Clinical Approach to Eating Disorders Flashcards
Which eating disorders are accompanied by suicidality?
Which has a greater risk?
Bulimia and Anorexia Nervosa
Bulimia has a 7x risk, while AN has a 5x greater risk.
What is the diagnostic criteria for AN?
Restriction of energy intake relative to
requirements, leading to a significantly low
body weight weight for age, sex and
development.
Intense fear of gaining weight or becoming
fat despite being underweight or persistent
behavior that interferes with weight gain.
Distorted perception of body weight and shape, undue influence of weight and shape on self-worth, or denial of the medical seriousness of one’s low body weight.
What are the 2 types of AN?
Restricting type: 3 mo. of no binging or purging (no self-induced vomiting or laxative use); excessive exercise, fasting, dieting.
Binge-eating/purging type: 3 mo. of the binging and purging behaviors; self-induced vomiting, laxative, diuretic, enema use.
*Patients may cross over between the two.
What is re-feeding syndrome?
What are complications?
A metabolic disturbance that occurs as a result of re-institution of nutrition to people who are starved, severely malnourished or metabolically stressed.
Clinical complications that occur as a result of fluid and electrolyte shifts during aggressive nutritional rehab of malnourished patients. They can be fatal!
- hypophosphatemia
- hypokalemia
- CHF
- peripheral edema
- rhabdomyolysis
- seizures
- hemolysis
How can re-feeding syndrome be avoided?
Judiciously limit the amount of calories and fluid provided in early stages of re-feeding.
Avoid rapid increases in the amount of daily calories ingested.
Closely monitor labs during the first few weeks of the re-feeding process.
What are 3 kinds of comorbid disorders with AN and BN?
Mood disorder: depression and dysthymic disorder.
- Anxiety disorders: OCD
- Impulse control disorders
Personality disorders: can be any of them.
Disordered personality traits: perfectionism, compulsivity, narcissism.
How many pounds per week should inpatients and outpatients with AN gain?
What is the calorie recommendation?
Inpatient: 2-3 lbs/wk
Outpatient: 0.5-1 lb/wk
Usual intake is 30-40 kcal/kg that is progressively increased to match body tolerance and weight goals.
What 2 areas of treatment are considered 1st-line for patients with AN?
Nutritional rehab + Psychotherapy
When should you consider meds for a patient with AN?
What meds should be avoided?
Cautioned?
Which drugs can be used?
Only in patients who have been resistant to other therapies and are willing to take meds.
Avoid Buprpion (seizures) and TCAs (cardiotoxicity).
Caution with antipsychotics and antidepressants (QT prolongation).
Olanzapine is shown to help weight gain.
Lorazepam may help reduce anxiety about confronting meals.
If anxiety/depression is severe, consider SSRIs. SGAs can be added if treatment is unresponsive to SSRIs.
What is the diagnostic criteria for BN?
Recurrent episodes of binge eating, defined as eating an unusually large amount of food in a discrete period of
time. Patients feel they cannot control their eating during
the episode.
Recurrent inappropriate compensatory behavior to
prevent weight gain.
Binge eating and inappropriate compensatory behaviors
occur at least two times per week for three
months.
What weights do people with BN generally have?
May fluctuate from underweight, normal, overweight, etc. This is a difference from AN.
What is the best course of therapy for BN?
Which one is considered “treatment of choice”?
Combination of nutritional rehab, CBT psychotherapy and pharmacotherapy.
CBT psychotherapy is treatment of choice.
First-line drug for BN:
Second-line drug for BN:
First-line: Fluoxetine 60mg qd
Second-line: other SSRI; Sertraline or Fluvoxamine
What is the diagnostic criteria for Binge Eating Disorder (BED)?
Episodes of binge eating, defined as consuming a large amount of food in a discrete period of
time (within 2 hour period of time).
Patients feel they lack control over eating during the episode.
Binge-eating episodes are marked by at least three of the following:
Eating large amounts of food when not hungry; eats rapidly; feels uncomfortably full after eating; Eating alone due to embarrassment over amount consumed; Feelings of guilt, depression, disgust after binging.
Episodes occur on average for once a
week for at least 3 months.
What is the first-line treatment for BED?
What drug is considered first-line?
What else has shown to be effective?
Psychotherapy: CBT or IPT.
Vyvanse
SSRIs are effective
