Eating disorders Flashcards
What are the Ix for Bulimia nervosa?
Bedside: Current weight - calculate BMI (will be normal!), rate of loss, ascertain duration, weight control behaviours, purging, beliefs etc during Hx Physical exam - exposure? MSE finish Bloods: - Imaging: - Special: Screen using SCOFF (>=2 = +ve) S - sick? C - control? O - 1 stone lost in 3 months? F - fat? F - food dominates life?
What is the Mx for Bulimia Nervosa?
May need immediate referral to specialist or ED if suicidal, has diabetes mellitus or physical sx such as syncope, seizures.
BIO: Adjunctive SSRI/SNRI after other therapy
PSYCH: CBT - guided self help or standard
SOCIAL: Nutritional and meal support
If pregnant, get specialist referral first
What are the Ix for Anorexia Nervosa?
Bedside: Full Hx, physical exam to see exposed body
Current weight, calculate BMI and rate of weight loss
MARSIPAN - BMI, Obs, hydration status, ECG, Muscle weakness, electrolytes, mental health/behaviours
Bloods: -
Imaging: -
Special: Screen using SCOFF to rule out Bulimia Nervosa
What are the Mx for Anorexia Nervosa?
Get an MDT involved: Medical team, Psychiatry, Dietician, OT
If suitable for outpatient mx:
BIO: Potassium supplement
PSYCH: psychotherapy - CBT-ED, MANTRA, SSCM or family based therapy for children and adolescents
SOCIAL: Structured eating plan and oral nutrition
If not suitable for outpatient mx:
BIO: Oral, enteral, parenteral feeding, fluid and electrolyte correction, olanzapine
PSYCH: psychotherapy
SOCIAL: -
Consider specialist referral for mx of comorbidities - CVD, GI, ENDOCRINE, NEURO etc
What are the Ix for Anorexia Nervosa IN CHILDREN?
Bedside: Hx from child (rather than parent i.e. using heads)
Physical examination: emaciated, lanugo hair, very thin, Measure Height; Weight and plot on growth chart - compare to parents; BMI: 16.5
Bloods: TFTs, FBC
Imaging: -
Other: Squat test
What are the Mx for Anorexia Nervosa IN CHILDREN?
Management
BIO: Referral to medical specialties for Ix? Watchful waiting?
PSYCHO: Anorexia-focused family therapy, ED-CBT, specialist supportive clinical management (SSCM), Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
SOCIAL: Education, family support
What is the difference between anorexia nervosa and bulimia nervosa?
Bulimia nervosa is characterised by periods of bingeing (eating excessively) followed by episodes of purging (using laxatives, forced vomiting, diuretics etc.)
What are some physical complications of anorexia nervosa?
Bradycardia and hypotension (risk of sudden death), arrhythmia
GI upset (constipation, abdominal pain, ulcers)
Amenorrhoea and infertility
Osteoporosis
Cognitive impairment
Peripheral neuropathy
List some medical causes of weight loss.
Hyperthyroidism, malignancy, GI disease (e.g. coeliac disease), Addison’s disease
What is the mortality rate of anorexia nervosa?
10%
When might inpatient treatment of anorexia nervosa be warranted?
BMI < 13 or rapid weight loss
Serious physical complications
High suicide risk
NOTE: MHA may be used to enforce compulsory feeding
What are differentials of an Anorexia Nervosa picture?
Bulimia nervosa Physical cause (e.g. hyperthyroidism, GI disease) Depression Eating disorder not otherwise specified Body dysmorphic disorder
What are some questions you should ask when a pt has Anorexia Nervosa?
Current weight, rate of loss
Duration sx
Current weight control behaviours - typical day eating
Body checking
Compensatory behaviours
Beliefs about weight, body, desired weight, eating
Biopsychosocial consequences of sx + behaviour
What are the RF of anorexia nervosa?
Maternal encouragement of weight loss
FHx of eating disorders
Adolescent period
Personal Hx of anxiety disorders
Depressive disorders or obsessive-complusive disorders
Perfectionist traits
At risk professions: sportspeople, dancers or models
