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Clinique 3 MT1 > Eating disorder > Flashcards

Eating disorder Flashcards

1
Q

7 types of eating disorder

A 
Anoreixia N,
Bulimia
BED
OSFED
ARFID
Pica
Rumination
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2
Q

Anorexia Nervosa
3 characteristics
physical (1)

A

Restriction of energy intake relative to requirements le

ading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.

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3
Q

Anorexia Nervosa
3 characteristics
Psychology (2)

A
  • Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain even though at a significantly low weight.
  • Disturbances in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or lack of recognition of t
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4
Q

Subtypes of anorexia nervorsa

A
  • Restricting type: No recurrent binge eating nor purging behaviors for the last 3 months.
  • Binge eating/purging type: Recurrent binge-eating and/or purging behaviors.
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5
Q

Prognosis AN

A

• Patients with illness onset before 17 y.o. achieve a better outcome than adult onset. Higher rate of full recovery and lower mortality rate in adolescents than in adults
• Pre-pubertal onset confers a more difficult course.
• Relapsing course
• In adults, time to complete remission is 5 to 6 years
Patients with illness onset before 17 y.o. achieve a better outcome than adult onset.
Higher rate of full recovery and lower mortality rate in adolescents than in adults.
• Pre-pubertal onset confers a more difficult course.
• Relapsing course.
• In adults, time to complete remission is 5 to 6 years.

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6
Q

The primary goal of DE treatment: the steps and key points

A
  • Target on adequate nutrient intake.
  • First, the weight-target intervention won’t do until the patient can eat a normal portion of food with diversity.
  • During the treatment (including relapsing) do not suggest intuitive eating.
    The best treatment is to stick on the meal plan.
  • Encourage group meal time.
  • Ensure 6 meals a day
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7
Q

Common observed diet patterns in AN (10)

A
  • Gradual decrease of food intake
  • Removal of high energy food.
  • Gradual decrease of portion sizes.
  • Limited to bulky nutrient-poor foods
  • Rigid schedule of eating.
  • Limited food choices/amount of calories.
  • Fat avoidance the main phobia.
  • Food avoidance related to digestive symptoms.
  • Vegetarianism and veganism.
  • fluid avoidance or excessive fluid intake.
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8
Q
  • Excessive dieting,_____ food preoccupation
  • Excessive concerns about weight, shape or health
  • Excessive_____perfectionism
  • Cognitive___ rigidity
  • Self-___denial
  • Social___withdrawal
  • Extreme focus on ___ob or school work
  • Anxiety
A
  • excessive food preoccupation
  • weight, shape, health
  • perfectionism
  • rigidity
  • denial
  • withdrawal
  • job or school work
  • Anxiety
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9
Q

Anaroxia Nervosa: severity measurement

A 
Based on BMI 
BMI  17 and +:       mild
BMI  16 -16.99:      moderate
BMI  15-15.99:        severe
BMI  less than 15:   extreme
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10
Q

Bulimia nervosa: Four characteristics

  • recurrent episode of ____
  • Recurrent inappropriate ____ to prevent weight gain
  • Self-evaluation is unduly influenced by _____ and _____
  • Repetitive at least ___ times /week for __ months
A
  • recurrent episode of binging eating
  • Recurrent inappropriate compensatory behaviour to prevent weight gain
  • Self-evaluation is unduly influenced by body shape and weight
  • Repetitive at least 1-3 times /week for 3 months
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11
Q

Two significant characteristics of recurrent episodes of binge eating:

  • Eating in a _____time with _____ of food
  • Sense of _______ during an episode
A
  • Eating in a discrete amount of time ( within 2 hours) with large amount of food
  • Sense of lack of control over eating during an episode
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12
Q

Bulimia: Severity measurement

A 
Average number of binge-eating episodes per week
Mild: 1-3
Moderate: 4-7
Severe: 8-13
Extreme: 14+
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13
Q

Common characteristics of BN individua

  • Obsessive thoughts focused on _____
  • Excessive concerns about ___ and ____
  • Long term ____
  • No short term ___ when reaching abstinence
A
  • Obsessive thoughts focused on restricting and binge eating
  • Excessive concerns about weight and shape
  • Long term weight gain
  • No short term weight loss when reaching abstinence
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14
Q

Common observed diet patterns in BN and BED (7)

Dr. Ffcab

A 
• Dieting history
• Removal of meals 
• fasting
• Avoidance of high  energy dense food 
• Carbohydrates phobia  
• Binge-eating 
‘forbidden food’ usually found in binge content
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15
Q

Purging disorder

A

purging w/o binging

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16
Q

Night-eating syndrome

A

eat large amounts of food after the evening meal, often waking up during the night to eat

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17
Q

BED

A

binge eating disorder

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18
Q

Bulimia vs BED

A

BED does not have sense of loosing control of food; BED without restriction going back to normal diet.

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19
Q

ARFID:Characteristics (4)

  1. _____that fail to meet appropriate _____needs
  2. Regardless of _____and ______
  3. Regardless the concerns on_____
  4. The severity excesses normal if in the context of another condition or disorder
A
  1. Eating or feeding disturbance that fail to meet appopriate nutritional/ energy needs
  2. Regardless of food availability and cultural factors
  3. Regardless the concerns on body shape or weight
  4. The severity excesses normal if in the context of another condition or disorder
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20
Q

4 Common Pattern in ARFID: one or more appeared

A
  • Significant weight loss
  • Significant nutrition deficiency
  • Dependence on eternal feeding or oral nutritional supplements
  • Marked interference with psychosocial functioning
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21
Q

Prevalence:

A

• Broad range of eating disturbances more commonly seen in childhood (may also happen in adulthood)

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22
Q

potential cause
• May develop from food refusal to _____ ( distracted or forced feeding)—- parent’s pressure
• ______ is common in ARFID
• Unresolved in____
• Adults with ARFID referred to ED programs;

A
  • May develop from food refusal to maladaptive coping strategies ( distracted or forced feeding)—- parent’s pressure
  • Anxiety is common in ARFID
  • Unresolved in 3-10% of ARFID children
  • Adults with ARFID referred to ED programs;
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23
Q

Prevalence of BED

which population has the highest number?

A

post-bariatric surgery patients 40%

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24
Q

What causes an ED? Co-mobility

A

effective disorder: Anxiety disorder,Post traumatic stress disorder
Personality disorder

other stress:
Effective disorder, Attention deficit hyperactivity disorder, Obsessive compulsive traits/disorder

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25
Q

4 the negative impact of vomiting ( bulimia compansary behavior)

A

• Dehydration
• Digestive resistance
• Recurrent Binge eating
Long term weight gain

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26
Q

the negative causes of laxatives (2)

A
  • Dehydration and electrolytes loss

* Hyperaldosteronemia and edema

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27
Q

if suddenly stopping laxatives? what to expect

A

there will be a water intension, which causes weight gain …

If it has been a long-term history, refer to the doctor.

Usually start as re-feeding first, then stop the laxitive… to gradually recover the digestive function

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28
Q

what you should tell the patient who plan to stop laxatives?

A

Total abstinence or gradual decrease
• Adequate energy intake, rich in fibers and fluid
• Weight gain to be expected
• May require medical supervision

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29
Q 
Type1 DM & ED: lab, physical and mental indications
• High level of \_\_\_\_
• Frequent episodes of \_\_\_\_\_\_
• Frequent \_\_\_\_\_\_
• Poor \_\_\_\_\_ monitoring
• Negative attitude toward \_\_\_\_\_\_
• Excessive preoccupation toward \_\_\_\_\_\_\_
• Low intake of \_\_\_\_\_\_\_
• Excessive exercise
A
  • High HbA1c
  • Frequent episodes of ketoacidosis
  • Frequent hospitalisations
  • Poor glycemic monitoring
  • Negative attitude toward diabetes
  • Excessive preoccupation toward weight and body shape
  • Low intake of carbohydrates
  • Excessive exercise
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30
Q

SCOFF

A

5 questions on questionnaire

that detects ED

31
Q

what are 5 Body image aware behaviours?

A
  • Frequent weighing
  • Measuring
  • Body checking
  • Comparing themselves to others
  • Social network (ideal body image
32
Q

describe restrictive- binge circle

A
  1. restrictive behavior
  2. hunger+ stress or negative emotions
  3. Guilt or fear to gain weight
  4. compensatory behavior
33
Q

Fat distribution after AN restoration
• AN adolescent females lose more _____ while adult females lose more _______
• Partial wt gain in adolescent females leads to greater fat mass deposition in _____ than other body regions
• After short term partial or complete wt restoration, adults show a _______phenotype with respect to health age-matched controls
• Central fat distribution is associated with ______, and it does not adversely affect e.d. psychopathology or cause distress in female adults
• Abnormal central fat distribution seems to _____ after long term maintenance of complete wt restoration

A

• central body fat while adult females lose more peripheral fat
• Partial wt gain in adolescent females fat mass deposition in the trunk region
• adults: a central adiposity phenotype with respect to health age-matched controls
• associated with increased insulin resistance.
• normalize after long term maintenance of complete wt restoration
- no extra fat gain, just fat displacement

34
Q

the four steps that ED causes negative health impact.

A
  1. Restrictive and bulimic behaviors
  2. Nutritional consequences
  3. Physical and psycho-social deterioration
  4. Loss of functional capacity
35
Q

give four common clinical signs/ complications with restrictive eating: skin, cardiovascular prob, endocrine changes, muscle-bone-dental,digestive systems,kidney function, brain, cognitive changes, psychological changes.

A
  • acrocyanosis
  • hypotension, loss of heart muscles, arrhythmia, braycardia
  • feel cold, amenorrhea/ impotency
  • osteoporosis, stress fracture and dental caries
  • SMA syndrome, early satiety
  • water-retention
  • brain atrophy change, neurocognitive functioning impairment
36
Q

give four common clinical signs/ complications with bulimia/purging: skin, cardiovascular prob, endocrine changes, muscle-bone-dental,digestive systems,kidney function, brain, cognitive changes, psychological changes.

A
  • Russell’s sign, nose bleeding
  • dizzyness, dehydration + eletrolyte imbalance, k deficit, heart palpitation, arrhythmia
  • T3 T4 imbalance– feel cold, irregular menstrual cycle
  • perimolysis (dental issue due to acidic erosion )
  • swollen salivary glands, esophagitis, hematemesis(vomiting blood)
37
Q

Lab finding and explanation

• Glucose: L___ H ____

A

• Glucose: L (malnutrition) H (insulin omission among diabetics)

38
Q

Lab finding and explanation

A

• CPK H (muscle breakdown) L (reduced muscle mass)

39
Q

Lab finding and explanation

sodium L

A

• Sodium: L (water loading or laxatives)

40
Q

Lab finding and explanation

Potassium L

A

• Potassium: L (vomiting, laxative, diuretics, refeeding)

41
Q

Lab finding and explanation

Magnesium L

A

• Magnesium: L (poor nutrition or refeeding)

42
Q

Lab finding and explanation

phosphorus L

A

• Phosphorus L (refeeding syndrome)

43
Q

Lab finding and explanation

Chloride L, H

A

• Chloride: L (vomiting) H (laxatives)

44
Q

Lab finding and explanation

bicarbonate H

A

• Bicarbonate: H (vomiting) L (laxatives)

45
Q

Lab finding and explanation

BUN H

A

• BUN: H (dehydration)

46
Q

Lab finding and explanation

creatinine H

A

• Creatinine: H (dehydration, renal dysfunction)

47
Q

Lab finding and explanation

Amlayse

A

• Amylase H (salivary origin - vomiting)

48
Q

Lab finding and explanation

ALT, AST and total bilirubin H

A

liver dysfunction

49
Q

T/F malnutrition causes the low level of albumin

A

F; not until very severe malnutrition

50
Q

common lab in patient with AN

A

normal K, high bicarbonate and anemia (but usually won’t show until being re-fed)

51
Q

example: medication causes BED

A

the meds for ADHD Vyvanse

52
Q

the four steps of treatment

A
  1. normalize eating behaviours
  2. weight gain ( if less than 18.5)
  3. abstinence of compensatory behaviors
  4. healthy attitude towards foods, wt and body image
53
Q

MI

A

motivational interviewing

54
Q

FBT

A

Family based treatment

55
Q

Psycho-social interventions

for adolescent pt with AN, and why to use this approach?

A

FBT

b/c the parents will in charge to kid’s behaviour change

56
Q

Psycho-social interventions

for pt with BED or BN

A

Cognitive Behavioral Therapy: recognize the disordered cognition, prescribing the proper behavior
Dialectical Behavioral Therapy
InterPersonal Therapy

57
Q

why may appear hypoglycemia after refeeding, especially after eating?

A

b/c there was no glycogen in the liver

58
Q

Nutrition assessment: list 3 specific parts

A
  • Personal and family wt history
  • Detailed food intake assessment
  • History of the eating disorder
  • History of the eating disorder

• Clinical signs and symptoms of malnutrition

59
Q

Admission criteria for hospitalization (7)

A
  • Severe or rapid weight loss
  • Severe binge-eating and purging
  • Medical complications: unstable vital signs, cardiac abnormalities, electrolytes imbalance
  • Lack of response to outpatient treatment
  • Severe psychiatric co-morbidity: suicide tendency, self-harm….
  • For laxative withdrawal
  • To clarify a diagnosis: hypoglatremia, coma, etc
60
Q

describe sequential model of care

A
  1. out-patient counselling
  2. day program 14 h/wk
  3. day hospital 40 hrs/wk
  4. hospitalization 3 m.o.
61
Q

ED program– weight gain: goal

A

500g /week if BMI < 20

62
Q

ED program– Meal planning

Portion, energy, times of meal, food introduction

A
  • Establish a regular pattern of eating 5 to 6 times a day
  • Introduce food that have been last removed from diet
  • Increase gradually energy intake
  • Use portion controlled foods: emphasize portion is a vague size but not an amount
63
Q

ED program: Behavioural strategies

  • weight
  • eating environment
  • cognitive identification
A
  • Stop from weighting oneself
  • use regular size of dish
  • serve normal serving of food
  • stop measuring food
  • eat with the one who has a positive influence
  • self-identify the eating symptoms and triggers; and limit the triggering food until ready to reintroduce
64
Q

describe the plate-by-plate approach for weight gain

A

50% grain/starch + 1/4 protein 1/4 F/V + diary drink

65
Q

describe the plate-by-plate approach for weight restoration

A

33% grain/starch + 33% protein + 33% F/V + diary drink

66
Q

why there is ambivalence in ED treatment?

A

because ED is a non-linear process— may have weight fluctuation and may be affected by emotional and psychological change.

67
Q

Why MI

A

working with ambivalence is key in motivational interviewing approach

68
Q

Approaches to refeeding in patients with AN:

(T/F) In mildly and moderately malnourished, choose lower calorie re-feeding.

A

F, it is too conservative

69
Q

Approaches to refeeding in patients with AN:
(T/F) Higher calorie re-feeding associates with increased risk for RS under close
medical monitoring and electrolyte correction.

A

F. it is safe to use HC Refeeding approach

70
Q

how to manage high calorie intake?

A

meal-based approaches or combined NGT+meals

71
Q

Hospitalization:

goal of weight gain

A

1kg / week

72
Q

Hospitalization: re-feeding approach (3)

A
  • oral re-feeding
  • no access to bathroom after meals.
  • liquid supplements to replace what is not completed.
73
Q

Hospitalization: re-feeding approach—- liquid, food choices, qunatity, f/v

A

liquid: limit liquid intake (prescription of water)
food: fear or real disliking
food choice: gradually introduce food with small frequent feeding. limit the food that patient may refuse to eat.
F/V: sufficient fibers but reduce the raw F/V to avod discomfort.

Clinique 3 MT1 (5 decks)

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