Eating Disorders

Question 1

What is the first line treatment for children and young people with anorexia nervosa?

Answer 1

Anorexia focused family therapy.

Question 2

What is the most common cause of admissions to child and adolescent psychiatric ward?

Answer 2

Anorexia nervosa.

Question 3

What changes in the oral cavity are seen in bulimia nervosa?

Answer 3

Tooth erosion.

Question 4

Describe the purging behaviours in bulimia

Answer 4

Vomiting, laxatives, diuretics, exercising.

Question 5

Define eating disorder

Answer 5

Mental disorder defined by abnormal eating habits that negatively affect a persons physical and mental health.

Question 6

What is the role of the MHA in the management of a patient with an eating disorder?

Answer 6

Feeding against a patient will should only be done in the context of the MHA or Children Act. Highly specialised procedure.

Question 7

List some complications of anorexia nervosa

Answer 7

Hypokalaemia, hyponatraemia.
Hypotension.
Arrhythmias.
Anaemia.
Hypoglycaemia.
Osteoporosis.
Infertility, amenorrhoea.
AKI or CKD.
Frequent severe infections.
Anxiety and mood disorders.

Question 8

What is the BMI for anorexia nervosa?

Answer 8

<17.5 kg/m2

Question 9

List some complications of bulimia nervosa

Answer 9

Haematemesis.
Metabolic abnormalities.
Electrolyte imbalances leading to arrhythmias, renal impairment and muscular paralysis.
Dental erosions.
Salivary gland enlargement.
Anorexia (in 10-15%).

Question 10

What is one of the first visible signs of refeeding syndrome?

Answer 10

Peripheral oedema.

Question 11

What is the most common cause of death from refeeding syndrome?

Answer 11

Cardiac arrhythmias.

Question 12

Define anorexia nervosa

Answer 12

Eating disorder characterised by restriction of energy intake resulting in low body weight and an intense fear of weight gain.

Question 13

What percentage of patients with anorexia nervosa are female?

Answer 13

90%

Question 14

Which ages are at high risk of anorexia nervosa?

Answer 14

13-18

Question 15

Describe the risk factors associated with anorexia or bulimia

Answer 15

Female, younger age, FHx, previous criticism of eating habits and weight, increased pressure to be slim, sexual abuse, low self-esteem, obsessive personality, BPD, abuse/trauma.

Question 16

Describe the clinical features of anorexia nervosa

Answer 16

Low BMI, bradycardia, hypotension, enlarged salivary glands, lanugo hair, failure of secondary sexual characteristics, cold intolerance, amenorrhoea, anxiety & depression.

Question 17

Describe the physiological abnormalities seen in anorexia nervosa

Answer 17

Raised cortisol and GH, hypercholesterolaemia, hypercarotinaemia, impaired glucose tolerance, low T3, hypokalaemia and low FSH, LH, oestrogen and testosterone.

Question 18

Describe the main parts of the DSM 5 diagnostic criteria for anorexia nervosa

Answer 18

Restriction in energy intake leading to a low body weight.
Intense fear of gaining weight.
Disturbance in the way in which one’s body weight/shape is experienced.

Question 19

What is the management for adults with anorexia nervosa?

Answer 19

Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED).
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA).
Specialist supportive clinical management (SSCM).

Question 20

What is the management for children and young people with anorexia nervosa?

Answer 20

Anorexia focused family therapy.

Question 21

Define bulimia nervosa

Answer 21

Eating disorder characterised by binge eating followed by purging.

Question 22

In bulimia nervosa, is an individuals body weight underweight, normal or overweight?

Answer 22

Normal, but it tends to fluctuate.

Question 23

At which age do individuals commonly suffer with bulimia nervosa?

Answer 23

20s & 30s

Question 24

What are the symptoms of bulimia nervosa?

Answer 24

Purgative behaviours, binge eating behaviours, distress over body image, frequent bathroom trips after meals, mood disturbance and anxiety.

Question 25

What is Russell’s sign?

Answer 25

Calluses on knuckles where they’ve scraped against the teeth due to repeated self-induced vomiting.

Question 26

What are the clinical signs seen in bulimia nervosa?

Answer 26

Normal body weight, tooth erosion, enlarged salivary glands, abdominal pain, mouth ulcers, gastro-oesophageal reflux and irritation, alkalosis, hypokalaemia, Russell’s sign.

Question 27

What causes alkalosis in bulimia nervosa?

Answer 27

Loss of HCl from stomach upon vomiting.

Question 28

Sum up the main points from the DSM 5 diagnostic criteria for bulimia nervosa

Answer 28

Recurrent episodes of binge eating.
Lack of control.
Recurrent purging behaviours.
Occurring once a week for 3 months.
Self-evaluation unduly influences by body shape and weight.

Question 29

What is the management for adults with bulimia nervosa?

Answer 29

Bulimia-nervosa-focused guided self-help.
CBT-ED.
High-dose fluoxetine.

Question 30

What is the management for children with bulimia nervosa?

Answer 30

Bulimia-nervosa focused family therapy.

Question 31

Define binge eating disorder

Answer 31

Eating disorder characterised by episodes of excessive overeating, often as an expression of psychological distress. Patients likely to be overweight.

Question 32

Define refeeding syndrome

Answer 32

Poetically fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding.

Question 33

What 3 electrolyte abnormalities occur in refeeding syndrome?

Answer 33

Hypomagnesaemia.
Hypokalaemia.
Hypophosphataemia.

Question 34

Which psychiatric illness has the highest mortality rate?

Answer 34

Anorexia nervosa.