Anorexia Nervosa Flashcards
which sex is affected most commonly by anorexia nervosa? and what is the ratio?
Female, 10:1
When is the typical onset of anorexia nervosa?
Early to mid-adolescence
What are the risk factors for anorexia nervosa?
- personal characteristics - perfectionism, low self-esteem, obsessional traits, premorbid obesity, early menarche, anxiety
- premorbid experiences - sexual abuse, dieting behaviour, occupational or recreational pressure, onset of puberty, criticism (perceived also) about weight or eating behaviour
- age
- female sex
- living in western society
- family history of eating disorder, depression or substance misuse
What may be the presentation of anorexia nervosa?
- refusal to maintain normal body weight
- BMI < 17.5 (weight below 85% of predicted)
- dieting or restrictive eating practices
- rapid weight loss
- having a dread of gaining weight
- disturbance in the way weight or shape is experienced
- denial of problem
- lack of desire for intervention or resistance to it
- features that may be secondary to starvation - depressed mood, impaired concentration, social withdrawal
- enhanced weight loss - vomiting, laxatives, diuretics, vigorous exercising
- problems controlling chronic diseases that involve diet control e.g. diabetes, coeliac etc.
What symptom may be present in women with anorexia nervosa, not experienced by men? and why?
Amenorrhoea for 3 months or longer, due to hypothalamic-pituitary dysfunction
What other symptoms may occur in anorexia nervosa due to complications?
- GI sx - constipation, dysphasia, abdo pains, feeling fullness after a meal
- fatigue
- dizziness
- syncope
- intolerance to cold
- delay in secondary sex characteristics if pre-pubescent
What needs to be examined in anorexia nervosa?
- height, weight and BMI
- vital signs
- blood pressure (postural hypotension)
- test muscle power - sit up and squat tests
What may be found on examination?
- bradycardia
- hypotension
- oedema
- gaunt face
- lanugo hair
- scanty pubic hair
- acrocyanosis
What investigations are undertaken for anorexia nervosa?
•bloods:
- ESR - check for organic cause
- gonadotrophin - may find low FSH and LH
- Growth hormone - may be raised 2º to reduced intake of carbohydrates
- TFTs - T3 may be low 2º to low body weight
- FBC
- LFTs
- random blood glucose
- creatinine
- U+Es - may have electrolyte disturbance, particularly when there are compensatory behaviours e.g. vomiting, laxatives etc.
•urinalysis
ECG - may show bradycardia or prolonged QT
What is the management of anorexia nervosa for those aged under 18?
FIRST LINE -> Anorexia Nervosa-focused family therapy
CBT, adolescent-focused psychotherapy
What are the psychological management options for adults with anorexia nervosa?
- individual eating disorder focused CBT
- Maudsley Anorexia Nervosa Treatment for adults
- Specialist Supportive Clinical Management
How would you manage the physical complications of anorexia nervosa?
- monitor U&Es and regular ECGs
- correct abnormal electrolyte balance either orally or intravenously depending on severity
- advise regular dentist check ups if a person is vomiting regularly
- oestrogen Tx or bisphosphonates for reduced bone mineral density on DXA scan dependent on age and specialist advice
When may urgent admission be required for those with anorexia nervosa?
•electrolyte imbalance or hypoglycaemia • severe malnutrition • severe dehydration • evidence of incipient organ failure • bradycardia •prolonged QT •very low BMI • rapid weight loss inability or incapacity of parents or carers to provide the support needed •need for medical stabilisation and refeeding •significant suicide risk
What are complications of anorexia nervosa?
Hypokalaemia: common and may cause fatal arrhythmias.
Hypotension.
Other cardiac problems including arrhythmias, mitral valve prolapse, peripheral oedema, sudden death.
Anaemia and thrombocytopenia.
Hypoglycaemia.
Osteoporosis: restoring the patient’s weight is the best treatment. Bone loss may never recover completely even once weight is restored.
Constipation.
Lack of growth in teenagers, and lack of development of secondary sexual characteristics.
Infertility.
Infections.
Renal calculi
Acute kidney injury or chronic kidney disease.
Alcohol dependency in some patients.
Anxiety and mood disorders.
Social difficulties.
What percentage of patients with anorexia nervosa make a full recovery?
around 50%
