Eating disorders

Question 1

List a screenin tool to use for eating disorders

Answer 1

SCOFF

Do you make yourself sick
Do you worry you have lost all control over how much you eat
Have you recently lost more than one stone (14 lbs) in a 1 month period
Do you believe yourself to be fat while others say you are too thin
Would you say food dominates your life

Question 2

List five things on physical exam you may see in eating disorders

Answer 2

Low Weight
Low BMI
Bradycardia
Hypotension
Dental erosions
Marks to knuckles
Palor
Lanugo hair

Question 3

What are some types of eating disorders (list three and their differences)

Answer 3

1. Anorexia: Restriction or energy relative to requirements with low body weight and fear of gaining weight
   (Can be restricting or purghing)
2. Bulemia: Binge eating with compensatory behavior (vomiting, exercising, laxatives etc) with image issues around weight
   -Has to happen at least once per week for 3 months
3. Eating disorder NOS
4. Binge eating disorder-Loss of control over what you are eating
5. Avoidant/Restrive Food intake disorder-Doesn’t have the low body weight that anorexia has

Amenorrhea is no longer required for diagnosis

Question 4

What do dx a thin gymnast who doesn’t have her period

Answer 4

Relative energy deficiency in Sport (no longer female athlete triad)

Question 5

List some common co morbidities

Answer 5

anxiety
OCD
Personality disorder
Depression

Question 6

What would you tell a family about prognosis of this condition

Answer 6

Highest mortality of all psych disorders

Question 7

Risk factors

Answer 7

Dieting in childhood
PRessure about weight
Sports
family history
Substance abuse
Psychiatric illness

Question 8

What BMI constitutes Mind Moderate and severe and extreme eating disorders

Answer 8

> 17=Mild
16-17=Moderate
15-16=Severe
<15=extreme

Question 9

What referrals could you make

Answer 9

Dietician
Group counseling
Family counseling**
ON line training
CBT
Yoga
Eating disorders clinic
ED if any metabolic abnormalities or unstable

Question 10

General treatments:

Answer 10

Family counseling
Dietician
Monitor closely
Target weight

Question 11

What investigations would you get

Answer 11

CBC
Extended lyste with phosphate
LFTs
TSH
Lipids
HCG
ECG
BMD
Echo

Question 12

Risk factors for refeeding and how to prevent

Answer 12

little or no intake for >10 days
Abnormal lytes
Rapid wt. loss

Admit
Monitor lytes and cluids
Refeed slowly

Question 13

Pharm management for Anorexia

Answer 13

SSRI (usually just for comorbid anxiety or depression but they probably have that so ends up being most people)

No SNRI or bupropion

Question 14

Pharm treatment for bulemia

Answer 14

Fluoxetine
Consider olanzapine for intrusive thoughts

Question 15

DDX for wt loss

Answer 15

Malignancy
Diabetes
Hyperthyroid
Celiac