Behav. Sci. Eating disorders Flashcards
obesity definition
more than 20% over ideal weight (BMI >30)
genetic component of obesity
leptin receptor mutation
melanocortin 4 receptor mutation
iatrogenic component of obesity
anti-psychotics and/or anti-depressants by blocking H1, Achm, 5HT2c receptors (anti-histamines turn off satiety center)
increase prolactin by D2 receptor blockade
what are the pharmacologic options for obesity?
amphetamines (decreases appetite, but gain weight when you go off)
orlistat (lipase inhibitor in gut - like putting someone on a low fat diet - but get diarrhea)
see updated PP for other 3 drugs*
Lorcaserin stimulates 2C not blocks*
what are the other options outside of medications to treat obesity?
surgical (bariatric and gastric banding)
realistic diet and exercise
anorexia nervosa diagnosis
- restriction of energy intake requirements leading to low body weight
- fear of gaining weight
- body image disturbance
what are the different subgroups of anorexia nervosa?
restricting = does not eat, does not purge
binge/purge type = does binge or purge
what is the severity of anorexia nervosa based on?
BMI
what is the personality profile of an anorexic?
rigid, controlling, high achieving
what is the most likely etiology of anorexia?
biopsychosocial approach
also: need control in life, lack sense of autonomy self, media/industry, family mood/drug disorders, neurepinephrine imbalance - low
comorbidity with anorexia
depression 50%, suicide increase, OCD, anxiety, rigid/perfectionist, delayed psychosexual development, denial, minimization, delusion
medical issues with anorexia
weight loss, hypothermia, edema, bradycardia hypotension, syncope, amenorrhea, electrolyte imbalance, lanugo hair, osteoporosis, delayed gastric emptying, metabolic acidosis, organ failure
common course for anorexia
- from spontaneous recover to gradual starvation and death
- recovery is only partial -> food preoccupation, poor social relations and depression continue
treatment course hospitalization
- restore nutritional state once 20% typical weight lost
- 2-6 months if 30%
- forced tube feedings, especially if severe, end organ damage, electrolyte or cardiac findings or patient unwilling to comply
- firm consistency
- behavioral plan
treatment for anorexia
-programming (AM weights, I/Os, labs, inaccessible bathrooms, progressives diets yield rewards, continue as day treatment then outpatient)
psychotherapy (psychodynamic, CBT, family)
medications for anorexia
???
- tricyclic antidepressents (+/-)
- SSRI
- ECT if depressed
- treat all comorbidities if detected (anxiety, depression, substance use)
what are the weight gain cocktails
mirtazapine and olanzapine
bulimia nervosa criteria
- recurrent binge eating
- eating an atypically large amount in discrete period of time disproportionate to typical eating
- purging vs non-purging types
- no anorexia present (otherwise called purge anorexia)
- loss of control
- compensatory behaviors (vomiting, laxatives, enemas, diuretics, exercise)
- binges 1X/wk for 3 months
how often do binges occur to be considered bulimia nervosa?
1X/wk for 3 months
which eating disorder has the greater prevalence?
bulimia more than anorexia
personality traits with bulimia
outgoing, angry, impulsive, borderline personality, less control, substance abuse
medical problems with bulimia
- poor dentition, enamel loss, cavities
- abraided knuckles (Russell’s sign)
- low PO4, low Mg
- high amylase
- salivary enlargement
- esophagitis/tears
who is bulimia common in?
college aged females who are normal/overweight and sexually active
course for bulimia
better than anorexia
50%+ improvement in most patients
waxing/waning course
3 year follow up, 30% doing well
treatment for bulimia
individual therapy (CBT vs dynamics, group therapy, family therapy)
- SSRI approved
- hospitalization rarely needed
medications for bulimia
antidepressants (SSRI)
-imipramine, desipramine (TCAs), trazodone, MAOi
binge eating disorder
binges, lack of control, ego dystonic, 1x/wk for 3 months, NO PURGES OR COMPENSATIONS
avoidant/restrictive food intake disorder
don’t meet full anorexia criteria
- failure to meet diet/energy needs
- weight loss, nutritional deficiency, supplementation needed, psychosocial distress
PICA
persistent eating of non-nutritive substance x1mo
- not developmentally or culturally appropriate
- not medical or from intellectual disability or autism
rumination
repeated regurgitation and re-chewing of food
- no weight gain
- not medical or from intellectual disability or autism
- before 6 years
