ADHD/ Eating Disorders Flashcards
ADHD: epidemiology
o 8.6% children ages 8-15
o More prevalent in males than females
o Symptoms usually present before age 3
ADHD: pathophysiology
Unknown exactly, but multifactorial
Genetic link = risk factors: • Paternal antisocial behavior • Maternal depression • Prenatal exposure to tobacco • Young maternal age at birth • Low birth weight • Premature birth
Biological:
• Reduced overall brain volume and gray matter volume
• Reduced cortical thickness in frontal, temporal, parietal, and occipital association cortices
• Higher volumes of white matter
• Associated NTs: epinephrine, DA, NE
Psychosocial: • Stressful event • Emotional deprivation • Disruptions to family • Exposure to video games and TV (>2 hours/day)
ADHD: clinical presentation
o Common symptoms: hyperactivity, emotional lability, short attention span, distractibility, failure to finish work, acting before thinking, poor organization
o 75% = symptoms of aggression and defiance
ADHD:prognosis
o Variable: predicted by family history, negative life events; comorbid conduct disorder, depression, anxiety
o Generally not remit before 12 years
o Remission usually from 12-20 year
o 15-20%: symptoms persist into adulthood
o Outcomes: lower academic achievement, behavioral problems, difficulty with peers, more likely to develop comorbid psychiatric disorders, higher risk for substance abuse
ADHD: pharmacological treatment
o Stimulants: methyphenidate, dextroamphetamine
• Screen for heart defects
o Non-stimulant: atomoxetine
• 1st line treatment
ADHD: psychosocial treatment
o Accommodations in school
• Ex: minimize distractions, help with organization
o Social functioning interventions
• Ex: social skills training
Anorexia nervosa: clinical presentation
Refusal to maintain minimal body weight, intensely afraid of gaining weight, has disturbance in perception of body size
• Unusual eating behaviors: extreme dieting, excessive interest in nutrition, cutting food into tiny pieces
• Obsessive interest in fitness
Sub-types:
• Restricting: weight loss primarily through dieting, fasting, and/or exercise
• Binge-eating/purging: engage in self-induced vomiting, misuse of laxatives, diuretics, enemas
Eating disorders: epidemiology
Prevalence: (in females)
• Anorexia nervosa: 1%
• Bulimia nervosa: 4%
• Rates in males =1/10 rates in females
o More common in industrialized nations; sports/roles involving control of body shape
o Less common in African-Americans
Onset:
• Anorexia nervosa: 14-18 years
• Bulimia nervosa: late adolescence or adulthood
o Comorbidities: depression (65%), social phobia (34%), OCD (26%)
Eating disorders: pathophysiology
Unclear
Biological
• Genetic role
• Diminished noradrenergic activity, increased serotonergic activity, HPA axis activation (increased CRF and cortisol), suppression of thyroid function
• Endogenous opioids (since opioid antagonists improve symptoms)
Psychosocial
• Societal pressures
• Personality: rigid and perfectionistic
• Close but troubled relationship with parents
Eating disorders: medical complications
Anorexia nervosa:
• Dehydration, hypothermia, bradycardia, hypotension, electrolyte imbalance
• Amenorrhea in females, low testosterone and hypogonadism in males
Bulimia nervosa:
• Hypocalcemia, hypokalemia, metabolic alkalosis, ECG changes, fatty degeneration of liver, malnutrition, parotid gland enlargement
• Frequent vomiting → calluses on dorsal hands, dental caries, esophageal tears
Anorexia nervosa: prognosis
- 10% mortality
- Poor outcomes = longer duration, older age of onset, prior psychiatric hospitalizations, poor pre-morbid adjustment, presence of co-morbid personality disorder
Describe the psychological and physical effects of semi-starvation.
Psychological
o Food-related behaviors and thoughts
o Decreased sex drive
o Depression
o Increased cigarette smoking, caffeine intake
o Problems with attention, learning new information
Physical
o Feeling cold, decreased energy
o Low pulses and BP
o Constipation
Eating disorders: Re-feeding syndrome
o Re-feeding → sudden shift from fat to CHO metabolism, sudden increase in insulin → increased cellular uptake of phosphate
o Fall in serum electrolytes: phosphate, K+, Mg2+, glucose, thiamine
o Risks: respiratory failure, cardiac failure, hypotension, irregular heartbeat, seizures, coma, sudden death
o Avoid: start with lower calorie intake; slowly increase (add supplemental electrolytes and vitamins if needed)
Eating disorders: behavioral therapy
Cognitive-behavioral therapy:
• Monitoring food intake, binging, and purging
• Identify associated emotions
• Challenge distorted beliefs
Interpersonal psychotherapy
• Effective for bulimia and binge eating
Maudsley method
• Treat anorexia in adolescents living at home
• Parents set reasonable, healthy expectations for anorexic child at each meal
Eating disorders: pharmacological treatment
o SSRI: fluoxetine = anorexia nervosa, bulimia nervosa
o Atypical antipsychotics = treat severely distorted beliefs about weight (verging on delusional)
o Opioid antagonist (naltrexone) and anti-emetics (ondansetron) = bulimia nervosa
Contraindicated:
• TCA’s in anorexia = risk of cardiac rhythm disturbances
• Bupropion in anorexia & bulimia = elevated seizure risk
