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Y5 Psychiatry > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

Describe the epidemiology of eating disorders?

A
  • F > M (90% are female) - Typical: “perfectionist, high-achieving young women, low self-esteem”
  • Lifetime incidence Age of onset:
    • Anorexia nervosa = 0.6% 16-22
    • Bulimia nervosa = 1.0% >22
  • Co-morbid depression, substance misuse, OCD
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2
Q

What is the most common eating disorder?

A
  • In clinic = Anorexia nervosa
  • In general = Binge Eating Disorder (BED)
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3
Q

What is Binge Eating Disorder (BED)?

A

Binge eating without vomiting

  • Can be described as Bulima without the vomiting
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4
Q

Describe the aetiology of anorexia nervosa.

A
  • Biological
    • Genetics = 58% heritability
  • Psychosocial
    • Psychological = perfectionist with low self-esteem
    • Social = social pressures - models, athletes, dancers
    • Personal = previous AN, child abuse
    • Family = parental overprotection, family enmeshment
  • FHx
    • Obesity
    • Depression
    • Substance misuse
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5
Q

Describe the aetiology of Bulima nervosa.

A
  • Biological
    • 5-HT dysregulation
    • Genetics - 54% heritability
  • Psychosocial
    • Psychological = perfectionist with low self-esteem
    • Social = social pressures - models, athletes, dancers
    • Personal = previous obesity, child abuse
    • Family =disturbed family dynamics, parental weight concern, high parental expectation
  • FHx
    • Obesity
    • Depression
    • Substance misuse
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6
Q

What are the appropriate investigations for a suspected eating disorder?

A
  • Examination = weight, height, lanugo hair, BP
    • Squat test (test for proximal myopathy)
  • Bloods and urine drug screen = exclude medical causes, i.e. hyperthyroidism
  • ECG = bradycardia, arrhythmia, long-QT
  • DEXA = osteoporosis (if > 2-year history)
  • Rating Scale = eating attitudes test
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7
Q

What ECG changes can be seen in patients with bulima nervosa?

A

Long QT

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8
Q

What factors may lead to an immediate admission of a patient with an eating disorder?

A
  • BMI low (not defined by NICE; approx. BMI <13)
  • WL >1kg/week
  • Septic-looking signs
  • HR <40bpm + long QT
  • Suicide risk
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9
Q

What is the diagnostic criteria for Anorexia nervosa?

A
  • BMI <17.5 (or weight is ≥15% less than expected)
  • Deliberate weight loss
  • “Fear of the fat”/Distorted body image
  • Endocrine dysfunction (amenorrhoea (F) or impotence (M), loss of libido, delayed puberty)
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10
Q

What are the risk factors for Anorexia nervosa?

A
  • OCD
  • Childhood feeding difficulties
  • FHx
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11
Q

What is atypical anorexia nervosa?

A
  • Sub-diagnostic features of anorexia nervosa
    • e.g. young boys that are losing weight to have a ‘six-pack’ but are currently at a healthy weight
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12
Q

What are the signs a symptoms of anorexia nervosa?

State ones that are specific to binge-purge type (in italics)/

A
  • General = lethargy, cold intolerance, cytopenia/anaemia, infections, dry skin/brittle hair and nails, lanugo hair (hair that covers face of newborns, downy and unpigmented in type), oedema, Russell’s sign (callous/cut knuckles from self-induced vomiting)
  • CVS = bradycardia, postural hypotension, arrhythmias (2nd to hypokalaemia)
  • GI = constipation, pain (ulcers), Mallory-Weiss tears, nutritional hepatitis
  • Reproductive = amenorrhoea, infertility, loss of libido
  • MSK = osteoporosis, proximal myopathy, Hx of fractures
  • Neurological = peripheral neuropathy, delirium, coma, intense fear of gaining weight
  • DDx = medical causes of WL, depression, bulimia nervosa, psychosis
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13
Q

What blood results occur in nutrional hepatitis?

A
  • Low protein
  • Raised bilirubin
  • Raised LDH
  • Raised ALP
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14
Q

What are the features of severe anorexia nervosa?

A
  • BMI <15
  • Rapid weight loss
  • Evidence of system/organ failure
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15
Q

What are the features of moderate anorexia nervosa?

A
  • BMI 15-17
  • No evidence of system/organ failure
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16
Q

What are the features of mild anorexia nervosa?

A
  • BMI >17 (still <17.5 or 15% of expected)
  • No additional co-morbidites
17
Q

What screening tool may indicate an emergency admission for anorexia nervosa?

A

MARSIPAN guidelines (Management of Really Sick Patients with AN)

18
Q

Define Refeeding syndrome.

A

Potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding

19
Q

What blood test results would you expect in someone with refeeding syndrome?

A
  • Low phosphate
  • Low magnesium
  • Low potassium
  • Low thiamine
  • Salt and water retention
20
Q

What are the signs and symptoms of refeeding syndrome?

A
  • Fatigue
  • Weakness
  • Confusion
  • High blood pressure
  • Seizures
  • Arrhythmia
  • Heart failure
21
Q

What is the prognosis of anorexia nervosa?

A
  • After 10 years:
    • 50% recover
    • 40% ongoing problems
    • 10% die (suicide = 1/3 of deaths)
22
Q

What are the complications of anorexia nervosa?

A
  • Infertility
  • Early death
  • Osteoporosis
  • Cardiac arrythmias
  • Cardiac failure
23
Q

What are some bad prognostic factors for anorexia nervosa?

A
  • Very low weight
  • Bulimic features
  • Later onset
  • Longer illness duration
24
Q

What is the name of the eating disorder screening questionnaire? Plus what questions are asked within it?

A

SCOFF - ≥2 = take a full history

  • Do you make yourself SICK because you feel uncomfortably full?
  • Do you worry you have lost CONTROL over how much you eat?
  • Have you recently lost more than ONE stone in a 3-month period?
  • Do you believe yourself to be FAT when others say you are too thin?
  • Would you say that FOOD dominates your life?
25
Q

What are the diagnostic criteria for Bulimia nervosa?

A
  • Binging or persistent preoccupation with eating and/or irresistible craving for food
  • Purging behaviours
  • Psychopathology
    • ​Feeling of a loss of control
    • Morbid dread of fatness
    • Patient sets sharply defined weight threshold (well below premorbid weight/healthy weight)
    • History of anorexia nervosa
26
Q

What are the signs and symptoms of Bulimia nervosa?

A
  • Mainly signs of MALNUTRITION - ARE SIMILAR TO AN BUT LESS SEVERE
  • General = lethargy, cold intolerance, cytopenia/anaemia, infections, dry skin/brittle hair and nails, lanugo hair (hair that covers face of newborns, downy and unpigmented in type), oedema, Russell’s sign (callous/cut knuckles from self-induced vomiting)
  • CVS = bradycardia, postural hypotension, arrhythmias (2nd to hypokalaemia)
  • GI = constipation, pain (ulcers), Mallory-Weiss tears, nutritional hepatitis
  • Reproductive = amenorrhoea, infertility, loss of libido
  • MSK = osteoporosis, proximal myopathy, Hx of fractures
  • Neurological = peripheral neuropathy, delirium, coma, intense fear of gaining weight
  • DDx = upper GI disorder (leading to vomiting), personality disorder, depressive disorder, obesity
27
Q

What are the features of severe bulimia nervosa?

A
  • Daily purging
  • Significant electrolyte imbalance
  • Co-morbidity
28
Q

What are the features of moderate bulimia nervosa?

A
  • Frequent binging and purging - >2/week
  • Some medical consequences - chest pain etc
29
Q

What are the features of mild bulimia nervosa?

A
  • Infrequent binging and purging - ≤2/week
30
Q

What is the management of bulimia nervosa?

A
  • Treat medical complications (regular dental review for acid-wear on teeth)
  • Treat co-morbid psychiatric illness (depression, OCD, substance misuse)
  • Moderate to severe = SSRIs (high-dose (60mg) fluoxetine) to reduce binging/purging + help impulses
  • Children: 1st line: Family therapy
  • Adults: 1st line: Guided Self-Help Programme (Bulimia Nervosa-Focused
    2nd line: CBT-ED
  • Mild = Guided self-help, recommend Beat charity, monitor for 8 weeks
  • Moderate = Guided self-help, recommend Beat charity, monitor for 12 weeks
  • Severe = Urgent referral to Community Eating Disorder Service (CEDS)
31
Q

What is the prognosis of Bulimia nervosa?

A
  • After 10 years:
    • 70% recover
    • 1% die
32
Q

What is the management of anorexia nervosa in adults?

A
  • Engage and Educate
  • Treat co-morbid psychiatric illness (depression, OCD, substance misuse)
  • Signpost support networks (Beat charity, MIND, NHS)
  • Weight Restoration and Nutrition Advice
  • 1st line
    • CBT-ED - Address low self-esteem, perfectionism, control issues
    • Maudsley Anorexia Nervosa Treatment in Adults (MANTRA) - Focus on what the cause of the anorexia is
    • Specialist Supportive Clinical Management (SSCM) - explore problems of anorexia, nutrition and eating habits and future beyond anorexia
  • 2nd line
    • Eating-disorder-focussed Focal Psychodynamic Therapy (FPT)
    • Adolescent-focussed psychotherapy
    • Motivational interviewing
    • Family therapy
    • Interpersonal therapy
  • Pharmacological Therpay = Fluoxetine (especially is preoccupied by food)
  • Mild = Monitor/advise/support, Beat charity, monitor for 8 weeks
  • Moderate = Routine referral to Community Eating Disorder Service (CEDS)
  • Severe = Urgent referral to CEDS
33
Q

How does the management of anorexia nervosa differ in children?

A
  • 1st line: Family therapy
  • 2nd line: ED-CBT
34
Q

What is the target weight gain for patient with anorexia nervosa?

A

0.5-1kg/week

Y5 Psychiatry (11 decks)

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