Anorexia Nervosa Flashcards
What is anorexia nervosa?
It is an eating disorder characterised by weight loss, difficulties in maintaining an appropriate body weight for their height, age and stature: and, in many individuals, distorted body image
This can be achieved through a reduction of intake; however, it also relies on compulsive compensatory behaviours when food cannot be avoided
What are the two clinical definitions of anorexia nervosa?
BMI less than 17.5
15% reduction in ideal body weight
In children, BMI measurements are not used in anorexia nervosa. What other measurement is used?
Weight to height
What are the three types of purging compensatory behaviours?
Self-induced vomiting
Laxative abuse
Diuretic abuse
What can purging compensatory behaviours lead to?
Neuro-chemical disruption with specific damage to the brain (seizures) and heart (arrythmias)
What is a feature of laxative abuse on colonoscopy?
Pigment laden macrophages
What are the three types of non-purging compensatory behaviours?
Excessive exercise
Fasting
Strict diets
What is the pathophysiological cause of anorexia nervosa?
A lesion in the lateral nuclei
What are the nine risk factors of anorexia nervosa?
Young Adults
Female Gender
Family History
Pregnancy Complications
Puberty
Depression
Anxiety
Traumatic Life Events
Drug Administration
What two drugs are associated with anorexia nervosa?
Levodopa
Digoxin
What are the twelve clinical features of anorexia nervosa?
Fatigue
Cold Peripheries
Delayed Puberty
Amenorrhoea
Alopecia
Lanugo Hair
Osteopenia
Infections
Syncope
Bradycardia
Hypotension
Enlarged Salivary Glands
What is lanugo hair?
It is defined as fine unpigmented hair
What screening questionnaire can be used to diagnose eating disorders?
SCOFF Questionnaire
What are the five questions included in the SCOFF questionnaire?
Do You Make Yourself Sick Because You Feel Uncomfortably Full?
Do You Worry You Have Lost Control Over How Much You Eat?
Have You Recently Lost More Than One Stone In A Three Month Period?
Do You Believe Yourself To Be Fat When Others Say You Are Too Thin?
Would You Say That Food Dominates Your Life?
What SCOFF questionnaire result would indicate an eating disorder?
2 positive answers
What is the screening questionnaire used to detect malnutrition?
MUST score
What two investigations can be used to diagnose anorexia nervosa?
Blood Tests
ECG Scan
What seven blood test results indicate anorexia nervosa?
Decreased Potassium Levels
Increased Cholesterol Levels
Increased Carotene Levels
Decreased T3 Levels
Decreased LH & FSH Levels
Decreased Oestrogen & Testosterone Levels
Decreased Glucose Levels
What are the two features of anorexia nervosa on ECG scan?
Bradycardia
Hypokalaemia Features
What are the five features of hypokalaemia on ECG scans?
Increased P wave amplitude
Prolonged PR interval
ST depression
T wave flattening/inversion
Prominent U waves
What are the three diagnostric criteria of anorexia nervosa?
A restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health
An intense fear of gaining weight or becoming fat, even though underweight
A disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
What are the five psychological management options for anorexia nervosa?
Psychoeducation
Cognitive Behaviour Therapy (CBT)
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
Specialist Supportive Clinical Management (SSCM)
Focused Family Therapy (FT)
What is psychoeducation?
It involves providing patients with information about their eating disorder and ways in which they can control and minimise it
What is CBT?
It is a talking therapy used to manage the way in which patients think, feel and behave
What does eating disorder focussed CBT programmes involve?
They encourage healthy eating and reaching a healthy body weight through the creation of a personalised treatment plan based on the processes that appear to be maintaining the eating problem
What is MANTRA?
It is a focussed therapy technique that has been developed for the treatment of anorexia nervosa
It aims to address the factors which maintain anorexia nervosa and gradually helping them to find alternative and more adaptive ways of coping
What is SSCM?
It utilises clinical management skills and supportive therapy techniques to guide people towards meeting their own treatment goals
When is FFT used to manage anorexia nervosa?
It is the first line management option in children and young people
What is the second line manageemnt option of anorexia nervosa in children and young people?
CBT
How do we manage eating disorders in primary care?
Once an eating disorder has been identified, referral to a community based eating disorder service for further assessment should be conducted
