Eating Disorders Flashcards
Define obesity
BMI greater than or equal to 30 or body weight 20% or greater over the ideal body weight
About 50% of patients with obesity experience ________
binge eating episodes
What are the four categories of obesity treatment?
- Behavior modification
- Medical therapy
- Medications
- Surgical
What are behavior modifications for obesity?
Exercise/ diet and group therapy
What medical therapy is indicated for obesity?
Antidepressants for underlying depression
What medications exist for obesity?
Orlistat and Lorcaserin
What is the MOA of Orlistat?
Decreases GI fat digestion
What is the MOA of Lorcaserin?
Serotonin agonist
What surgical options exist for obesity?
-Gastric bypass
-Gastric sleeve
-Gastric band
-Bariatric surgery
Who should be screened for obesity?
Everyone 6 and older
Binge Eating Disorder:
-Recurrent episodes of _______
-Severe distress over binge eating
-May be triggered by stress or mood changes
binge eating at least weekly for three months
Binge Eating Disorder:
-Recurrent episodes of binge eating at least weekly for three months
-Severe ________
-May be triggered by stress or mood changes
distress over binge eating
Binge Eating Disorder:
-Recurrent episodes of binge eating at least weekly for three months
-Severe distress over binge eating
-May be _______
triggered by stress or mood changes
Describe episodes of binge eatin
Recurrent episodes of eating within a 2 hour period more than people would eat in a similar period with lack of control during an overeating episode
Unlike Bulemia Nervosa, binge-eating episodes….
are not associated with compensatory behaviors, and they are not as fixated on the body shape or wait
What are the four managements for binge eating disorder?
- Psychotherapy
- Strict diet and exercise plan
- Topiramate
- Stimulants
Why is topiramate indicated for binge eating disorder?
Antiepileptic associated with weight loss
Define anorexia nervosa
Failure to maintain a normal body weight, fear and preoccupation with body weight, body image and being thin
Anorexia nervosa is most commonly seen in
Teenage girls ages 14-18 (often athletes, dancers etc)
There is a 60% incidence of _____ in anorexia nervosa
Depression
What psychiatric condition has the highest mortality rate and why?
anorexia nervosa secondary to arrhythmias
What are the clinical manifestations of anorexia nervosa?
Behaviors targeted at maintaining a low weight (excess water intake, food-related obsessions)
Is anorexia nervosa ego-syntonic or dystonic?
Syntonic
What are the two types of anorexia nervosa?
- Restrictive type
- Binge eating / purging type
What does restrictive anorexia nervosa present with?
Strict reduced calorie intake, dieting, fasting, excessive exercise and diet pills
What does binge/purging anorexia nervosa look like?
Self induced vomiting, diuretic, laxative or enema abuse
What can be seen on physical exam in anorexia nervosa?
-Emaciation
-Hypotension
-Bradycardia
-Skin or hair changes (lanugo)
-Dry skin
-Salivary gland hypertrophy
-Amenorrhea
-Arrhythmias
-Osteopenia
Russel’s Sign
What is Russel’s SIgn?
Callouses on the dorsum of the hand from self induced vomiting
What are the weight categories of anorexia nervosa?
BMI 17.5 or less OR body weight <85% of ideal weight
What are the diagnostic criteria of anorexia nervosa (3)
- Restriction of calories leading to significantly low body weight
- Intense morbid fear of fatness or gaining weight
- Distorted body image
What might be seen on labs of anorexia nervosa?
Hypokalemia
Lactic Acidosis
Maybe also:
-Increased BUN
-Hypochloremia
-Hypogonadotropic hypogonadism
-Hypothyroidism
What are the treatments for anorexia nervosa? (4)
- Medical stabilization
- Nutritional rehab
- Psychotherapy
- Pharmacotherapy
When should patients be hospitalized with anorexia nervosa?
<75% expected weight or significant complication
What is the most dangerous complication of anorexia nervosa?
Electrolyte imbalances > arrhythmias
What is the most common complication of nutritional rehab in anorexia nervosa?
Refeeding syndrome
What is refeeding syndrome?
Increased insulin leads to hypophosphatemia and cardiac complications
What medications may be useful in anorexia nervosa?
If depressed: SSRIs and atypical antipsychs
What is the basic definition of bulemia nervosa?
Binge eating combined with compensatory behaviors to prevent weight gain
What two things differentiate bulimia nervosa from anorexia?
- Bulimia usually maintains a normal weight (or even overweight)
- Bulimia behaviors are often dystonic
What three things may be seen on physical exam in bulimia nervosa?
- Teeth pitting or enamel erosion
- Russell’s Sign
- Parotid gland hypertrophy
What are the lab findings of bulimia nervosa?
Increased amylase (from salivary gland hypertrophy and vomiting)
Maybe also:
-Hypokalemia
-Hypomagnesemia
-Metabolic alkalosis
What are the diagnostic criteria for bulimia nervosa?
- Recurrent episodes of binge eating at least weekly for 3 months plus compensatory behaviors
-Perception of self worth excessively influenced by body shape and weight
What are the two types of compensatory behaviors in bulimia nervosa?
Purging type and nonpurging type
What are the behaviors of purging type in bulimia nervosa?
Primarily vomiting
DIuretic, laxative or enema abuse
What are the behaviors of non-purging type of bulimia nervosa?
Reduced calorie intake, dieting, fasting, excessive exercise and diet pills
What is the management of bulimia nervosa?
- Psychotherapy
- Fluoxetine
What is the only medication FDA approved for bulimia nervosa?
Fluoxetine
What are the dangers of fluoxetine in bulimia?
Cardiac effects, esp in the setting of electrolyte abnormalities.
