anorexia nervosa

Question 1

what is anorexia nervosa?

Answer 1

Anorexia nervosa is a serious mental health disorder characterized by self-imposed starvation and a relentless pursuit of extreme thinness.

Question 2

subtypes of AN?

Answer 2

Restrictive and bulimic

Question 3

what Is the restrictive subtype?

Answer 3

Characterized by minimal food intake and excessive exercise.

Question 4

what is the bulimic subtype?

Answer 4

Involves episodic binge eating followed by behaviors like laxative use or induced vomiting.

Question 5

how do you diagnose AN as per DSM-5

Answer 5

1. 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.
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. 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.

Question 6

how do you diagnose AN via ICD-11?

Answer 6

Question 7

who does it affect?

Answer 7

adolescents and young adults, with a higher prevalence among females

often co-occurs with other psychiatric disorders, such as depression and anxiety

age 13-17

Question 8

describe the pathophysiology

Answer 8

Question 9

what are the features in hx?

Answer 9

Question 10

what are features on examination?

Answer 10

Question 11

what additional features may be seen in the bulimic subtype?

Answer 11

Question 12

what ix are done?

Answer 12

Question 13

how do you manage in adults?

Answer 13

Question 14

how do you manage in kids?

Answer 14

Question 15

when is inpatient admission needed?

Answer 15

Indications for specialist inpatient programs may include severe or rapid weight loss, significant suicide risk, or inability to perform the SUSS test (sit-up, squat, and stand). Admission is also indicated if proximal muscle weakness suggests weak respiratory muscles.
If patients are very unwell the MARSIPAN checklist should be used to guide management.

Question 16

what are complications of anorexia?

Answer 16

Refeeding syndrome
Cardiac arrhythmias:
Osteoporosis‚ a long-term complication

Question 17

what is referring syndrome?

Answer 17

A potentially fatal disorder that occurs when nutritional intake is resumed too rapidly after a period of low caloric intake

Question 18

what are symptoms of refeeding syndrome?

Answer 18

symptoms may include oedema, confusion and tachycardia

Question 19

what causes refeeding syndrome?

Answer 19

Rapidly increasing insulin levels lead to shifts of potassium, magnesium and phosphate from extracellular to intracellular spaces‚ these need to be replenished

Question 20

how can referring syndrome be prevented?

Answer 20

The provision of high-dose vitamins (eg. Pabrinex) before feeding commences
Monitoring with daily bloods and replenishing electrolytes early
Building caloric intake gradually with the help of a dietitian‚ NICE recommends that refeeding is started at no more than 50% of calorie requirement in ‘patients who have eaten little or nothing for more than 5 days’

Question 21

what cardiac arrhythmias are seen in anorexia?

Answer 21

Bradycardia and prolonged QTc are often seen

Question 22

what are positive prognostic indicators?

Answer 22

The presence of normal social‚ emotional milestones‚ this is important to form bonds with therapists during CBT

Question 23

what are negative prognostic indicators?

Answer 23