Eating disorders

Question 1

Anorexia nervosa

Answer 1

Most common cause of admissions to CAHMS wards
90% are female

Question 2

Diagnosis

Answer 2

Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory and physical health

Intense fear of gaining weight or becoming fat even though underweight

Disturbance in the way in which one’s body weight or shape is experienced

Question 3

Management

Answer 3

Individual eating disorder focused CBT

Maudsley anorexia nervosa treatment for adults

Specialist supportive clinical management

Question 4

Management for children and young people

Answer 4

Anorexia focused family therapy first line

Question 5

Anorexia features

Answer 5

Reduced BMI

Bradycardia

Hypotension

Enlarged salivary glands

Question 6

Anorexia physiological abnormalities

Answer 6

Hypokalaemia

Low FSH, LH, oestrogens and testosterone

Raised cortisol and growth hormone

Impaired glucose tolerance

Hypercholesterolaemia

Hypercarotinaemia

Low T3

Question 7

Bulimia diagnosis

Answer 7

Recurrent episodes of binge eating

Sense of lack of control over eating during the episode

Recurrent inappropriate compensatory behaviour in order to prevent weight gain (vomiting, laxatives, diuretics, fasting, exercise)

On average once a week for 3 months

Question 8

Bulimia physical signs

Answer 8

Erosion of teeth

Russell’s sign (calluses on knuckles)

Question 9

Bulimia management

Answer 9

Referral for specialist care

Bulimia-nervosa-focused guided self-help for adults

If unacceptable/ contraindicated/ ineffective after 4 weeks consider CBT-ED

Children should be offered bulimia-nervosa-focused family therapy

High-dose fluoxetine is currently licensed for bulimia