Eating Disorders Flashcards
What is anorexia nervosa?
Eating disorder characterised by deliberate weight loss, intense fear of fatness, distorted body image and endocrine disturbances.
What are the two subtypes of anorexia nervosa?
Restrictive type
Bing eating/purging type
What is the ICD10 diagnostic criteria for anorexia nervosa?
Refusal to maintain or achieve normal body weight, BMI <17.5
Intense fear of gaining weight or becoming fat
Body shape disturbance
Undue influence weight and shape on self evaluation
Amenorrhoea
What are some risk factors for anorexia nervosa?
Female Occupational eg dancer Perfectionism OCPF personality disorder Young dieting behaviours
What are some of the predisposing factors to AN?
Genetics, family history
Female, early menarche
Sexual abuse
Premorbid anxiety or depressive disorder
Low self-esteem
Perfectionism, obsessional/anankastic personality
Bullying at school, stressful life events
What are perpetuating factors to AN?
Starvation leads to neuroendocrine changes that perpetuate anorexia.
Perfectionism and obsession
Occupation, western society
How long must symptoms be present for a ICD10 diagnosis of AN?
Present for at least 3 months, there must be the absence of recurrent episodes of binge eating, and preoccupation with eating/craving to eat.
What are the differences between anorexia nervosa and bulimia nervosa?
AN - significantly underweight, BN normal
AN - more likely to have endocrine abnormalities
BN has strong cravings for food, episodes of binge eating
What is noted in AN on MSE?
Appearance thin weak, slow, anxious, may try to disguise emaciation.
Speech slow, slurred or normal
Mood can be low with co-morbid depression or euthymic
Thought - preoccupation with food, overvalued ideas about weight and appearance
Perception - no hallucinations
Cognition normal or poor if physically unwell
Insight - often poor
What investigations should be requested in AN and what are the results?
Bloods FBC - anaemia, leukopenia U&Es increase in urea and creatinine if dehydrated, decrease in ions TFTs low T3 and T4 LFTs decrease in albumin Lipids increase in cholesterol Increase in cortisol Decrease in LH and FSH Decrease in glucose Check amylase as pancreatitis is a complication
Venous blood gas - metabolic alkalosis if vomiting, metabolic acidosis if using laxatives
DEXA scan rule out osteoporosis
ECG for arrhythmias such as sinus bradycardia, prolonged QT
EAT questionnaires
What are the differentials for AN?
Bulimia nervosa Eating disorder not otherwise specified Depression Obsessive-compulsive disorder Schizophrenia Organic causes of low weight Alcohol or substance misuse
What are the complications of anorexia nervosa?
Metabolic - hypokalaemia, hypercholesterolaemia, hypoglycaemia, deranged LFTs and electrolytes
Endocrine - increase in cortisol, GH, decrease in TFTs and LH/FSH, amenorrhoea
GI - enlarged salivary glands, pancreatitis, constipation, peptic ulcers, hepatitis
CV - cardiac failure, ECG abnormalities, arrhythmias
Renal failure and stones
Seizures, peripheral neuropathy
Iron deficiency anaemia, thrombocytopenia, leucopenia
Dry skin, brittle nails, infections, suicide
What is the management of AN?
Biological
Treatment of medical complications e.g. electrolytes
SSRIs for co-morbid depression or OCD
Psychological Psycho-education CBT Cognitive analytic therapy Interpersonal psychotherapy Family therapy
Social
Voluntary organisations
Self-help groups
Risk assessment for suicide and medical complications
Treatment as an inpatient - for weight gain of 0.5-1kg/week or as an outpatient of 0.5 kg/week
Hospitalisation necessary for severe anorexia, BMI <14, severe electrolyte abnormalities and psychiatric reasons e.g. suicidal ideation
In cases where insight is clouded, use of MHA or Children Act may be needed
What is refeeding syndrome?
Life threatening syndrome results from food intake - whether parenteral or enteral after prolonged starvation or malnourishment.
Due to changes in phosphate, magnesium and potassium.
Occurs as result of insulin surge following increased food intake.
Fluid balance abnormalities, hypokalaemia, hypomagnesaemia, hypophosphataemia, abnormal glucose metabolism.
Phosphate depletion causes reduction in cardiac muscle activity, can lead to cardiac failure.
What is the treatment/prevention of refeeding syndrome?
Identify high risk
Immediately prior to feeding and during first 10 days supplement with oral thiamine, Vit B, multivitamins
Start nutritional support under supervision of dietician; max 10kcals/kg/day and increase gradually
Check baseline electrolytes, correct as appropriate
Restore circulatory volume, monitor fluid balance
What bloods test results characterise refeeding syndrome?
Low phosphate, magnesium and potassium
Low thiamine
High glucose
What is bulimia nervosa?
An eating disorders characterised by repeated episodes of uncontrolled binge eating, followed by compensatory weight loss behaviours and overvalued ideas regarding ideal body shape and weight.
What is the vicious cycle of BN?
Sense of compulsion to eat
Binge eating
Fear of fatness
Compensatory weight loss behaviours e.g. vomiting, using laxatives, exercising excessively, alternating with periods of starvation.
What are the risk factors for bulimia nervosa?
Female sex Family history Early onset puberty Childhood obesity Co-morbid mental illness Abuse as a child Low self-esteem Environmental stressors
What should be screened for alongside EDs?
Depression Anxiety Deliberate self-harm Substance misuse Emotionally unstable personality disorder
