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NMSP Exam 3 > Clinical Approach to Eating Disorders and Refeeding Syndromes > Flashcards

Clinical Approach to Eating Disorders and Refeeding Syndromes Flashcards

1
Q

What are some societal and cultural influences on eating disorders?

A
  • Many aspects of the united states culture display on obsession with weight loss
  • Women’s magazines often include stories about weight management, dieting, or how to tighten specific muscle groups
  • Models and actors often display a level of thinness that is difficult to attain
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2
Q

What are bulimia and anorexia nervosa usually accompanied with?

A
  • Suicidality
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3
Q

What are the specifics of suicide in eating disorders?

A
  • Specific, high lethality, suicide plan or intent is an indication for hospitalization
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4
Q

What is Anorexia Nervosa?

A
  • Restriction of energy intake relative to requirements, leading to a significantly low body weight for age, sex and development
  • Have an 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
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5
Q

What is the screening for eating disorders?

A
  • Are you satisfied with your eating patterns? (No is abnormal)
  • Do you ever eat in secret? (Yes is abnormal)
  • Does your weight affect the way you feel about yourself? (Yes is abnormal)
  • Have any members of your family ever suffered with an eating disorder? (Yes is abnormal)
  • Do you currently suffer with or have you ever suffered in the past with an eating disorder? (Yes is abnormal)
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6
Q

What are the different types of Anorexia Nervosa?

A
  • Restricting Type: 3 months of no binging or purging (no self-induced vomiting or use of laxatives) –> Excessive exercising, fasting, dieting
  • Binge eating/Purging type: 3 months of the binging and purging behaviors –> self-induced vomiting and misuse of laxatives, diuretics, enemas
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7
Q

What are some considerations with Anorexia Nervosa?

A
  • Patients are often underweight and those with normal body weight will trend down if untreated
  • Weight loss if often viewed as a form of control. Self esteem may largely revolve around weight and body image. Excessive viewing in the mirror, weighing of self or body parts are common behaviors
  • Patients may still deny starvations symptoms despite acknowledgement of emaciated appearance
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8
Q

What are common weight loss strategies in Anorexia Nervosa?

A
  • Excessive exercise
  • Fasting
  • Binging and purging
  • Laxatives
  • Diuretics
  • Enemas
  • Dietary restriction
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9
Q

How may patients deny, conceal, or express their disorder?

A
  • Through related somatic or mood symptoms

- Family, friends, coworkers, employers, or teachers may not be aware of a problem until symptoms become severe

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10
Q

What happened in Madrid in 2006?

A
  • Ordered that every model must have BMI of 18
  • Models who were 5ft 9in must weigh a minimum of 123 lbs
  • Restrictions were placed after a death of a Brazilian model who had a BMI of 13.4
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11
Q

What did the survey say that was conducted by Model Alliance in 2012?

A
  • 64.1% of models said they have been asked by their agencies to lose weight
  • 31.2% admitted to suffering from an eating disorder
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12
Q

What are some cardiac complications seen in AN?

A
  • Bradycardia
  • Hypotension
  • QT dispersion
  • Cardiac atrophy
  • Mitral valve prolapse
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13
Q

What are some gynecologic complications seen in AN?

A
  • Amenorrhea

- Decreased libido

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14
Q

What are some endocrine complications seen in AN?

A
  • Osteoporosis
  • Hypothermia
  • Euthyroid
  • Hypoglycemia
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15
Q

What are some GI complications seen in AN?

A
  • Gastroparesis

- Constipation

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16
Q

What are some electrolyte complications seen in AN?

A
  • Dehydration
  • Hypokalemia
  • Hypophosphatemia
  • Hypomagnesemia
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17
Q

What are some pulmonary complications seen in AN?

A
  • Respiratory muscle atrophy

- Dyspnea

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18
Q

What are some hematologic complications seen in AN?

A
  • Anemia
  • Leukopenia
  • Thrombocytopenia
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19
Q

What are some neurologic complications seen in AN?

A
  • Brain atrophy
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20
Q

What are some dermatologic complications seen in AN?

A
  • Xerosis
  • 1anugo
  • Carotenoderma
  • Acrocyanosis
  • Seborrehic dermatitis
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21
Q

What is a note for treating refeeding syndrome?

A
  • Do not rehydrate or feed patients beyond their current capacity.
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22
Q

What is refeeding syndrome?

A
  • Clinical complications that occur as a result of fluid and electrolyte shifts during aggressive nutritional rehabilitation of malnourished patients
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23
Q

What are some complications of refeeding syndrome?

A
  • Hypophosphatemia
  • Hypokalemia
  • Congestive heart failure
  • Peripheral edema
  • Rhabdomyolysis
  • Seizures
  • Hemolysis
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24
Q

How do you avoid refeeding syndrome?

A
  • Judiciously limiting the amount of calories and fluid provided in the early stages of refeeding
  • Avoiding very rapid increases in the amount of daily calories ingested
  • Closely monitoring the patient during the first few weeks of the refeeding process
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25
Q

What are some mood disorders seen with AN?

A
  • Depression and dysthymic disorders

- Anxiety disorders: OCD and impulse control disorders

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26
Q

What are some personality disorders seen with AN?

A
  • OCD
  • Avoidant
  • Dependent
  • Narcissistic
  • Paranoid
  • Borderline
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27
Q

What are some disordered personality personality traits seen with AN?

A
  • Perfectionism
  • Compulsivity
  • Narcissism
28
Q

What is the treatment for AN?

A
  • Requires interdisciplinary team
  • Nutritional rehabilitation and psychotherapy are needed at minimum for first line care
  • Always monitor patients for medical complications
29
Q

Why is hospitalization needed in AN?

A
  • Complications of starvation
  • Resistance to refeeding
  • Suicidality
  • Severe psychosocial barriers to care
  • Should last until normal weight is achieved to reduce relapse and re-hospitalization
30
Q

What is the nutritional rehabilitation of AN?

A
  • First line therapy supervised by a registered dietitian with a focus on proper weight gain practices
  • May include supervised meals
  • 2-3 lbs gained per week for inpatients
  • 1-2 lbs gained per week for outpatients
31
Q

What is the usual initial intake for AN patients?

A
  • 30-40 kcal/kg and is progressively increased to match body tolerance and weight gain goals
32
Q

What is the ultimate goal in the nutritional rehabilitation for AN?

A
  • Bring patient back to normal body weight and teach patient proper eating habits for long term self-care
33
Q

What is first line therapy in psychotherapy for AN?

A
  • Focus on helping patients confront their disorder and change their eating habits and/or thoughts about weight gain
34
Q

How is the choice made for the psychotherapy in AN?

A
  • Based on patient preference

- Could include CBT, specialist supportive clinical management, motivational interviewing, or Family therapy

35
Q

What are some pharmacotherapy considerations for treating AN?

A
  • Consider only for patients who have been resistant to other therapies and are willing to take medications
  • Start low and increase as needed due to increased risk of side effects
  • Avoid bupropion (increased seizure risk) and tricyclic antidepressants (cardiotoxicity)
  • Be careful with antipsychotics and antidepressants with risk of QT prolongation
36
Q

What medication can be given that has shown to help with weight gain?

A
  • Olanzapine (adjunctive medication)
37
Q

What medication can be given that has shown to help confront meals?

A
  • Lorazepam to help reduce anxiety
38
Q

What meds should be considered if anxiety or depression becomes severe enough to create barriers?

A
  • SSRI
39
Q

What is Bulimia Nervosa?

A
  • Recurrent episodes of binge eating defined as eating an unusually large amount of food in a discrete period of time
  • Patients cannot control their eating during the episode
40
Q

What is considered binge eating in bulimia nervosa?

A
  • Occurs at least two times per week for three months
41
Q

What are some considerations in bulimia?

A
  • Patients can vary between normal body weight, slightly underweight, overweight, or obese. Compare this to patients with AN who are mostly underweight
  • Patients can use the same weight loss tactics as those with AN
  • DSM does not divide into different categories
42
Q

Do bulimia patients want to become thin?

A
  • No, just don’t want to be fat

- Purging behaviors are used to counteract the weight gain from binge-eating

43
Q

What are the electrolyte complications seen in bulimia?

A
  • Dehydration
  • Hypokalemia
  • Hypochloremia
  • Metabolic alkalosis
44
Q

What are some cardiac complications seen in bulimia?

A
  • Hypotension
  • Orthostasis
  • Sinus tachycardia
  • ECG changes
  • Arrhythmias
45
Q

What are some GI complications seen in bulimia?

A
  • Mallory-Weiss syndrome
  • Esophageal rupture
  • Parotid and submandibular gland hypertrophy
  • Abdominal pain and bloating
  • Constipation
46
Q

What are some dental and skin complications seen in bulimia?

A
  • Tooth enamel erosions and dental caries
  • Scar and callus on dorsum of hand (Russell’s Sign)
  • Xerosis
47
Q

What are some comorbidities?

A
  • Anxiety, mood, and substance use disorders
  • Personality disorders: OCD, avoidant, dependent, histrionic, paranoid, and borderline
  • Disordered personality traits: impulsivity, perfectionism, compulsivity, and narcissism
48
Q

What is the treatment for bulimia?

A
  • Combination of nutritional rehabilitation, CBT psychotherapy, and pharmacotherapy
  • Pharmacotherapy or psychotherapy alone is appropriate treatment if other options are not available
49
Q

What is nutritional rehabilitation is used for in bulimia patients?

A
  • Helps counsel patients about proper eating habits, and to help control binging and purging
50
Q

What is the treatment of choice for BN?

A
  • CBT psychotherapy
51
Q

How does CBT psychotherapy help BN?

A
  • Shown to help reduce binging and purging. Not indicated for reducing weight
  • Improves self-esteem
  • Decrease emphasis upon thinness
  • Eliminate dietary restraint
  • Create pattern of regular eating
  • Eliminate binge and purge habits
52
Q

What improves the effectiveness of CBT psychotherapy?

A
  • When combined with pharmacotherapy
53
Q

What medications should be avoided in BN?

A
  • Bupropion due to increased seizure risk with binging and purging
54
Q

What is needed to be done when giving medications to BN patients?

A
  • Counsel on side effects. Especially given to increased suicidality and weight change for this patient population
55
Q

What is the first line pharmacotherapy for BN patients?

A
  • Fluoxetine 60mg per day (either start with full dose or titer up, increases 20mg after starting at 20mg each week
56
Q

What is the second line pharmacotherapy for BN patients?

A
  • Other SSRIs at doses higher than starting dose used to treat major depression. Recommended is Sertraline or fluvoxamine
57
Q

What is the third line pharmacotherapy for BN patients?

A
  • Tricyclics, topiramate, trazodone, and MAOIs
58
Q

What is binge eating disorder?

A
  • Episodes of binge eating, defined as consuming a large amount of food in a discrete period of time (within a 2 hour window)
59
Q

What do people with binge eating disorder feel like?

A
  • Feel they lack control over eating during the episode
60
Q

What are the binge-eating episodes marked by in binge eating disorder?

A
  • 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
61
Q

How is binge eating disorder different from bulimia?

A
  • There is no regular use of inappropriate compensatory behaviors (purging, fasting, or excessive exercise) as are seen in bulimia nervosa
62
Q

What is the purpose of treatment for BED?

A
  • Focus on help reduce the patient’s:
    1. Binge eating
    2. Excess weight gain
    3. Psychiatric comorbidities
    4. Excessive body image concerns
63
Q

What is the first line therapy for BED?

A
  • Psychotherapy like CBT and interpersonal therapy
64
Q

What medications are usually given for BED?

A
  • Vyvanse for moderate to severe BED
65
Q

What SSRIs are given to help with BED?

A
  • CItalopram, Escitalopram, fluoxetine, fluvoxamine, and sertraline
  • Usually chosen over topiramate or zonisamide
66
Q

What kinds of medications are not given to patients with BED?

A
  • Anti-obesity drugs

- They have poor efficacy and serious adverse effects

NMSP Exam 3 (18 decks)

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