Eating disorders

Question 1

INVESTIGATION

i) name three differentials for weight loss
ii) three differnetials for amenorrhoea

Answer 1

i) GI - coeliac, IBD, PUD, malignancy
drugs or alcohol, endocrine - diabetes, hyperthyroid

ii) pregnancy, PCOS, hypothalamic

Question 2

ANOREXIA NERVOSA

i) name two clinical features?
ii) wha compesatory behaviours may be seen? what is there intense fear of?
iii) what BMI is AN? what is medium risk? what is high risk?
iv) name three situations where you would refer a patient to specialist services?

Answer 2

i) low body weight (BMI <18.5) not due to another health condition
- persistent pattern of behavs to prevent restoration of normal eight

ii) reduced eating, purging (vomiting or laxatives), behaviours to increase energy expenditure
- intense fear of gaining weight

iii) AN is <18.5
med risk 13-15
high risk <13

iv) rapid weight loss >1kg per week, BMI <15, other concerns/complications/RFs, severe psych comorbids

Question 3

BULIMIA NERVOSA

i) how it characterised?
ii) what behaviours may be seen? what is the person preoccupied with?
iii) what body weight may be seen

Answer 3

i) charac by frequent, recurrent episodes of binge eating
- binge eating over distinct period of time > loss of control over eating

ii) compensatory behaviours to prevent weight fain eg vomiting, laxitives, exercise
iii) normal or high BMI

Question 4

REFEEDING SYNDROME

i) what is it? after how many days of re instating food does it occur?
ii) what happens to electrolytes? which five are affected
iii) name three systemic effects it has? name two cardiac effects? what can happen in severe cases
iv) name three things that need to be monitored? what two thigns can be prescribed?
v) what calorie intake should be started

Answer 4

i) dangerous and potentially fatal complication
- occ 1-5 days after eating is reinstated following a period of starvation

ii) rapid shift in electros back into cells > drawn out during starvation
- phosphate, potassium, magnesium, calcium, thiamine

iii) systemic - weakness, confusion, resp depress, high BP, liver dysfunc, rhabdomyolysis
cardiac - arrhyhtmia, QT prolong, ST/T change, pericarditis, HF
severe - cardiac fail, seizures, coma and death

iv) monitor electrolytes, ECG and physical observations
- prescribe theamine and vit B - pabrinex

v) start on low calorie intake and gradually increase (250 cals per day)

Question 5

PSYCHOLOGICAL THERAPIES FOR ANOREXIA

i) what is the most commonly used approach? how does it help?
ii) name two other types of therapy
iii) is there a role for medication
iv) what is the prognosis? how can outcomes be improved

Answer 5

i) CBT - develop healthy eating behavs, explore psych issues around food
ii) family therapy, psychodyamic psychotherapy (explore what the symps mean to the person and how it affects them and others)

iii) limited role - only for comorbid conditions
- adverse drug reacs are more common in malnouished people

iv) anorexia has the highest mortality rate of all mental health disorders
- offer support early and long term therapies to improve outcomes