Clinical Approach to Eating Disorders and Refeeding Syndrome Flashcards

1
Q

who is likely to develop an eating disorder?

A

women and adolescents

western societies

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2
Q

what ideology often accompanies eating disorders?

A

suicidality

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3
Q

DSM5 criteria for anorexia nervosa (AN)

A

restriction of energy intake relative to requirements, leading to low body weight for age, sex and development

intense fear of gaining weight or becoming fat despite being underweight

distorted perception of body weight and shape or denial of low body weight

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4
Q

screening questions for eating DOs

A
  1. are you satisfied with your eating patterns?
  2. do you ever eat in secret?
  3. does your weight affect the way you feel about yourself?
  4. have any family members suffered with an eating disorder?
  5. do you currently suffer with or have suffered in the past with an eating DO?
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5
Q

restricting type AN

A

3 months of no binging or purging (no vomiting or lax)

excessive exercising, fasting, dieting

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6
Q

binge-eating/purging type AN

A

3 months of binging and purging behaviors

self-induced vomiting
misuse of laxatives, diuretics, or enemas

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7
Q

AN cardiac complications

A
bradycardia
hypotension
QT dispersion
cardiac atrophy
mitral valve prolapse
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8
Q

AN gynecologic complications

A

amenorrhea

decreased libido

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9
Q

AN endocrine complications

A

osteoporosis
hypothermia
euthyroid
hypoglycemia

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10
Q

AN GI complications

A

gastroparesis

constipation

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11
Q

AN electrolyte complications

A

dehydration
hypokalemia
hypophosphatemia
hypomagnesia

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12
Q

AN pulmonary complications

A

respiratory muscle atrophy

dyspnea

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13
Q

AN hematologic complications

A

anemia
leukopenia
thrombocytopenia

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14
Q

AN neurologic complications

A

brain atrophy

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15
Q

AN derm complications

A
xerosis (dry skin)
lanugo (peach fuzz)
carotenoderma (orange skin)
acrocyanosis (blue ext)
seborrheic dermatitis
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16
Q

Refeeding syndrome

A

clinical complication that occurs as a result of fluid and electrolyte shifts during aggressive nutritional rehabilitation of malnourished patients

17
Q

complications of refeeding syndrome

A
hypophos
hypok
CHF
peripheral edema
rhabdomyolysis 
seizures
hemolysis
18
Q

how to avoid refeeding syndrome

A

limiting the amount of calories and fluid provided in early stages of refeeding

avoid rapid increases in the daily calories ingested

closely monitoring labs and the patient during the first few weeks of refeeding

19
Q

AN comorbidities

A

OCD
depression
impulse control DO
personality DO

20
Q

AN treatment

A

mental health clinician, registered dietitian and general medical clinician

nutritional rehab and psychotherapy

hospitalization to avoid refeeding syndrome, suicidality or starvation

hospitalization until normal weight achieved

meds may be used when depression/anxiety creating barriers to care

21
Q

AN nutritional rehab

A

supervised meals

2-3 lbs per week for inpatient

0.5-1 lb per week for outpatient

start at 30-40 Cals/kg and progressively increase

22
Q

AN psychotherapy

A

focus on helping patient confronting DO and change eating habits/thoughts of weight gain

cognitive behavioral therapy
specialist supportive clinical management
motivational interviewing
family therapy

23
Q

AN pharmacotherapy considerations

A

only for patients who have been resistant to other therapies

start at low doses

24
Q

AN meds

A

Olanzapine (anti-psych)
Lorazepam for anxiety
SSRI for anxiety or depression

25
DSM5 criteria for bulimia nervosa (BN)
recurrent episodes of binge eating - eating large amounts of food in a discrete period of time recurrent compensatory behavior to prevent weight gain (vomiting, lax) binge/purge occurs at least 2x/week for 3 months patients self-eval is influenced by body weight and shape disturbance does not occur exclusively during an episode of AN
26
BN considerations
patients vary between normal body weight, underweight or overweight may use same weight loss tactics as AN patients feel lack of control over binge eating but try to conceal it dysphoria after binging fearful of weight gain - may not want to become thin but just don't want to become fat
27
BN medical complications
similar to that of AN except: Mallory-weiss syndrome/esophageal rupture glandular hypertrophy abd pain, bloating and constipation tooth enamel erosion and caries Russel's sign - scar and callus on dorsum of hand
28
BN comorbidities
anxiety mood DO substance abuse personality DO
29
BN treatment
combination of nutritional rehab, CBT psychotherapy and pharmacotherapy
30
BN pharm considerations
less effective than CBT - best used in combo avoid bupropion
31
BN meds
fluoxetine | SSRIs
32
DSM5 criteria for Binge Eating Disorder (BED)
episodes of binge eating lack of control over eating ``` binge-eating marked by at least three of the following: eating large amounts when not hungry eating rapidly feels uncomfortably full after eating eating alone due to embarrassment feeling of guilt after eating ``` episodes occur at least 1x/week for 3 months
33
BED treatment
CBT and interpersonal therapy are most effective pharmacotherapy used in combo with psychotherapy
34
BED pharmacotherapy
Vyvanse SSRIs *anti-obesity drugs NOT recommended