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

6/11- Eating Disorders 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)

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2
Q

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

A
  • 52% total
  • 37% girls
  • 67% boys
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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
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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
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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
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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

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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
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8
Q

Cultural risk factors for an eating disorder?

A
  • Thin ideal for beauty and happiness
  • Acculturation to Western value
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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
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10
Q

Sports risk factors for an eating disorder?

A
  • Weight loss for performance
  • “Under-fueling” due to schedule and excessive practices
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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
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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
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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…

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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
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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
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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
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17
Q

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

A

AN involves chronic low weight

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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
Physical findings: **Neurologic**?
Neurological - Cortical atrophy - Syncope - Cognitive impairment
26
Physical findings: **Psychiatric**?
Psychiatric - Anxiety - Obsessive-compulsive symptoms - Depression
27
Physical findings: **Fluid and electrolytes**?
Fluid and Electrolytes - Dehydration - Electrolyte abnormalities (decreased Ca, Na, PO4, K, Mg)
28
Physical findings: **Cardiovascular**?
Cardiovascular - Bradycardia - Hypotension (especially orthostasis) - Prolonged QTc
29
Physical findings: **Dermatological**?
Dermatological - Lanugo (fine hair) - Russell's sign (knuckles that may be impacted by teeth during vomiting)
30
Physical findings: **HEENT**?
HEENT - Enamel erosion - Parotid hypertrophy
31
DDx for eating disorder?
- 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
Laboratory evaluations to look at?
- 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
Indications for hospitalization?
- 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
T/F: People with eating disorders have a higher lifetime suicidality?
True
35
General approach to treatment for eating disorder?
- **\< 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
Recommendations to PCP?
- PCP visits weekly until care is established with specialists - Food supplements helpful when introduce as "prescribed medication" - Treatment- empathic and not punitive
37
Natural history of eating disorder?
**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
What is Binge Eating Disorder?
- 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 m**uch 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
What is the most common eating disorder?
Binge Eating disorder
40
What is the prevalence of binge eating disorder?
- 1 in 35 adults - 3.5% female - 2% male
41
Up to __ of people with binge eating disorder are obese
Up to **2/3** of people with binge eating disorder are obese
42
Treatment for Binge Eating Disorder?
- **Cognitive behavioral therapy (CBT)** - **Mindfulness** training - One FDA approved drug in adults; **Lisdexamfetamine dimesylate (Vyvanse)**
43
**_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
Merp

Term 5: Behavioral Science (24 decks)

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