eating disorder + substance abuse Flashcards
anorexia nervosa: DSM-5 criteria
( greek for loss of appetite)
1) Persistent Restriction of Energy Intake leading to low body weight compared to what is expected for age sex, developmental trajectory, and physical health
- typically: BMI < 17.5 or less than 85% of expected body weight
2) Intense Fear of Gaining Weight/being fat or persistent behavior that interferes with weight gain
3) Disturbance in Body Image:
- distorted perception of their body weight or shape
- self-worth is excessively tied to their body size, with a disproportionate emphasis placed on weight and shape in evaluating their overall value
- lack of recognition of the seriousness of their low body weight
4) Duration: behaviors present for 3+ months
labs: anorexia
-Leukopenia
-Hypoglycemia
- hypotension
-Hypokalemic, hypochloremic metabolic alkalosis (if purging)
-EKG Changes-ST depression, T wave flattening/inversion, PROLONGED QTC, BRADYCARDIA
clinical features of anorexia: how does it manifest + starvation related medical sx
-Intense desire for thinness often despite apparent starvation
Starvation related medical sx:
-Amenorrhea
-Hypothermia
-Fatigue/weakness
-Dependent edema, cold/swollen extremities
-Cardiac arrhythmias: tachy, bradycardia
-Gastric bloating, abdominal pain, constipation
-Seizure
-Lanugo: Body knows youre losing weight - hair growth to keep you warm
-Tooth decay from purging
anorexia behavior observations
-Preoccupied with food
-Loss of appetite RARE, LATE (they just choose to starve)
-Peculiar food related behaviors
-Abuse of laxatives/diuretics
-Excessive ritualistic exercise
-Rigid, perfectionistic
-Somatic complaints
-Lack of sexual drive
bulimia nervosa: DSM-5 criteria
(greek = ravernous hunger)
Recurrent episodes of binge eating at least once a week for 3 months characterized by :
-Eating, in a discrete period of time (e.g. within any 2-hour period!!!), an amount of food that is definitely larger than most people would eat during a similar period of time and 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)
Recurrent compensatory behavior to prevent weight gain:
- Self-induced vomiting
- Misuse of laxatives, diuretics, or other medications
- Fasting or excessive exercise
Disturbance Does Not Occur Exclusively During Episodes of Anorexia Nervosa
Clinical Features of Bulimia Nervosa: how does it relate/compare to anorexia, what type of binge, vomiting
Premorbid History of Anorexia Nervosa:
- ~ 50% of those with Anorexia may later meet criteria for Bulimia Nervosa
- its hard to be anorexic…. often the rigid control and restricting breaks pt down and they begin the binge-purge cycle
- Malnutrition may not be as obvious in bulimics as it is in anorexia
- Bulimics have a better prognosis compared w/ anorexics
Secretive binges:
- food often consumed rapidly, sometimes without chewing
- High-calorie, sweet foods with a smooth texture are frequently chosen during binge
Vomiting: can be sticking fingers down throat but some can vomit at will
what signs for what ds
BULLEMIA sx
russell’s sign: Bruises on knuckles from upper part of your mouth from purging
tooth enamel changes from purging up gastric acid
pathology and lab examine in bulimia
-Malnutrition may not be as obvious in bulimics as it is in AN.
-Dehydration is common in patients who purge repeatedly
-Electrolyte abnormalities: decreased Mg, hypokalemia (PROLONGED QT -> SEIZURES), decreased chloride
- hypochloremic hypokalemic metabolic alkalosis: in patients who vomit, use laxatives repeatedly
-Gastric ulcers
-Gastric, esophageal tears
-Esophageal cancer
-Hypotension, bradycardia
psychological factors associated with bulimia: what are common comorbid ds
-Difficulties with impulse control: substance abuse, shoplifting, self-injurious behaviors/suicide attempts, destructive emotional relationships
-More outgoing, angry, emotionally labile
-Bulimics have a better prognosis compared w/ anorexics
comorbid ds:
- Borderline Personality Disorder
- Bipolar Disorder II
- anxiety
- impulse control ds
- substance abuse
binge eating disorder: DSM-5 criteria
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
-Eating, in a discrete period of time (e.g. within any 2-hour period!!!!), an amount of food that is definitely larger than most people would eat during a similar period of time and 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).
- episodes avg 1x/wk for 3 months
binge eating episodes are associated with 3+ sx with eating:
- RAPIDLY
-feeling UNCOMFORTABLY FULL
- large amounts of food when not feeling physically hungry
-eating ALONE because of feeling embarrassed by how much one is eating
-feeling disgusted with oneself, depressed or very guilty afterward
THERE IS NO COMPENSATORY BEHAVIORS (no vomiting/laxatives)**
Binge Eating Disorder (BED) Key Criteria
- Occurs on average, at least once a week for three months.
- Not associated with inappropriate compensatory behaviors (e.g., self-induced vomiting) as seen in Bulimia Nervosa.
- Does not occur exclusively during Bulimia Nervosa or Anorexia Nervosa.
- Binge Eating Disorder (BED) involves subjective distress about eating behaviors and often co-occurs with other psychological problems.
- BED is less common but more severe than overeating
treatment of eating disorders: hospitalization
Hospitalize when the risk of death is likely:
- malnutrition
- dehydration
- electrolyte imbalance
- BW 20% less than expected norm
- BW 30% less than expected norm usually requires long term care
- suicidal ideation
note:
- Expect resistance from anorexics!!!
- Bulimics rarely require admission
pharmacotherapy of eating disorders
-Antidepressants (especially SSRI’s) have shown effectiveness
- give FLUOXETINE FOR BULIMIA NERVOSA: reduce binge-purge cycle
-Higher doses typically required compared to mood disorders
-Rate of compliance better with bulimics compared to patients with anorexia
NEVER GIVE BUPROPRION: risk of seizures
inpatient tx of AN and BN: management strategies
-Daily weight monitoring
-Monitoring input and output
-Monitoring electrolyte levels
-Small meals to prevent circulatory overload, total 500 calories over maintenance wt
-Bathroom observation
-Stool softeners for constipation-never laxatives!
-positive/negative reinforcement
-Education
-Medication
-CBT, group therapy
match column to eating ds
alcohol dependence: DSM 5
At least two of the following within a 12-month period:
- alcohol is often taken in larger amounts or over a longer period than was intended. [Do you drink more than you mean to?]
- persistent desire or unsuccessful efforts to cut down or control alcohol use.[Do you want to stop, but can’t?]
- A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.[Is drinking taking over your life?]
-Craving, or a strong desire or urge to use alcohol. [If you can’t drink, are you thinking about drinking?]
-Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.[Is your drinking getting in the way of day-to-day activities?]
-Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. [Is drinking getting in the way of your relationships?]
- Tolerance
- withdrawal: characteristic withdraw syndrome or drinking to avoid the sx
Substance Use Disorder: Key Signs
-Taking the substance in larger amounts or for longer than you’re meant to
-Wanting to cut down or stop using the substance but not managing to
-Spending a lot of time getting, using, or recovering from use of the substance
-Cravings and urges to use the substance
-Not managing to do what you should at work, home, or school because of substance use
-Continuing to use, even when it causes problems in relationships
-Giving up important social, occupational, or recreational activities because of substance use
-Using substances again and again, even when it puts you in danger
-Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
-Needing more of the substance to get the effect you want (tolerance)
-Development of withdrawal symptoms, which can be relieved by taking more of the substance
Alcohol Withdrawal Symptoms
Mild/Early:
- Tremulousness
- Minor Agitation
- Restlessness/ Insomnia
- Anxiety
Moderate = Alcohol Hallucinosis
- Occurs within 12-24 hours
- Resolves in 24-48 hours
- stable vital signs
Severe = Severe Alcohol Withdrawal Syndrome
- Seizures
- Occur within 6-48 hours
- Kindling Effect: Risk of withdrawal seizures increase with each repeated withdrawal
- MC = Generalized Tonic-Clonic Seizures
Delirium Tremens
Definition: Rapid-onset, fluctuating disturbance of attention and cognition
- Occur within 72-96 hours
- Altered sensorium: confusion, agitation, disorientation
- abnormal vital signs: Fever, Tachycardia, Hypertension, Sweats
CAGE questions
