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Psychiatry > Eating Disorder > Flashcards

Eating Disorder Flashcards

1
Q

What are the 3 main clinical symptoms related to having an eating disorder?

A
  1. restricting - planned limitation of food intake, chronic dieting, ritualized caloric intake count
  2. purging- behaviors to expend or limit calorie intake [exercise, vomit, laxative, diuretics, enemas]
  3. binging - eating more in 2 hours than a normal person of similar size/activity level, unable to control eating during a binge
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2
Q

What are the main psychological symptoms related to having an eating disorder?

A

Thoughts [cognitions]

  1. low self-esteem
  2. body shape
  3. body weight
  4. perfectionism
  5. food

Feelings [emotions]

  1. Anxiety- GAD, separation anxiety, OCD
    - often presents somatically as upset stomach/nausea
  2. Depression - bulimia/binge-eating
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3
Q

What vital signs do you look for in the medical workup for eating disorders?
What would you look for on the PE?

A

Vitals:

  1. BP lying, sitting, standing
  2. HR >50 with no orthostatic change
  3. height, weight, BMI [although BMI is not diagnostic or evidence based]

PE:

  1. cachexia - loss of muscle, fat
  2. cardiac- bradycardia, hypotension, arrythmia
  3. GI- bloating, delayed emptying, ab pain
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4
Q

What percent body fat is necessary for menstruation?

A

20-25 to start, 25 to be fertile

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5
Q

When will electrolytes be altered in eating disorders?

What changes would you see? [5 things decrease, 2 increase]

A 
In purging disorders [vomiting, laxatives] you would see:
Decreases:
1. hypokalemia
2. hypomagnesia
3. hypochloric metabolic alkalosis
4. hypoglycemia 
5. anemia, pancytopenia

Increases:

  1. elevated salivary amylase
  2. serum cholesterol increases because the liver is constantly releasing it due to catabolized fat
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6
Q

What is refeeding syndrome?

What are the implications?

A

Refeeding syndrome is when an anorexic person has been in starvation [less than 500 calories] for 5 days or more and their metabolism has changed
When food is resumed, demands for phosphorus, b-vitamins, K and Mg exceed available reserves and acute depletion occurs leading to—>
1. cardiac arrythmia
2. sudden death

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7
Q

Optimal bone health depends on the Ca intake ages ______to _____.
When should bone scans be done in a suspected eating disorder?
What are z-scores for osteopenia, porosis, athletes?

A

Optimal bone health depends on Ca from 10-25.
Bone scans should be done if a person has:
1. amenorrhea
2. 6 months at low weight

Z-scores should be high for athletes so if they are low-normal, consider it to be low.
Osteopenia = -1 to -2.5
Osteoporosis = -2.5 and below

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8
Q

What is the diagnostic criteria for anorexia nervosa according to DSM5?

A
  1. restriction of calorie intake leading to
    - low weight for age, sex, developmental history, physical health
  2. intense fear of gaining weight
  3. undue influence of weight/body shape on self-evaluation; denial of seriousness of low body weight

Subtypes:

  1. restricting - during the last 3 months they did not have recurrent binging or purging behavior
  2. binge-eating/purging type - during the last 3 months the person has engaged in recurrent acts
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9
Q

What is the most common age of onset for anorexia nervosa?
What is the prevalence ?
What are the 2 most common comorbid illnesses?

A

14-18 years old
1% of 12-23 year old women, with a 3-10% mortality, 50% recovery

Comorbid with:

  1. anxiety- social phobias, separation anxiety, OCD
  2. depression
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10
Q

What 2 major characteristics are present in a culture with Anorexia?

A
  1. availability of food

2. society where thinness is valued and linked to beauty

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11
Q

What is the etiology of anorexia nervosa?

A

Multifactorial:

  1. biological - genetics, neural circuits, temperament
  2. psychological - personality, food behavior, body image
  3. social - dieting, relationships
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12
Q

A patient has been brought in by her mother because she is demonstrating odd food behaviors such as:

  • chewing excessively
  • hoarding/hiding food
  • rearranging food on the plate
  • secrecy around bizarre behaviors

She says her daughter is a perfectionist.
The daughter denies that she is hungry but has other somatic complaints like a “nervous stomach”. What are these clinical features indicative of?

A

Anorexia nervosa- restricting type

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13
Q

On physical exam of a patient you note:

  1. cachexia- with loss of fat/muscle, cold intolerance, hypoglycemia, elevated cholesterol
  2. hypotension, bradycardia, arrythmia
  3. delayed gastric emptying, bloating, ab pain
  4. downy, wooly hair, edema
  5. leukopenia, anemia
  6. osteoporosis

What are these signs/symptoms indicative of?

A

anorexia nervosa restricting type

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14
Q

In addition to cachexia, cardiac problems, GI problems, anemia/leukopenia, osteoporosis and lanugo [wooly hair] what other medical findings suggest PURGING subtype of anorexia nervosa?
[4]

A
  1. hypokalemia [ST, T wave EKG changes], hypomagnesia, hypochloric met. alkalosis
  2. salivary gland enlargement with elevated salivary amylase; pancreatic inflammation with elevated amylase
  3. esophageal, gastric erosion
  4. dental enamel erosion
  5. seizures, neuropathies due to electrolyte imbalance
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15
Q

What is the mortality for anorexia nervosa?
What % recover completely?
What % significantly improve and function well?

What subtype has a worse outcome?

A

5-15% mortality
25% recover completely, 25% improve and function well

RESTRICTING TYPE IS WORSE

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16
Q

What are the 3 branches of treatment for a person with anorexia nervosa?

A
  1. hospitalization to restore nutritional state
    - patient weighed daily [blindfolded]
    - fluid intake/output recorded
    - supervised meals/bathroom trips
    - feeding by NG if necessary [add food slowly b/c of refeeding syndrome!!!]
  2. Psychotherapy
    - CBT = monitor eating habits, feelings, problems with relationships; cognitive restructure problem
    - Family therapy = BEST OUTCOME [90% recover] where parents take control of nutrition then the patient is gradually involved
  3. pharmacotherapy for comorbid disorder [depression, anxiety], bone mineral management
17
Q

For long term recovery of anorexia nervosa, the patient needs to do what 3 things?

A
  1. develop self-esteem
  2. understand their emotions
  3. improve relationships

recovery has nothing to do with ideas of FOOD or BODY IMAGE

18
Q

What are the DSM5 criteria for bulimia nervosa? [5]

A
  1. Recurrent binge-eating with
    - significant overeating during discrete period
    - lack of control over eating binges
  2. recurrent compensatory action
    - vomit, laxative, enema, diuretic
  3. binge/purge at least 1x a week for 3 months
  4. self-eval is influenced by body shape/weight
  5. NOT during anorexia
19
Q

What is the prevalence of bulimia in young women?
What is the age of onset?
What is the M:F ratio?
How does it differ from anorexia in terms of patient weight?

A

1-3% of young women with a later onset than anorexia.
The M:F ratio is 1 to 10

Anorexia- patient is underweight
Bulimia- patient is normal or overweight

20
Q

What is the etiology of bulimia nervosa?

A

Multifactorial:

  1. biological- genetics, temperament, neural circuits
  2. social - dieting, relationships
  3. psychological - body image, personality, food behavior
21
Q

What are the 5 main clinical features of bulimia?

A
  1. binging - precedes vomiting by 1 year, loss of control in the binge
  2. purging - vomiting at will, decreases bloated feeling
  3. post-binge anguish
  4. concerned about body image/sexual attractiveness
  5. comorbid conditions
22
Q

What conditions are comorbid with bulimia?

A
  1. depression
  2. impulse control disorder
  3. substance abuse
  4. personality disorder
  5. anxiety
  6. dissociative disorders
  7. sexual abuse
23
Q

What is the prognosis for bulimia?

What is recovery rate?

A

It is poorly studied but thought to be better than anorexia.

  • less likely to obtain treatment, but milder
  • chronic disorder with wax/wane

50% recover, 20% continue to meet full criteria

24
Q

What is treatment for bulimia?

A
  1. psychotherapy
    - CBT to interrupt cycles of binging/dieting
    - address dysfunctional beliefs about food, weight, self
  2. pharmacotherapy
    - SSRI [fluoxetine]
    - if comorbid bipolar add lithium or valproic acid
25
Q

What adjustments were made from DSM4 to DSM5 that will allow more people to be diagnosed with anorexia and bulimia, and less with eating disorder NOS?

A

Anorexia
-dropped amenorrhea

Bulimia
- included reducing freq. from 2x weekly to 1x weekly

26
Q

What is binge-eating disorder?

What are the 2 subtypes?

A

recurrent episodes of binge-eating where the patient:

  1. eats within a 2 hr period an amount of food that is significantly larger than most people would eat during a similar period
  2. lack of control over eating during the episode

Subtypes:

  1. anorexia-like = person has low weight [but not as low as anorexia], fixation on health, anxiety
  2. bulimia-like = person is distressed by purging, emotional overreating, binge LESS than DSM for bulimia
27
Q

What 5 features describe the binge associated with binge-eating disorder?

A
  1. too fast
  2. uncomfortably full
  3. large amounts of food when not physically hungry
  4. eating alone b/c embarrassed of how much they eat
  5. disgusted with oneself, depressed, guilty

Psychiatry (18 decks)

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