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Psychiatry > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

Define Anorexia Nervosa

A

Eating disorder characterised by deliberate weight loss, intense fear of fatness, distorted body image and endocrine disturbances

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2
Q

Give four predisposing risk factors for Anorexia Nervosa

A

Family History
Female
Sexual Abuse
Perfectionism

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3
Q

Give precipitating risk factors for anorexia nervosa

A

adolescence and puberty
criticism regarding eating, body shape or weight
occupational or recreational pressure to be slim

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4
Q

Give three perpetuating risk factors for Anorexia Nervosa

A

Starvation causes neuroendocrine changes that perpetuate anorexia
Perfectionism
Western Society

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5
Q

Describe the ICD10 diagnosis of Anorexia Nervosa

A

Present for at least 3 months in the absence of recurrent binge eating

  • Fear of weight gain
  • Endocrine disturbance resulting in amenorrhoea/Impotence
  • Emaciated (BMI<17.5)
  • Deliberate Weight Loss
  • Distorted Body Image
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6
Q

Give four physical symptoms of Anorexia Nervosa

A

Fatigue
Hypothermia
Bradycardia
Lanugo Hair

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7
Q

Describe the expected Appearance, Speech, Mood and Thought of an anorexic patient

A
  • Appearance - Thin, Weak, Slow, Anxious
  • Speech - Slow, Slurred
  • Mood - Euthymic or Low
  • Thoughts - Preoccupation with food/weight/appearance
  • Perception - no hallucinations
  • cognition - normal or poor if physically unwell
  • insight - poor
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8
Q

Describe the typical blood results of an Anorexic Patient

A
  • Increased Urea and Creatinine
  • Low Electrolytes (Mg, K, PHO3, Cl)
  • Low Albumin
  • Low Thyroid Hormones
  • High Cholesterol
  • High Cortisol
  • Low glucose
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9
Q

Other than bloods, Name three other investigations for Anorexic Patients

A
  • VBG (Alkalosis - Vomiting, Acidosis - Laxatives)
  • DEXA - rule out osteoporosis
  • ECG (Bradycardia or Long QT)
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10
Q

Name three complications that people with Anorexia Nervosa are at increased risk of

A
  • Pancreatitis
  • Hepatitis
  • Cardiac Failure
  • Osteoporosis
  • Renal failure and renal stones
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11
Q

Describe the Biological Management of Anorexia Nervosa

A

SSRIs for Comorbid Depression

Aim for weight gain of 0.5-1kg/week if inpatient, or 0.5kg/week if outpatient

Treat medical complications ie electrolyte disturbance

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12
Q

Name 5 Psychological interventions for Anorexia Nervosa

A
  • Psychoeducation about Nutrition
  • CBT
  • Cognitive analytic therapy
  • Interpersonal Psychotherapy
  • Family Therapy (ANFFT)
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13
Q

what are 2 social interventions to help AN patients?

A

voluntary organisations

self-help groups

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14
Q

What is Refeeding Syndrome?

A

Downregulation of enzymes causes metabolic abnormalities if feeding is started at a rate too quick

changes in phosphate, magnesium and potassium

caused by a large insulin surge following increased food intake

Causes Fluid Imbalance, Hypokalaemia, Hypophosphataemia, Decreased Muscle Activity

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15
Q

what can occur as a result of phosphate depletion relating to refeeding syndrome?

A

cardiac failure

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16
Q

How can Refeeding Syndrome be prevented?

A

Start feeding at 1200kcal and increase every 5 days

measure serum electrolytes prior to feeding and monitor refeeding bloods daily

monitor for signs such as tachycardia and oedema

17
Q

how is BMI calculated

A

weight / height2

18
Q

Define Bulimia Nervosa

A

Eating disorder characterised by repeated episodes of uncontrolled binge eating followed by compensatory weight loss behaviours and overvalued ideas regarding ideal shape and weight

19
Q

Describe the aetiological cycle of Bulimia Nervosa

A

1) Sense of compulsion to eat
2) Binge eating
3) Fear of Fatness
4) Compensatory Weight Loss Behaviours

Patients often have a history of childhood obesity

20
Q

risk factors for bulimia nervosa - predisposing, precipitating, perpetuating and biological, psychological and social

A
21
Q

What are the two types of Bulimia Nervosa?

A

Purging - the patient uses self induced vomiting/laxatives/diuretics after eating

Non Purging - less common, excess exercise or fasting

22
Q

Describe the ICD10 criteria of Bulimia Nervosa

(acronym Bulimia Patients Fear Obesity)

A
  • *B**ehaviours to prevent weight gain
  • *P**reoccupation with eating
  • *F**ear of fatness
  • *O**vereating (At least 2 episodes a week for 3 months)
23
Q

other than the ICD10 criteria for bulimia nervosa, what are some other features?

A

normal weight - usually the potential for weight gain from binging is counteracted by the weight loss/purging behaviours

depressed and low self esteem

irregular periods

signs of dehydration

consequences of repeated vomiting and hypokalaemia

24
Q

Give 5 consequences of repeated vomiting

A

Hypokalaemia
Mallory Weiss Tear
Dental Erosions
Russell’s Sign
Aspiration Pneumonitis

25
Q

Describe the expected Appearance, Speech, Mood and Thought of a patient with Bulimia Nervosa

A

Appearance - Depression or Anxiety, Normal Weight, Parotid Swelling, Russell Sign
Speech - Slow or Normal
Mood - Low
Thought - Preoccupation with size/shape/eating

26
Q

Define Kline Levin Syndrome

A

Sleep disorder characterised by recurrent episodes of BingeEating and Hypersomnia

27
Q

what investigations may you do for a patient with bulimia nervosa?

A

blood tests - FBC, U&E, amylase, lipids, glucose, TFTs, magnesium, calcium, phosphate

VBG - may show metabolic alkalosis

ECG - arrhythmias are a consequence of hypokalaemia, classic ECG changes

28
Q

Describe the biological management of Bulimia Nervosa

A

Fluoxetine
Treat any complications
Electrolyte Monitoring

29
Q

Describe the Psychological management of Bulimia Nervosa

A

Psychoeducation about Nutrition
CBT-BN
Interpersonal Psychotherapy

30
Q

Describe the Social management of Bulimia Nervosa

A
  • Food Diaries
  • Techniques to avoid binging (distractions, having company)
  • Small regular meals and self help programmes
31
Q

differences between anorexia and bulimia

A
32
Q

what is binge eating disorder?

A

recurrent episodes of binge eating without compensatory behaviour such as vomiting, fasting, excessive exercise

33
Q

what is EDNOS (eating disorders not otherwise specified) or atypical eating disorder?

A

⅓ of patients referred for eating disorders have EDNOS

closely resembles anorexia nervosa, bulimia nervosa and/or binge eating but does not meet the precise diagnostic criteria

34
Q
A

Psychiatry (18 decks)

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