anorexia nervosa Flashcards
what is anorexia nervosa?
Anorexia nervosa is a serious mental health disorder characterized by self-imposed starvation and a relentless pursuit of extreme thinness.
subtypes of AN?
Restrictive and bulimic
what Is the restrictive subtype?
Characterized by minimal food intake and excessive exercise.
what is the bulimic subtype?
Involves episodic binge eating followed by behaviors like laxative use or induced vomiting.
how do you diagnose AN as per DSM-5
- 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.
- Intense fear of gaining weight or becoming fat, even though underweight.
- 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.
how do you diagnose AN via ICD-11?
who does it affect?
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
describe the pathophysiology
what are the features in hx?
what are features on examination?
what additional features may be seen in the bulimic subtype?
what ix are done?
how do you manage in adults?
how do you manage in kids?
when is inpatient admission needed?
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.
what are complications of anorexia?
Refeeding syndrome
Cardiac arrhythmias:
Osteoporosis‚ a long-term complication
what is referring syndrome?
A potentially fatal disorder that occurs when nutritional intake is resumed too rapidly after a period of low caloric intake
what are symptoms of refeeding syndrome?
symptoms may include oedema, confusion and tachycardia
what causes refeeding syndrome?
Rapidly increasing insulin levels lead to shifts of potassium, magnesium and phosphate from extracellular to intracellular spaces‚ these need to be replenished
how can referring syndrome be prevented?
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’
what cardiac arrhythmias are seen in anorexia?
Bradycardia and prolonged QTc are often seen
what are positive prognostic indicators?
The presence of normal social‚ emotional milestones‚ this is important to form bonds with therapists during CBT
what are negative prognostic indicators?
