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U15 Spine > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

How esting has changed

A
  • Our bodies used to absorb and store surplus calories due to not havign a steady state of food
  • Eating brings people togethe and devlops societls bonds.
  • Frming meant humans could develop
  • Population boom
  • Lots undernutrition in 20th centures from wars and more food was a godo thing
  • In 20th C there becme more sedentary office work
  • Now - excessice doos, hgihly processed, high sugar, high carbohydrate and less acitvity so weight gain
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2
Q

BMI categories

A

BMI = weight kg/ height m2

  • <18.5 = underweight
  • 18.5 -24.9 = healthy
  • 25-29.9 = overwieght
  • 30+ obese
  • 35+ extrmeely obese
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3
Q

Describe the 21st vcentury obesity epidemic

A
  • Obesity tripled sincd 1975
  • 1.9B adults overweight-650m obese
  • 39% adults overweight
  • 13% obese
  • Our food should be our medicien an dour medicie shoyld be our food (hippocrates)
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4
Q

What is the psychological burden of oebsity

A
  • Not easy to treat for an individual
  • Stigmtising
  • 20-60% of obes epeople ave psychosologicl distress
  • 5X more likely to have major depression
  • 1/3 depressed at tiem bsristric surgery
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5
Q

What is obesity associated with

A

Anxiety, substance abuse, low self-esteem, decreased QOL, suicidal ideation. ALl improved with weight loss

Complications: Psychological, CV disease, diabetes, hypertension, NAFLD (non alcoholic fatty liver disease), cancer, reduced life expectancy

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6
Q

Management of obesity

A
  • Diet, Exercise, boot camps, drugs, surgery, government policy/ education. tret assoicated morbidity.
  • Surgeyr - gastric bypass or band.
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7
Q

Prevalence of eatign disorders

A
  • AN: 1 in 250 F, 1 in 2000 M
  • BN: 1 in 50 F, 1 in 400 M
  • OSFED: perhaps more common
  • 6.5/100,000 admissions per year in NE
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8
Q

Anorexia Nervosa

A
  • BMI<17.5
  • Weight loss seen as positive
  • Reinforcing
  • Exercise to excess
  • Amenorrhoea
  • 16-17 onset
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9
Q

Bulimia Nervosa

A
  • Binge eating
  • Compensatory behaviour - exercise, vomiting, laxatives, thyroxine
  • SLighlty older at 18-19 than AN
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10
Q

Binge Eating disorder

A
  • Recurrent Binge eating
  • Without compensatory behaviours
  • Impacts on weight loss efforts
  • Common - 3.5% women, 2% men, 1.6% teenagers
  • Large food intake over <2 hours- loss of control - eats alone - no compenstory acts
  • Embarrassed and negative feelings

It’s like a switch is turned on in your mind and the only thing you can do is eat until you physically cannot anymore. It’s terrifying because it’s like the real you is still in your head but has no power over what you are doing. You’ve suddenly become something else.

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11
Q

OSFED (other specified feeding and eating disorder)

A
  • Don’t quite fit AN, BN or BED definitions
  • Often seen in childhood

–Atypical AN

–Subthreshold BN

–Subthreshold BED

–Purging Disorder

–Night Eating Disorder

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12
Q

Aetiology of Eds

A

•Multifactorial

–Genetic – 11.4 X

–Physical – pre-morbid obesity

–Adverse life events – 70%

–Family factors

–Socio-cultural

–Perfectionism

–Impulsivity

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13
Q

Outcomes of EDs

A
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14
Q

Mortality with EDs

A

•6009 females with AN admitted (1973-2003)

–90% primary diagnosis

–10% secondary

•265 deaths

–139 natural causes

–126 “un-natural”

  • Suicide 84
  • AN 39
  • SMR of 6.2
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15
Q

MARSIPAN - 2010& 2014

A
  • Management of really sick patints with anorexia nervosa
  • Report sent out let down patients when they are sickest as medical and psychiatric care not coordinated
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16
Q

Fcats about EDs and diagnosis etc

A
  • Almost half of sufferers will wait longer than a year after recognising symptoms before seeking help.
  • Trends in seeking help, getting effective help, and relapse rates
  • Early help have a relapse rate of only 33% compared to an average level of 63% for all those who sought later help.
  • Early identification and intervention = best chance of recovery
17
Q

Risks with very Low BMI

A

PHYSICAL

•Starvation – HIGH RISK is BMI<13

–Re-feeding

–Under-feeding

  • Hypoglycaemia
  • Electrolyte disturbances
  • ECG abnormalities
  • Sepsis
  • Death – SMR 6-10 times baseline

Behavioural

  • Patients with anorexia nervosa are subject to an extreme compulsion to pursue thinness. This compulsion has been likened to addiction to heroin and patients will take terrible risks in order to satisfy it.
  • They may deny that they have the compulsion, to others and sometimes to themselves, and hardly be aware of their behaviours.
18
Q

Bheaviours patients can do to avoid eatign disorder diagnosis etc

A
  • Falsify weight
  • Excessive exercise
  • Light clothing – promote shivering
  • Sabotage feed – NG into sink, pillow, turn off, water down
  • Purging
  • Splitting – he said/she said etc.
  • “They will invariably promise to stop”
19
Q

How to manage relly low BMI

A
  • Agree a contract–Central is aim to increase weight 0.5-1kg/week
  • Careful observations

–Meal times, Eye level, 1-2-1 – low threshold for this

  • Consistency of message
  • Be cynical and don’t believe anything!
20
Q

patients presentation vs waht theyre feeling

A

Presentaiton - behavioural, mniupulative, attention seeking, aggressive, elfish, stubborn

We feel - stuck, disturbed, anxious, worried, frustrated, helpless

Need to think psychologically to understand our patients

21
Q

Some psychological functions of eating disorders

A
22
Q

Example of patient expeirence in medical admisison of EDs

A
23
Q

How to reframe our reactions in ED

A
24
Q

Feeding through a relationship not reacting

A
25
Q

My therapeutic role in EDs

A

–Acknowledge complex causation of ED

–Acknowledge function of the ED (what it gives that person e.g. safety, control)

–Be aware of your emotional reactions

  • understand these, rather than act on them
  • Relate rather than control

–Expect & tolerate their ambivalence

–Explain the rationale for treatment

–Repetition - expect that they may forget everything you have said!

TIPS: warmth, compassion, empathy, understanding

  • “I understand your concerns but I must do this to keep you safe.”
  • “You may not agree with me right now but I am acting in your best interests.”
  • “I can see that you are scared.”
  • “I hear what you are saying.”
  • “Based on what you’ve told me, I can see why you are acting in this way.”
  • “You may not wish to look after yourself right now yet my job is to look after you.”
26
Q

Aims of management in EDs

A
  • Restrict activity
  • Correct micronutrients
  • Deliver calories safely
  • Correct electrolyte disturbances
  • Improve weight
  • Treat psychological disturbance
  • Control behaviour
27
Q

Rules of thumb in ED mnagement

A

•BMI <13 = sick patient = must improve BMI – likely needs admission

–Bed rest

–NG feed

  • BMI < 14.5 = Concern – need to be vigilant and support
  • Likely to need 1-2-1 nursing – contact nurse bank
28
Q

Feeding for EDs

A
  • Aim for BMR plus 500 calories
  • Start at 35kcal/kg (controversial)
  • Give pabrinex, thiamine and m-vits
  • Correct electrolytes BUT also increase feed rate
  • Aim for 0.5-1.0kg/week weight gain
  • BUT care with excess exercise – this can burn up many hundreds of calories and therefore mean “needs more food”
29
Q

Capacity and stravation

A

•These patients do not have capacity with respect to eating and food therefore the MCA can be used to treat them in their best interests

–NG feed etc

•Starvation is an EMERGENCY

30
Q

Mental health Act and rleevant sections for EDs

A
  • Deprivation of liberty
  • Approved mental health professional (AHMP) - SW, Nurse, OT, Psychologist, Approved by local SS
  • Relevant sections - 5(2),2 ,3
31
Q

Section 5(2) = order applied to a patient who is already an in-patient. Use this for non complying in EDs. Psych nurse can hold for 6hours.

A
32
Q

Section 2

A
  • Compulsory admission to hospital
  • Assessment
  • 28days
  • Application by AMHP
  • 2 doctors confirm: Patient has mental disorder that needs admission, needs detaining for own or others safety.
33
Q

Section 3

A
  • COmpulsory admisison to hospital
  • Treatment
  • Up to 6m
  • Application by AMHP
  • 2 doctors confirmed: Patient has mentla disorder that needs admisison, tretment is available in hospital, needs detaining for own or others safety
34
Q

What is recovery (ED)

A
  • “Challenging, exhausting, lonely, miserable”
  • No one felt it was about weight
  • Learning from mistakes, keeping going, building confidence, feeling empowered and express emotions in a non-destructive way
  • Being able to laugh again and enjoy life (and food!), do the things you love
  • Learning to accept your body; not feeling constantly disgusted and angry with yourself
  • Finding out and accepting who you are (it’s not all about your appearance)
  • Managing symptoms and accepting that you won’t necessarily be symptom-free
  • Not being controlled by the eating disorder
35
Q

Why is Recovery in ED important

A

•Affect young people

–Peak onset 15-19 F; 10-14 male

–62% develop symptoms before age 16; 86% by age 19; 95% by age 24 (BEAT 2015)

–Rates increasing.

–In girls aged 10-19 years, there are nine times as many new cases of eating disorder (1.2 per 1000 population) diagnosed every year as of type 1 diabetes (Micali 2013)

  • Increased mortality rate (Arcelus 2011)
  • Long term physical sequelae

–Osteoporosis and increased fracture rate (Lucas 1999)

  • Impact on social, academic and occupational outcomes (Mond 2014)
  • Increased suicide risk (Franko 2006)
  • Economic impact estimated at £15 billion per year (Beat 2015)
36
Q

Recovery rates in anorexia nervosa (AN)

A
  • 50% full recovery
  • 30% partial recovery
  • 20% chronic illness (Steinhousen 2002)
  • Recovery rates reduce after 5 years of illness BUT they never drop to zero (Lacey 2015)
37
Q

Prognostic factors

A

•Indicators of good prognosis (Steinhousen2002; Nogel 2009)

–Young age

–Short duration of illness

•Indicators of poor prognosis (Berkman 2009)

–Very low BMI

–Previous treatment episodes

–Psychiatric co morbidity

U15 Spine (11 decks)

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