Eating Disorders

Question 1

Name that psych condition:
Eating or feeing disturbance -> failure to meet appropriate nutritional or energy needs: no interest, avoidance, adverse consequences of eating
significant weight loss and nutritional deficiency
Need supplements
Interference with psychosocial functioning

Answer 1

Avoidance/restrictive food intake disorder

Question 2

Name that psych condition
restriction of energy intake relative to requirements
intense fear of gaining weight or becoming fat
Disturbance in way body is experienced

Answer 2

Anorexia nervosa

prevalence: 0.4% in women. F:M 10:1

Question 3

The mortality rate for anorexia is _____.

Answer 3

5%. This is higher than ANY other psychiatric disorder

Question 4

There are two types of anorexia nervosa. They are:

Answer 4

Restricting: no episodes of binge eating. weight loss through fasting + excesive exercise
Binge-Eating/Purging: during last 3 months- has engaged in recurrent bingeing OR purging

Question 5

What are the BMI ranges for the different severities of anorexia nervosa?

Answer 5

Mild >17, moderate 16-17, severe 15-16, extreme <15

Question 6

Name that psych disorder
Recurrent episodes of binge eating categorized by: eating more than normal AND lack of control during eating
Compensatory behaviors to prevent weight gain (vomitting, laxative, diuretics, fasting, exercise)

Answer 6

Bulimia nervosa
prev: 1.5-3%
F:M 10:1

Question 7

What is the timeline for bingeing and purging for someone to qualify having bulimia?

Answer 7

at least once a week for 3 months.

Question 8

Unspecified feeding or eating disorder is when symptoms are there and _______ in function but does not ___________

Answer 8

impairment, does not meet criteria for other disorders OR there is insufficient info to make better diagnosis

Question 9

What’s the most common eating disorder for men?

Answer 9

Bulimia nervosa

Question 10

What are some symptoms that are suggestive of an eating disorder?

Answer 10

dizziness, weakness, headache, fainting, poor concentration, abdominal pain, amenorrhea, pain in oropharynx dysphagia

Question 11

Vital signs in individuals with eating disorders?

Answer 11

hypotension, hypothermia, bradycardia(at rest), tachycardia (with movement)

Question 12

Things that might be seen on physician exam in someone with eating disorders

Answer 12

blood in emesis, dot like lesions in sclera, tooth erosion, dehydration, thinning hair, pathos ulcers, hypercarotenemia (yellow skin), Russell’s signs (on knuckles from inducing vomit), swollen parotid, peripheral edema, muscle wasting, lanugo hair (soft unpigmented hair growth),

Question 13

Eating disorders are often comorbid with

Answer 13

mood disorder, anxiety disorder (OCD), personality disorder

Question 14

What are the first and second line treatments for eating disorders

Answer 14

1st: CBT and family therapy (outpatient->partial hosptialization->residential->inpatient)
2nd: antidepressants, olanzapine (anxiety + weight gain), mirtazapine (insomnia + appetite stimulant), lisdexamphetamine (for binge eating)

Question 15

What is the inpatient criteria for adults and children for someone with an eating disorder?

Answer 15

Adults <85% ideal body weight, BMI <17.5

Children <85% body weight or failure to gain weight during growth period

Question 16

Name that psych disorder

Metabolic disturbances as a result of reinstitution of nutrition to patients who are starved or malnourished

Answer 16

Refeeding syndrome

first described during WW2

Question 17

What is the pathophysiology of refeeding syndrome?

Answer 17

Refeeding->insulin->K+, Mg2+, PO4 2- jump into the cell and get dangerously low in the serum-> heart problems

Question 18

Clinical manifestations of refeeding syndrome include

Answer 18

N/V, lethargy, rhabdomyolysis, respiratory and CV failure, hypotension, arrhythmias, seizures, coma, sudden death

Question 19

How to prevent refeeding syndrome

Answer 19

avoid overfeeding, monitor mag, phos, k, restrict fluid, give thiamine supplement

Question 20

What are medical complications associated with refeeding

Answer 20

gastroparesis, constipation, hypoglycemia, pseudo-batter, deconditioning