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PSYCH > Eating and Feeding disorders > Flashcards

Eating and Feeding disorders Flashcards

1
Q

Progression of eating and feeding disorders

A
  • normal eating
  • rf (low SE, diet, parental, media ideal bodies)
  • partial-sx ED (binge and diet)
  • full-syndrome ED
  • treatment
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2
Q

Criteria for ED

A
  • consistently below or above caloric needs to maintain wt
  • accompany by anx and guilt (varies with dx)
  • occur w/o hunger or fails to satiate
  • physio imbalance or medical comps
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3
Q

Mortality of ED

A

26% suicide attempt
- 2nd highest mort rate of AMI besides opioid dx

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4
Q

Factors that influence ED

A

genetics, puberty onset, female, vuln personality, uncontrolled diet, major life chx and stressors, fam fxn style, societal focus on thinness, perfectionism, impulsivity, hx obesity

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5
Q

psych fx that infleunce ED

A

dec self-esteem, inadequatecy, lack of control, anx/dep, loneliness, trauma

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6
Q

interpersonal fx that influence ED

A

relx prob, emo expression, hx teased for size/wt, hx abuse

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7
Q

social fx that infl

A

culture glorify thinness, narrow beauty definition, external value on bod

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8
Q

biological fx that influence ED

A

hor fxn, genetics
- altered 5-HT (alter mood, appetite, impulse control)

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9
Q

Enviro fx that influence ED

A

child trauma and sex abuse, culture
- hx abuse = poorer outcomes

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10
Q

ED common comorbidities

A
  • anorexia and anx
  • binge and alc/sub use
  • bulimia and dep, sub use, personality dx
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11
Q

Are ppl with ED hard to tx

A
  • rarely get help
  • leave tx early
  • unmotivated
  • some recover spon but some lifetime probs
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12
Q

Anorexia nervosa

A
  • char: intense fear of wt gain, severely distorted body image, restrict cal r/t requirements with sig low BMI during last 3M
  • low body wt relative to age, sex, phys health, dev trajectory
  • diff in taste and satiety that may make not want to eat
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13
Q

types of anorexia

A
  • Restricting type - no binge/purge; diet, fast, and/or excess exercise in last 3M
  • Binge eat and purge type - self-vom or lax, diuretic, enema with periods of cal restriction in last 3M
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14
Q

s/s anorexia

A
  • BMI (15% or more below expected for age, ht, activity level)
  • amenorrhea (post-puberty)
  • peripheral edema
  • lanugo
  • mottled cool skin or extremities
  • fatigue, weak
  • constipation, low BP, pulse, temp
  • dec bone density
  • abnormal labs
  • dec renal
  • anemia pancytopenia
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15
Q

When will someone with AN have altered electros?

A

If they purge

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16
Q

Epidemiology of AN

A

fem, adol and young adults, athletes, queer
- comorb with BPAD, anx, OCD, dep, PTSD, trauma, AUD/SUD

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17
Q

etiology of Anorexia

A
  • genetic corr with MDD, anx, OCD, schiz
  • glucose and lipid metab?
  • Tryptophan and 5-HT synth
  • internalized thin bod and deficit in bx control in response to distress
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18
Q

Psych and cog eti fx r/t anorexia

A
  • struggle with emo ID, reg, process
  • exhibit low distress tolerance and deficit in bx control in response to distress
  • ego-syntonic dx
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19
Q

ego-syntonix dx

A

know actions are harmful but benefits outweight risks

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20
Q

rf for anorexia

A

fem, fam, obese, diet, overexac, low self-esteem, body dissat, lack assertion, other ED, hx abuse, comorbid, distorted body image, media, fashion, athletics

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21
Q

Warnings of ED

A
  • dramatic wt loss
  • preocc with food and cals
    refused to eat some foods or whole categories
  • comments about feeing fat or overwt or anx about wt gain
  • denial of hunger
  • food rituals
  • excuses for meals
  • excess exercise
  • w/d from fam, friends
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22
Q

Clinical course of anorexia

A
  • chronic relapse and sig wt loss, 50% 1 year relapse
  • continue to be preocc with food
  • 10-25% get bulimia
  • 1/5 die with suicide
  • poor outcome r/t min wt, presence of purge, early onset
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23
Q

Comps of anorexia

A
  • lose fat and muscle
  • osteoporosis
  • metabolic hypo thy, hypoG, electro abnorm
  • cardiac brady, hypoT, lose cardiac muscle, small heart, chest pain, sudden death, arrhythmia
  • GI bloat, dec emptying, gas and diarr, GERD, hemorrhoids
  • reprod infert and dec libido
  • dry and brittle skin, lanugo, edema, dec wound healing, acrocyanosis, yellow skin
  • ab taste sens, apathetic dep, mild mental sx, sleep disturb, fatigue
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24
Q

What might cause dec taste sensation?

A

dec zinc

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25
Q

Lab findings for anorexia

A

leuko, anemia, thrombocytopenia, hyperchol, hypercarotenemia

26
Q

Hospitalization criteria for anorexia

A
  • extreme electro imbalance or wt under 75% of ideal body wt
  • under 10% body fat
  • HR under 50 BPM
  • systolic BC under 90
  • temp under 96
  • arrhythmias
27
Q

Tx for anorexia once medically stable

A
  • nut rehab, health tech and promotion
  • resolve body image and conflict, inc coping, often hospital, intensive therapy, partial outpt
  • wt restoration program to 90% ideal BW
  • precise mealtime with obs and schedule
  • observe when go br and see visitors
  • potential refeeding sx
  • milieau therapy to dec anx, dysphoria, dec self-esteem, lack control
28
Q

Refeeding syndrome

A
  • when starving, body shifts to preserve fat and prevent muscle b/d
  • switch glucose to fat and pro based energy
  • when nutrients restored, insulin stim glycogen, fat, and pro synth; process requires minerals like mag and phos
  • serious condx with shifts in electros that help body metabolize food
  • can cause dec mag, K, P, vits, thiamin
29
Q

How to avoid refeeding syndrome

A

slowly increase nutrition

30
Q

Long term bio tx for anorexia

A

There aren’t any…fluoxetine for OCD

31
Q

therapies for anorexia long-term

A
  • no specific
  • none is best - adol CBT, family-based, insight oriented (for adol)
  • integrative yoga, massage, acupuncture, bright light therapy
32
Q

Bulimia nervosa

A

recurrent binge (1500-5000k in 2h), compensatory bx to avoid wt gain thru purge like self-vom, lax, diuretics

33
Q

epidemiology of bulimia

A
  • increasing in women 25-45
  • later adol onset
  • often comorb mood/anx dx, SUD, AUD!!
34
Q

Etiology of bulimia

A
  • eating dysreg, dec 5-HT, fam
  • psych - impulsive, non-nurturing fam, poor interpersonal relx, anx, self-esteem
  • enviro - internal thin body, child sex/phys abuse
35
Q

Triggers of bulimia

A

stress, dec body image, food, restriction

36
Q

DSM criteria for bulimia

A

binge/purge weekly for 3M

37
Q

facts about bulimia

A
  • older onset (18)
  • usually not life-threat
  • more prevalent
  • tx outpt
  • better outcomes
  • more lower
  • meds effective
38
Q

Clinical course of bulimia

A
  • few outward, not phys ill
  • at/near normal wt
  • b/p in secret
  • tx delayed for years
  • tx start when control of eating is last
  • ind social butterfly and overwhelmed
  • big rules about food/restrict
  • shame, guilt, disgust
  • compulsive/impulsive in other areas
  • often couple recovery when tx done except if dep/personality dx present
39
Q

rf for bulimia

A

AN hx, dep, interrelx prob, impulsive, inc anx/compulsions, SUD

40
Q

Warning signs of bulimia

A

binge eat, eat secret, purge bx, rigid exercise regimen, life schedule to make time for binge, w/d from fam, wt loss, parotid swelling, callus hands, knuckles from vom, dental caries, tooth erosion and stains

41
Q

s/s bulimia

A
  • sz, fatigue, weak, mild mental
  • cardiac - ipecac cardiomyopathy, arrhythmia
  • Russells (callus on back of hands)
  • dental erosion
  • xerostomia
  • parotid gland swelling
42
Q

NC for bulimia tx

A
  • determine pt perceptions
  • phys assess with labs
  • daily activity, incl exercise
  • self hx suicide, NSSI
  • eating habits, diet
  • specific shape and wt
43
Q

tx for bulimia

A
  • hospital if life threat (often outpt)
  • stable and normal eating
  • restructure dysfxn throughts
  • healthy boundary setting
  • nut counsel
  • bx tech like diary
  • CBT first line
  • SSRI second line
  • also DBT, group psycho
44
Q

Which therapy tx will you not use with bulimia

A

NOT fam bc of age

45
Q

Binge eating disorder

A
  • recurrent binge with distress and impaired control over such bx
  • an avg weekly for 3M
  • not assoc with compensatory bx like with BN
46
Q

What is the most common ED

A

binge eating dx

47
Q

epidemiology of BED

A

fem, normal/overwt, equal among racial/ethnic, 1/2 risk genetic, most have other dx
- low self esteem, body dissat, prob coping, food insecure, hx trauma, adverse child event, normal or overwt

48
Q

BED s/s

A

freq large quantity in short time, feel out of control, dep, guilty, disgusted
- eat when not hungry, eat alone, eat until uncomf full
- upper and lower GI probs

49
Q

What often brings people with BED to the dr

A

GI probs

50
Q

Cues to assess for with BED

A
  • pt perception
  • psych hx
  • phys assess
  • triggers
  • nut pattern
  • hx wt cyclin
  • hx foods/freq of binge
51
Q

Health consequences of binging

A

HTN, inc chol, HD, DM, GI, gallbladder, mskl

52
Q

BED tx

A
  • often not hospital
  • pt prefer term “unhealthy BMI” over “wt prob” or “heavy”
  • explore feelings and triggers
  • pharm SSRI, lisdexamfetamine dimesylate
  • ind or group CBT, DBT, support group
53
Q

Pica

A

eat subs w/o nut value
- childhood for few months in M and F

54
Q

Pica intetrvention

A

bx interventions like reward good eating
- monitor eating bx

55
Q

Rumination disorder

A
  • undigested food returned to mouth then rechewed and swallowed or spit out
  • dx after 1 M sx at any age, often 3-12M onset
  • occurs more freq with intellectual disability
  • childhood neglect predis fx to dev dx
56
Q

Rumination disorders

A
  • reposition infant and small kids during feeding
  • improve intx btwn caregiver and child and make mealtimes pleasant
  • distract kid when bx starts
  • may need for therapy
57
Q

Avoidant/restrictive food intake dx (ARFID)

A
  • can cause sig wt loss, nut def, dependence suppl or enteral feeding
  • food avoidance r/t strong dislike d/t sensory qualities of food (appearance, color, smell, texture, temp, taste)
58
Q

ARFID epidemiology

A

M and F infants and early child
- personal anx and fam anx

59
Q

ARFID tx

A
  • bx mod for food
  • tx anx and dep sx
  • edu on specific bx techniques
60
Q

When can pt with anorexia switch to outpt partial hospitalization?

A

Stable - maintain contracted wt, normal VS, and inc abstinence from ED bx

61
Q

hospitalization for BN

A
  • syncope
  • K under 3.2
  • Cl under 8
  • esophageal tears
  • hemoptysis
  • arrhythmia
  • intractable vom
  • SI

PSYCH (15 decks)

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