Eating Disorders Flashcards
1
Q
What are the ICD 11 changes for anorexia criteria?
A
no longer a specific BMI cut off and no longer have to have amenorrhoea
2
Q
Criteria for anorexia?
A
- Significant low body weight for individuals height, age, developmental stage or weight history (commonly used threshold is BMI < 18.5 but also think about rapid weight loss in individuals or failure to gain weight in growing children/ adolescents)
- Low body weight is not better accounted for by another medical condition or unavailability of food
- A persistent pattern of restrictive eating or other behaviours aimed at establishing or maintaining abnormally low body weight, typically with extreme fear of weight gain e.g. fasting, slow eating of small amounts of food, hiding or spitting out food, purging behaviours
- Excessive preoccupation with body weight or shape
3
Q
Boundary between anorexia and bulimia?
A
basically those with anorexia may participate in binge purge behaviour but difference is the low body weight
those with anorexia may go on to develop bulimia if they regain normal weight and then start binge purging
4
Q
What condition has the highest mortality of all psychiatric illnesses?
A
anorexia
5
Q
Co-morbidity in anorexia?
A
- Co-morbidity with other psychiatric conditions is common, particularly anxiety, depression and OCD, there is also increasing evidence that many patients with anorexia meet the criteria for ASD
6
Q
How long does it usually take for patients with anorexia to present?
A
3 years
7
Q
Psychiatric features and behaviours of anorexia?
A
- Patients generally eat little but are obsessed by food
- They have obsessional ruminations on food, body shape and exercise
- Altered mood and irritable
- Social withdrawal
- Cognitive deficits
- Mimics depression
- Sleep disturbance
- Use food fads to explain diet
- Odd eating behaviours e.g. cutting food into very small pieces and eating slowly
- Over or under drinking fluids
- Secretiveness
8
Q
Physical features of anorexia?
A
- Sensitivity to cold
- Potential amenorrhoea (although this has been removed as diagnostic criteria now)
- Hypotension
- Bradycardia
- If they use laxatives or vomiting they may have electrolyte abnormalities
- If they use vomiting they may have dental problems
- Vitamin, mineral or potassium deficiencies can cause peripheral paraesthesia, tetany or seizures
- Signs of renal and hepatic damage due to starvation
- Loss of fat causes amenorrhoea, reduced body temperature and abnormal thyroid function
9
Q
Management of anorexia?
A
- Outpatient management unless severe weight loss with marked CVS signs and/ or electrolyte and vitamin disturbances
- If in hospital may get oral or artificial nutrition with close monitoring
- Family based therapy is 1st choice in children and adolescents
- Many other therapies available e.g. CBT, interpersonal therapy
- Medications should never be offered as a sole treatment, antidepressants may be offered for low mood, olanzapine or quetiapine may be used in severe cases off license to manage anxiety/ obsessions around refeeding
- Remember paediatric doses of medication if low body weight!
10
Q
If giving medications for anorexia what do you need to remember?
A
paediatric doses
11
Q
What is refeeding syndrome?
A
- Occurs on increasing nutritional intake after period of starvation
- Intracellular movement of electrolytes (potassium, phosphate, magnesium)
- Potentially fatal due to cardiac compromise (also other organ issues)
12
Q
How do you reduce the risk of refeeding syndrome?
A
- To avoid slow gradual increase in calorific intake and daily blood monitoring, replacing abnormalities, high phosphate foods, lower carb e.g. use of supplements initially
- Risk generally lower in community but be careful if people think they should eat loads to avoid admission
13
Q
Diagnostic criteria for bulimia?
A
- Frequent recurrent episodes of binge eating (discrete period of time where lose control over eating)
- Repeated inappropriate compensatory behaviours to prevent weight gain – most commonly self induced vomiting, others include fasting, diuretics, enemas, excessive exercise
- Excessive preoccupation with body weight or shape
- Marked distress about pattern of binge eating and compensatory behaviour or significant impairment in functioning
- Symptoms do not meet criteria for anorexia
14
Q
Clinical features of bulimia?
A
- There is commonly co-morbid depression
- Often alcohol and substance misuse
- Impulsive behaviours e.g. shop lifting are common
- Dental caries
- The person may be normal weight
- Russel’s sign: calluses on the back of their hands due to self-induced vomiting
- Parotid hypertrophy
- U and Es abnormal (hypokalaemia, alkalosis)
- Irregular periods (amenorrhoea is rare)
15
Q
Management and prognosis of bulimia?
A
- This has a better prognosis that anorexia nervosa
- Individual or group CBT
- High dose fluoxetine has been shown to reduce cravings for food
