s sign (knuckles that may be impacted by teeth during vomiting)
30
Q

Physical findings: HEENT?

A

HEENT

  • Enamel erosion
  • Parotid hypertrophy
31
Q

DDx for eating disorder?

A
  • Feeding disorder
  • Inflammatory bowel disease
  • Primary endocrine disorder
  • Diabetes mellitus
  • Addison’s disease
  • Depression or other psychiatric disease
  • Malignancy including CNS tumor
  • Other GI illness (achalasia, cystic fibrosis)
32
Q

Laboratory evaluations to look at?

A
  • CBC, CMP including Ca, Mg, Phos-
  • Thyroid stimulating hormone (may have decreased levels of T3/T4 secondary to malnutrition?)
  • Urine POC dipstick, pregnancy test if sexually active
  • ESR, CRP, (amylase, lipase)
  • Baseline EKG when HR < 50 or moderate malnutrition
  • FSH, LH, Prolactin, estradiol (amenorrhea)
33
Q

Indications for hospitalization?

A
  • Sever malnutrition (under 75% ideal body weight)
  • Physiologic instability (severe bradycardia < 50, hypotension, hypothermia, severe orthostatic changes)
  • Dehydration or electrolyte imbalance
  • Cardiac arrhythmias
  • Hematemesis
  • Suicidal or acute mental status changes
  • Others: intractable vomiting, hematemesis, esophageal tears
34
Q

T/F: People with eating disorders have a higher lifetime suicidality?

A

True

35
Q

General approach to treatment for eating disorder?

A
  • < 30% seek care related to weight or eating
  • Medical care provided by clinicians trained in eating disorders

- Interdisciplinary team is ideal (nutritional support, psychological component for individual and family, psychiatric evaluation as needed for diagnosis and medication)

  • Tried SSRis (prob to increase appetite) and anti-psychotics, but not great results
36
Q

Recommendations to PCP?

A
  • PCP visits weekly until care is established with specialists
  • Food supplements helpful when introduce as “prescribed medication”
  • Treatment- empathic and not punitive
37
Q

Natural history of eating disorder?

A

Recovery

  • 72% achieve partial or full recovery
  • 28% persistent illness
  • 22%-35% relapse

Long-term

  • Decrease in fertility
  • Alterations in cognitive and social functioning

High mortality rates

  • 5.9% AN
  • 1.9% BN
38
Q

What is Binge Eating Disorder?

A
  • Eating in a discrete period of time within any 2 hours period, an amount of food that is definitely larger than what most people would eat in a similar period under similar circumstances
  • Sense of lack of control over eating during the episode , a feeling that one cannot stop eating or control what or how much is eaten, and marked distress associated with the binge-eating episodes;

— The episodes occur on average at least once a week for at least 3 months, are not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa, and do not occur exclusively during the course of bulimia nervosa or anorexia nervosa

— Three or more of the following factors are also present:

+ Eating much more rapidly than normal

+ Eating until feeling uncomfortably full

+ Eating large amts of food when not feeling physically hungry

+ Eating alone b/c of feeling embarrassed by how much is being eaten

+ Feeling disgusted with oneself, depressed, or very guilty afterward

39
Q

What is the most common eating disorder?

A

Binge Eating disorder

40
Q

What is the prevalence of binge eating disorder?

A
  • 1 in 35 adults
  • 3.5% female
  • 2% male
41
Q

Up to __ of people with binge eating disorder are obese

A

Up to 2/3 of people with binge eating disorder are obese

42
Q

Treatment for Binge Eating Disorder?

A
  • Cognitive behavioral therapy (CBT)
  • Mindfulness training
  • One FDA approved drug in adults; Lisdexamfetamine dimesylate (Vyvanse)
43
Q

Summary:

  • Eating disorders affect many adolescents and adults (chronic illness with high morbidity and mortality rate)
  • Physicians should recognize the early signs
  • Multidisciplinary care with experienced providers improves outcomes
  • Urgent medical and/or psychiatric hospitalization may be needed
A

Merp

Term 5: Behavioral Science (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions