Behavioral Science - eating disorders Flashcards
T/F obesity is a diagnosable condition marked by being more than 20% over ideal weight with BMI > 30
True
What two receptor mutations are associated with obesity?
Leptin receptor mutation
Melanocortin 4 receptor mutation
Blocking which histamine receptor can cause weight gain?
Blocking histamine 1 receptor - makes you tired and groggy but also turns off satiety center (fat because you don’t feel full and keep eating)
Blockade of muscarinic receptors (Achm) results in weight gain or weight loss?
Weight gain
Blockade of 5HT2c receptors cause weight gain or weight loss?
Blockade or serotonin 2c receptor raises NE and DA in cortex (good for depression) but also removes inhibitory control on fat cell growth causing weight gain
Increased prolactin levels correspond to weight gain - blockade of which receptors can indirectly trigger this?
D2 receptor blockade
What are the two types of drugs that contribute the most to “iatrogenic” obesity?
Anti-psychotics and anti-depressants
What are 3 lifestyle factors that contribute to obesity?
sedentary lifestyle
dependence on automobiles
Large portion sizes with high fat/carb content
When would you consider bariatric surgery or gastric banding for treatment of obesity?
When lifestyle modification therapy (e.g. attempts to lose weight with diet, exercise) fails
Why are amphetamines an effective weight loss medications?
decrease appetite
T/F research data has shown that exercise rather than diet is the better target for obesity treatments
False - exercise alone isn’t enough to curb obesity - diet has the largest impact on weight gain/loss
Pharmacological treatments can be very effective for weight loss. Why are they not considered a long term solution?
Rebound appetite increase after medication is stopped. Long term solutions are lifestyle and behavioral modifications (portion control etc.)
What is orlistat?
What are major side effects?
weight loss medication that inhibits gastric lipase so fats don’t get absorbed/metabolized
profuse diarrhea and fecal accidents
What are topiramate and zonisamide?
anti-convulsant medications used for weight loss
How do the anti-convulsant medications (topiramate and zonisamide) facilitate weight loss?
lower gluconeogenisis and improve carb metabolism (results in less conversion to fat)
What is phentermine?
psychostimulant that is used primarily to cause appetite suppression and weight loss
topiramate/phentermine are used in conjunction for weight loss medications due to which properties?
improved carb metabolism and appetite suppression
Why is naltrexone effective for weight loss?
opiate receptor blocker prevents reward sensation from after eating (interrupts positive re-enforcement)
Why is bupropion effective for weight loss?
appetite suppressant
What is lorcaserin?
5HT2c receptor agonist - used as weight loss medication because it increases metabolism (by inhibiting adipocyte growth)
What are the 3 required diagnostic criteria for DSM-5 diagnosis of anorexia nervosa?
1) Persistent restriction of energy intake leading to low body weight
2) Intense fear of gaining weight or of becoming fat
3) Body image disturbance (dysmorphism)
T/F Missed menstrual cycles (x3) and refusal to maintain 85% typical weight can substitute for other diagnostic criteria for anorexia nervosa.
False - these criteria were from DSM4; no longer in DSM 5
What are the two subtypes of anorexia nervosa?
Restricting type = does not eat, does not purge
Binge/Purge Type=does binge or purge
How is anorexia nervosa scaled for severity?
Severity based upon BMI and classified as mild, moderate, severe, or extreme
What constitutes mild, moderate, severe, extreme anorexia nervosa?
Severity based upon BMI (so depends on weight and height)
Mild >17 kg/m2
Mod 16-16.99
Severe 15-15.99
Extreme
What age range is the typical start of anorexia nervosa?
Starts mid-teens to 20s
T/F Individual socioeconomic status is an associated risk factor for development of anorexia nervosa
False - Individual Socioeconomics are not related
T/F prevalence of anorexia nervosa is 10x females>males
False - 20x females>males
Though increasing in males possibly due to increased adonis complex prevalence – body dysmorphia in men (body builder vs barbie complex)
What is the personality profile of a patient with anorexia?
more rigid and controlling, perfectionistic, and high achieving
(may encounter this description in vignettes - if there is a rigid of personality type described, associated with weight loss suggestive of eating disorder and choices include bulimia or anorexia - answer is anorexia)
T/F addition rates are higher in patients with anorexia
False - lower!
T/F depression/suicide/anorexia/OCD are more common in patients with anorexia
true
T/F patients with anorexia exhibit delayed pschyosexual development
true
T/F patients with anorexia often exhibit these associated medical issues:
Poor dentition, enamel loss, cavities Abraided knuckles (Russell’s Sign) Normal/overweight Sexually active Salivary enlargement Esophagitis/tears/chronic esophageal reflux Lab changes: (low PO4, low Mg, high amylase)
False - those are for bulimia!
Common medical issues in anorexia include:
Weight loss Hypothermia Edema Bradycardia, hypotension, syncope Amenorrhea Electrolyte imbalance, low K+ ST, T, QT cardiac changes Lanugo hair Osteoporosis Delayed gastric emptying Metabolic acidosis Organ failure
Pt presents with anorexia what are some associated medical concerns?
amenorrhea, osteoporosis, hair loss, muscle loss/weakness, dehydration, abnormal heart rate, bradycardia, edema, hypotension, syncope, soft downy hair growth all over body including the face (lanugo hair), depression, hypothermia, delayed gastric emptying, metabolic acidosis, organ failure
Pt presents with:
constipation, depression, electrolyte imbalance (low PO4, low Mg, high amylase), facial/neck swelling, dehydration, GERD, tooth decay, peptic ulcers/Esophagitis/tears
, abraided knuckles (Russell’s Sign), and is sexually active with normal or increased body weight.
What do they have?
Bulimia
Pt presents with:
Weight loss Hypothermia Edema Bradycardia, hypotension, syncope Amenorrhea Electrolyte imbalance, low K+ ST, T, QT cardiac changes Lanugo hair Osteoporosis Delayed gastric emptying Metabolic acidosis Organ failure
What diagnostic criteria must they meet to be diagnosed according to DSM-5?
Dx Anorexia nervosa must have:
1) Persistent restriction of energy intake leading to low body weight
2) Intense fear of gaining weight or of becoming fat
3) Body image disturbance (dysmorphism)
T/F if 20% of typical weight is lost, anorexic patients should be hospitalized to restore nutritional state
true
T/F 2-6 month hospitalization is sometimes indicated if 30% or more typical weight is lost
true
T/F forced tube feeding is appropriate if severe anorexia with end organ damage, electrolyte or cardiac findings or if patient unwilling to comply
true - if severe enough can be committed because not competent decision maker/delusional
Does psychotherapy help for treatment of anorexia?
Yes - there is controlled clinical data supporting efficacy
Which FDA drugs are approved to treat anorexia?
none approved - non-compliance due to fear of weight gain is a major barrier to drug treatment
What are the DSM 5 criteria for diagnosis of bulimia nervosa?
Recurrent binge eating (eating an atypically large amount in discrete period of time disproportionate to typical eating)
No anorexia present
Loss of self control over eating behavior
Must exhibit compensatory behaviors for Dx (vomiting, laxative use, enemas, diuretics, exercise)
must have binges 1x/wk for 3 months
According to DSM 5 how frequent must binging behavior be to qualify for Dx of bulimia nervosa? Persistent for how long?
must have binges 1x/wk for 3 months
vomiting, laxative use, enemas, diuretics, exercise are common among patients with bulimia nervosa. What are these symptoms called?
compensatory behaviors - required for DSM5 Dx!
According to DSM 5, can a Dx for bulimia be made if there is no purging?
Yes 2 subtypes
Purging VS non-purging
if no purging must have other compensatory behaviors
What is the “personality type” for bulimia?
erratic, emotional, chaotic personality - Outgoing, angry, impulsive traits, borderline personality, less rigid and more conflicted
in contrast to anorexic with rigid, perfectionist, obsessive compulsive, high achieving
T/F bulimia is 10x female>male
true
T/F bulimia is most common in high school aged females
false - college aged females
later onset than anorexia (40% of all cases in college aged women)
T/F normal to overweight is common presentation of patients with bulimia
true
What is Russell’s sign?
abraided knuckles - from contact with teeth during purging
What are the expected lab findings for bulimia?
Low PO4, Low Mg, high amylase
What are the approved drugs for treatment of bulimia?
SSRI’s - regulation of serotonin is beneficial for treatment
T/F psychotherapy has demonstrated efficacy for treatment of bulimia in controlled clinical trials
true
What is avoidant/restrictive food intake disorder?
Failure to meet diet/energy needs
Weight loss, nutritional deficiency, supplementation needed, psychosocial distress
Doesn’t meet full anorexia criteria
What criteria for anorexia is lacking in avoidant/restrictive food intake disorder?
no evidence of a disturbance in the way one’s body weight or shape is experienced
What criteria define binge eating disorder?
Binges
Lack of control
Ego Dystonic (self perception unduly influenced by body weight/shape)
1X/wk for 3 months
What criteria of bulimia is absent in binge eating disorder?
No purging or compensations (required for bulimia Dx)
What is Pica?
persistent eating of non-nutritive substance x 1mos
Not developmentally or culturally appropriate
Not medical or from intellectual disability or autism
What time period of persistent symptoms is required for Dx of Pica
1 month
What is Rumination Disorder?
repeated regurgitation and re-chewing of food
no weight gain
Not medical or from intellectual disability or autism
When does rumination disorder commonly present?
Before age 6
What time period of persistent symptoms is required for Dx of Rumination Disorder
1 month
What differentiates over-eating from bing eating disorder?
significant subjective distress regarding the eating behavior
