eating and feeding disorders

Question 1

anorexia nervosa

Answer 1

an eating disorder in which a person (usually an adolescent female) maintains a starvation diet despite being significantly (15% or more) underweight.

anorexia has the highest mortality rate of any psych disorder

Question 2

types of anorexia and physical effects

Answer 2

types:
restriction: extremely low calorie diet, excessive exercise, purging (use of laxatives and induced vomiting to force food out)

binge/purge: binge eating, combined with restriction behavior

physical effects:
abnormally slow heart rate
low bone density
fatigue
dehydration (severe)
extremely low BMI
hair loss

Question 3

anorexia assessment

Answer 3

perception of the problem
eating habits
history of dieting or purging
methods used to achieve weight control
value attached to a specific shape and weight
interpersonal and social functioning

Vitals
ROS, appearance
screen for suicide or self harm behaviors
nutritional and fluid intake
daily activities
labs (review)

Question 4

anorexia interventions

Answer 4

Suicidal ideation first
Psychosocial interventions
Pharmacotherapy/medical intervention
Psychotherapy
Nutrition
Health teaching and health promotion
Safety and teamwork

Question 5

anorexia: treatments

Answer 5

Pharmacotherapy
Medications like antidepressants, antipsychotics, or mood stabilizers may help treat coexisting psychiatric illnesses such as anxiety or depression.

refeeding (MUST watch for refeeding syndrome)
Nasogastric feeding is preferred over other enteral or parenteral nutrition when oral feeding is not possible. Total parenteral nutrition is reserved for significant gastrointestinal dysfunction.
In most patients with anorexia nervosa, the aim of nutritional therapy is an average weight gain of 2 to 3 pounds (1 to 1.3 kg) per week for inpatient and 0.5 to 1 pound (0.2 to 0.5 kg) per week for outpatient management.
The initial calorie supplement should be 30 to 40 kilocalories/ kilogram per day. In the later stage, caloric intake can be advanced slowly to 70to 100 kcal/kg per day.
Electrolytes need to be carefully assessed, and refeeding should be gradual.

Question 6

refeeding syndrome

Answer 6

Refeeding syndrome is clinical and metabolic changes arising from aggressive nutritional rehabilitation of a malnourished patient. The most common complication is hypophosphatemia. Fluid overload common in refeeding syndrome.
The following factors help in preventing refeeding syndrome:
The initial protein intake=1.2 grams per kilogram of ideal body weight per day.
low-calorie intake of 30 kcal/kilogram/day during the first week
Phosphorus should be supplemented to maintain serum levels above 3.0 mg/dL.

Monitoring for Refeeding
Clinical Monitoring -
Continuous cardiorespiratory monitor
Focus on cardiac and neurologic
Strict intake and output
Calorie count
Daily weights
Biochemical Monitoring (At baseline and at least daily)
Measure phosphorus, magnesium, potassium, glucose, sodium, and renal function
Zinc and pre-albumin levels are also measured.

Treatment of refeeding syndrome
Rehydrate carefully and correct the electrolyte imbalance.
Administer thiamine before feeding at the dose of 100 to 300 mg per day oral or 50 to 100 mg/day intravenous.
Start feeding at lower calories of 10 kcal per kg/day and gradually increase over seven days.

Question 7

bulimia nervosa

Answer 7

an eating disorder in which a person alternates between binge eating (usually of high calorie foods) with purging (by vomiting or laxatives) and fasting.

Question 8

tx: buliumia nervosa

Answer 8

inpatient rarely considered unless person has comorbidity

CBT first line treatment (individual and groups), CBT focuses on breaking the binge-purge cycle

Fluoxetine (Prozac) can be helpful in breaking the cycle, this is the only FDA approved one

Question 9

bulimia nervosa assessment

Answer 9

Patient’s perception
Vital signs, systems review & appearance
Psychosocial history
Nutritional & fluid intake
Daily activities
Laboratory testing review

Question 10

Binge-eating disorder DSM 5 criteria

Answer 10

Recurrent episodes of binge eating
Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
Marked distress over binge eating
Occurs at least 1X/week for 3 months & is not associated with other disorders

Question 11

binge eating disorder assessment

Answer 11

Patient’s perception
Vital signs, systems review & appearance
Psychosocial history
Nutritional pattern
History of weight cycling
History of binge-eating triggers, foods, and frequency

Question 12

binge eating treatment: pharmacotherapy

Answer 12

SSRIs
Weight tends to return after treatment
SNRIs
Lisdexamfetamine
Lowered relapse risk

Question 13

binge eating treatment: advanced

Answer 13

Surgical Interventions
Bariatric surgery
Psychological Therapies
Cognitive-behavioral therapy
Dialectical behavior therapy
Interpersonal therapy

Question 14

other feeding disorders

Answer 14

rumination (like a cow)
pica (eating things that aren’t food–big prevalence in geri population, especially those that have dementia)