Eating Disorders Flashcards
What is a willful dieting leading to irreversible self-starvation?
Anorexia nervosa
What is a description of Hilda Bruch that “a paralyzing sense of ineffectiveness wc pervades all thinking and activities”?
A core psychological facet of anorexia nervosa
What type of anorexia nervosa does Princess Margaret of Hungary have?
Restricting type
What type of anorexia nervosa does Catherine of Sienna have?
Binge eating purging type
Martha Taylor
Self starvation
Dr. Louis-Victor Marce of Paris described many cases of young girls, who at pd of puberty, and after a precocious development, became subject to what?
Inappetence carried to the utmost limits
Sir William Gull of London and Ernest Charles Laseque almost simultaneously published papers on the description and tx of what?
Hysterical anorexia
What has been theorized to be the cause of anorexia nervosa?
Cognitive and perceptual development defect
What is a potent inhibitor of feeding?
CRF (Corticotropin Releasing Factor)
What stimulates feeding behavior, and was found to be elevated in CSF of underwt and recently wt-restored AN px?
Neuropeptide Y
What is the cause of amenorrhea in AN?
Decreased secretion of GnRH
GnRH is highly influenced by what, which help regulate eating behavior and mood?
Norepinephrine and serotonin
What is some evidence for a cerebral-CNS serotogenic deficiency in bulimia nervosa px?
High binge frequency is related to lower CSF5 HIAA
Normal wt bulimia px have decreased what?
Prolactin response to the pharmacological challenge test of fenfluramine and methchlorophenylpiperazine (mCPP)
What are Russell’s criteria?
(1) behavior that is designed to produce marked wt loss
(2) a morbid fear of becoming fat
(3) evidence of an endocrine disorder that in the post pubertal girl causes the cessation of menstruation
What is the DSM-IV diagnostic criteria for AN?
A. Refuse to maintain body wt
B. Intense fear of gaining/be fat even underwt
C. Disturbance in body wt or shape or denial of low wt
D. In post menarchal, amenorrhea, i.e., the absence of at least 3 consecutive menstrual cycle
What is dt diminished secretion of GnRH, which diminishes the pituitary secretion of FSH and LH –> low estrogen?
Amenorrhea
Medical complications of Eating Disorders related to wt loss:
Cachexia: fat loss, muscle mass, reduced thyroid met (low T3 syn), cold intolerance, and difficulty maintaining core body temp
Cardiac: loss of cardiac muscle, smol heart, cardiac arrhythmias, atrial and ventricular premature contractions, prolonged His’ bundle transmission (prolonged QT int), bradycardia, ventricular tachycardia; sudden death
Digestive-GI: delayed gastric emptying, bloating, constipation, abdominal pain
Reproductive: amenorrhea, low LH and FSH
Derma: lanugo (fine bblike hair over the body), edema
Hema: leukopenia, relative lymphocytosis
Neuropsychiatric: abn taste sensation (Zn def), apathetic depression, mild cognitive disorder
Skeletal: osteoporosis
Medical complications of Eating Disorders related to wt loss:
Related to purging (vomiting and laxative abuse):
- metabolic: electrolyte abn, hypokalemia, hypochloremia alkalosis, hypomagnesemia
- digestive-GI: saliv gland and pancreatic inflamm and enlargement w inc serum amy, esophageal and gastric erosion, dysfxnal bowel w haustral dilation
- dental: erosion of enamel
- neuro: seizures, mild neuropathies, fatigue and weakness, mild cogni dis
Where does wt fluctuations, vomiting, and peculiar food handling may occur?
Somatization disorder
What are chronic med illnesses frequently associated with wt loss?
Crohn’s dse
Hyperthyroidism
Addison’s dse
DM
What has a bimodal peak of onset either between ages 14 and 15 or at age 18?
Anorexia nervosa
What is the most effective tx for AN?
Multifaceted tx approach
Includes medical mgmt, psychoeducation, and indiv therapy utilizing cognitive and behavior therapy principles
What is the first drug used in treating anorectic px?
Chlorpromazine
In high doses of these, it can facilitate wt gain in anorectic restrictors and also has an antidepressant effect
Cyproheptadine (Periactin) up to 28mg/day
What may be effective in preventing relapse in px w AN?
Fluoxetine
It was first describe by Gerald Russell in 1979 as a distinct syndrome
Bulimia nervosa
What are raised in some bulimia nervosa px who vomit, leading to the possibility that the feelings of well being experienced by some of those px after vomiting?
Plasma endorphins lvls
GFM Russell defined bulimia in 1979 proposing 3 criteria:
(1) a powerful and intractable urge to overeat, resulting in eps of overeating
(2) avoidance of fattening effects of food by inducing vomiting or abusing purgatives or both
(3) morbid fear of becoming fat
What is the DSM-IV diagnostic criteria for BN?
A. Recurrent eps of binge eating (a. Eating discrete within 2 hr pd or b. Lack of ctrl eating)
B. Recurrent inappropriate compensatory behavior to prevent wt gain, s/a self induced vomiting; misuse of lax, diuretics, enemas; fasting or excessive exercise
C. Binge eat and inappropriate compensatory behaviors both occur, on ave, at least twice a wk for 3 mos
D. Self-eval (shape and wt)
E. Disturbance doesn’t occur exclusively during eps of AN
What usually begins from a pd of a few wks to a yr or longer after dieting?
Bulimia nervosa
What is the ave length of a bingeing episode?
1 hour
What do bulimia nervosa px take to reduce their appetite and lose wt?
Amphetamines
What also do BN px use to induce vomiting?
Ipecec
Exposure to gastric juices through vomiting can cause what?
- severe erosion of teeth
- pathological pulp exposures
- diminished masticatory ability
- unaesthetic appearance
What is associated w elevated serum amylase conc and is commonly observed in px who binge and vomit?
Parotid gland enlargement
What is the cause of cardiac failure from ipecac toxicity that results in death?
Cardiomyopathy
Pericardial pain
Dyspnea
Generalized muscle weakness ass w hypotension, tachycardia, and electrocardiogram abn
They’re symptoms of what?
Ipecac intoxication
Lab exam of BN px
Elevated serum amylase
Hypokalemia
Met alkalosis
What are the 2 features distinguishing these eating disorders?
Severe wt loss
Amenorrhea
What can occur from overeating eps wc consist of visual agnosia, compulsive licking and biting, inability to ignore any stimulus, and hypersexuality?
Kluver-Bucy syndrome
What uncommon syndrome is associated w hyperphagia wc is characterized by periodic hypersomnia lasting for several weeks?
Kleine-Levin syndrome
Double-blind, placebo-ctrlled trials anti-depressant meds include
- desipramine (Norpramin)
- imipramine (Tofranil)
- amitriptyline (Elavil)
- nortriptyline (Pamelor)
- phenelzine (Nardil)
- fluoxetine
What is a recurrent ep of binge eating in the absence of inappropriate compensatory behaviors characteristic of bulimia nervosa falls into the category?
S/a px not fixated on body shape and wt
Binge eating disorder
DSM-IV Research Criteria for Binge Eating Disorder
A. Recurrent eps of binge eat.
- eating in a discrete pd of time (e.g., w/in any 2-hr pd), an amt of food that’s def larger than most ppl would eat in a similar pd of time under similar circumstances
- a sense of lack ctrl
B. 3 or more of ff.:
- eat rapidly than normal
- eat until feelin uncomfortably full
- eat large amnts when not hungry
- eat alone bcs embarrassed of amt of food he eats
- feelin disgusted of self, depressed, guilty after overeating
C. Marked distress regarding binge eating
D. Binge occurs at least 2 days a wk for 6 months on average
After a full criteria for BN were previously met, some, but not all, of criteria have been met for a sustained pd of time
Partial remission
After a full criteria for BN were previously met, none of criteria have been met for a sustained pd of time
Full remission
An ave of 1-3 eps of inappropriate compensatory behaviors per wk
Mild
An ave of 4-7 eps of inappropriate compensatory behaviors per wk
Moderate
An ave of 8-13 eps of inappropriate compensatory behaviors per wk
Severe
An ave of 14 or more eps of inappropriate compensatory behaviors per wk
Extreme
Binge behavior of bulimics may also be a response to low what in the brain?
Serotonin
