Eating Disorders Flashcards
What is Pica?
Who/What is this associated with?
- Ingestion of non-food substances/repeated Regurgitation and spitting out
- Children/Pregnant women
- Associated with parent/child conflict
Eating disorders have periods of symptom ____ and ____. What often causes exacerbation?
- Periods of remission and exacerbation
* Exacerbation often caused by ANXIETY
Cognitive symptoms such as _____ are often the last to ____. Usually precede the onset of what actions?
- Obsessions w/ food and weight
- Last to remit
- Precede restricting, binging, and purging.
What does the time to remission of symptoms usually depend on? Which disorder has a longer time to remission?
- Depends on severity of disease
* Anorexia has longer duration to remission period than bulimia
2 Most common causes of death in eating disorder illness?
- Suicide
* Cardiac failure
3 components of biological etiology for eating disorders?
- Genetics (11x risk for anorexia, 4x risk for bulimia)
- Disruptions to hypothalamus relating to hunger and satiety.
- Neurochemical changes
- Abnormalities in ___ receptors and concentration is a neurobiological factor of_____.
- Abnormalities in ____ which inhibits pleasure seeking behaviors.
- Serotonin
- Anorexia nervosa
- Dopamine
What hormone plays role in modulating serotonin activity? What is seen as a result?
- Estrogen
* Anorexia is more prevalent in women
Etiology of eating disorders?
- Struggle with ____/_____
- ______ families
- ____ ____ disturbances
- _____ factors (media)
- Identity/autonomy
- Enmeshed families/Family dysfunction
- Body image disturbances
- Sociocultural (Media, pressure from others)
What are the peak periods for onset of eating disorders? Examples?
- Developmental periods indicative of change (Can be stressful)
- Transition in schools (elementary to middle and middle to high)
- Puberty
- Transition to independent living
Where is there an increased prevalence in eating disorders?
*Industrialized countries
What is used to diagnose eating disorders and view their patterns, besides body weight?
*Various standardized screening tools
What are 5 aspects to look at when screening for eating disorder?
- Height/Weight and changes in weight
- Menstrual history (any pauses)
- Determine body image
- Obsession w/ counting calories and dieting
- Type/amount and frequency of exercise
A current biologic theory states that eating disorders stem from a disruption to what?
*Hypothalamus
Common psychological symptoms of Anorexia?
- FEAR of gaining weight/being fat
- REFUSAL to maintain normal body weight
- DISTURBED perception of body image
- DENIAL that there is a problem/hiding problem (baggy clothes)
Usual onset of anorexia?
Ages 14-18 (but sometimes younger)
What are five physical characteristics of someone with anorexia?
- Low body weight
- Skin is yellow
- Lanugo
- Cold extremities
- peripheral edema
What issue might be seen with the GI system with Anorexia?
*Constipation
What issue may be seen with the reproductive system in anorexia?
*Amenorrhea
What are three cardiac complications that may be seen with anorexia?
- Hypotension
- Bradycardia
- Hypokalemia
What are 3 Labs that may be seen in Anorexia?
- Hypokalemia
- Low levels of TRH (T3,T4)
- Decreased bone mineral density
Three points of medical management for anorexia?
- Nutritional/Fluid and Elyte restoration
- Psychopharmacology
- Therapy - Psycho, Family, Individual, cognitive behavioral
Binge eating in bulemia is usually done in____. Followed with compensatory behaviors to avoid____. These include what? Feelings of ____and ___ follow.
- Done in secret
- Avoid Weight gain
- Purging - vomiting, laxatives, diuretics, fasting, excessive exercise, insulin, thyroid medication
- Guilt and remorse
What are 3 medications used in treating anorexia nervosa?
- Fluoxatine (SSRI)
- Amitriptyline (TCA)
- Olanzapine (Antipsychotic)
Onset of bulimia? When can precipitate this condition
- Late adolescence/early adulthood (18-19)
* During/After dieting
What form of therapy is used to treat Bulimia? What is the FDA approved pharmacological treatment?
- Cognitive behavioral therapy
* Fluoxetine (SSRI)
5 Physical Presentations of Bulimia?
- Scars/Calluses on hands (Russel’s sign)
- Swollen parotid glands/esophageal and dental erosion
- Peripheral edema
- Muscle weakness
- irreversible growth stunting
What labs will appear to be abnormal in Bulimia?
- Abnormal Na/K values
* Decreased basal metabolic rate
What are four Cardiac issues that can arise with Bulimia?
- EKG changes (can be from muscle wasting)
- Cardiomyopathy/Reduced contractility/output
- Bradycardia <50 bpm
- Orthostatic pressure changes
To diagnose bulimia nervosa, how many episodes of binging and purging must the patient engage in?
*Once weekly for 3 months
What substance should clients with bulimia avoid?
*Caffeine
2 GI complications seen in Anor/Bul? How long does it take for Motility to return to normal with balanced diet?
- Slow motility/constipation
- Abdominal distention
- 3 weeks
3 skeletal complications seen in Anor/bulimia?
- Failure to achieve height potential
- Osteopenia/Osteoporosis
- Higher risk for fractures due to decreased mineral density
2 brain complications from anor/buli?
- Cerebral atrophy w/ventricular enlargement
* Loss of gray/white matter
Diets low in ____ and ____ can result in depletion of which neurotransmitters? What will this contribute to?
- Tryptophan and tyrosine
- Dopamine and serotonin
- Depression/anxiety/attention deficits
Weight below ____ of normal body weight requires hospitalization
*85%
4 goals/ treatments in medically hospitalized eating disorder clients?
- Cardiac stabalization
- Electrolyte supplementation
- NG feedings
- Weight gain of 2 to 3 lbs per week (in anorexia)
Appearance of bulimic client in regards to weight?
*Usually normal weight
Outpatient medical management for people with eating disorders:
- Outpatient weight gain goal of _____?
- Resumption of ___? How long?
- Appropriate amount of ____ an ____
- Calcium supplementation of _____-____ divided into ___ doses per day.
- How much Vitamin D?
- How much Zinc?
- 0.5-1 lb a week
- Menses within 6 months (when at 90% ideal body weight)
- Exercise and activity
- 1200-1500mg of calcium divided into 3 doses per day
- 400-1000IU per day of vitamin D
- 30mg/ day of zinc
3 types of therapy indicated for BED?
*Family, Cognitive behavioral, Psycho
2 pharmacological treatments for BED?
- lisdexamfetamine(Vyvanse)
* combo of buproprion/naltrexone (wellbutrin/vivitrol) (Contrave)
When assessing history of anorexia clients usually display what kind of children?
*Model child/ in control
When assessing history of bulimia clients usually display what kind of children?
*Eager to please/avoid conflict
which reproductive hormones are affected in men and women with eating disorders?
- Low testosterone in men
* Low FSH and LH in women (amenorrhea)
Four outcomes for people with eating disorders?
- Establish adequate nutritional eating patterns
- Eliminate compensatory behaviors
- Demonstrate positive coping mechanisms
- Verbalize acceptance of body image w/ ideal body weight
A coping strategy for a person w/ bulimia would be _____? Whats an example?
- Self-monitoring
* Food diary
People diagnosed with bulimia nervosa have lower levels of which neurotransmitter?
*serotonin
Re-feeding resulting in a _____weight gain can overwhelm the _____, resulting in ______collapse.
- Too-rapid
- Heart
- Cardiovascular
