Anorexia Nervosa Flashcards
mortality rate
20% - highest morality of mental illness
name methods in which weight loss is self induced
excessive exercise, dieting, laxative abuse, diuretics, appetite
what effect does anorexia have on sexual development etc
- dec GnRH secretion from hypothalamus
- if onset is pre pubertal it can delay /arrest pubertal developments
- sexual dysfunction, amenorrhoea, infertility, loss of sexual interest
what must weight be to meet ICD 10 criteria
<85% normal or BI ≤17.5
is amenorrhoea in ICD 10 criteria
yes - 6 consectuive menstrual cycles absent unless on pill
female to male ratio
4: 1
what kind of traits are often present in people
perfectionist and obsessive traits
anxiety disorders are often seen pre-morbidly
how does an anorexic person think of food
preoccupation with thoughts of food, morbid fear of fatness
cognitive effects
fatigue, poor concentration, weakness, slow thinking
hair skin and nails
hair thinning
dry skin
cracked nails
what is the hair called that grows on anorexic person
lanugo hair
cardiac effects
bradycardia and prolonged QT
blood pressure
hypotension - hypovolaemia/bradycardia/low CO
body temperature
low - poor insulation
pt has cold intolerance
what is seen in the hands in cold weather
Raynauds
skin goes what colour
yellow tinge - hypercarotenemia
what happens to gastric emptying
slows down as food intake is insufficient, leads to non specific GI symptoms, eg bloating, cramping and nausea
what does repeated vomiting do to electrolytes
lose stomach acid - body fluids are more alkaline
low sodium, potassium, calcium etc
fluid balance
redued fluid intake, vomiting and laxative abuse leads to dehydration
glucose level
typically low
thyroid hormones
low T3 is common
what problems might a patient taking ADs encounter with anorexia
they are not as effective when low body weight is present
what effect does AN have on bones
later on in the course of the llness there is osteopenia and osteoporosis
decreased oestrogen leads to increasd OC activity and dec OB activity
there may be a dietary lack of Ca and vitamin D
should thyroid supplementation be given for low T3
no
what ECG changes does hypokalaemia show
flattened T waves and prominent U waves
stimulus for cardiac arrhythmias
what investigations should be done
bloods and serum chemistry
TFT
LFT
urinarlysis to assess hydration status
ECG
DEXA bone scan
what is the most effective therapy in teens
family based therapy
other psychotherapies
CBT
what is refeeding syndrome
- prolonged fasting depletes IC minerals and causes fat and protein to be used for energy instead of carbs
- BMR also decreases (20-25%)
when refeeding:
- glycaemia leads to insulin secretion and decreased glucagon secretion - stimulates fat protein and glycogen synthesis
- this all requires minerals of which there is a shortage of
- are taken up into cells and there is a deficiency of them
what is the hallmark biochemical feature of refeeding syndrome
hypophosphatemia
diet recovery
may restrict carbs at first and slowly increase
dietary phosphate
what may the patient develop during refeeding due to fluid shifts
oedema, monitor for refeeding syndrome
