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Eating disorders Flashcards

Anorexia Nervosa Bulimia Nervosa OSFED

1
Q

Anorexia diagnosis

A

BMI < 18.5
Persistent pattern of behaviours to prevent restoration of normal weight
Body image distortion
Low body weight/shape central to self evaluation
Intense fear of gaining weight

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2
Q

Subtypes anorexia

A

Significantly low body weight < 14-18.5
Dangerously low body weight < 14
Restricting pattern
Bu he purging pattern
In recovery with normal body weight - healthy body eight, cessation of behaviours over a year

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3
Q

What is a dangerously low body weight

A

<14

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4
Q

BMI in anorexia

A

<18.5

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5
Q

Persistent weight pattern of behaviours to prevent restoration normal weight in anorexia

A

Dietary restriction
Excessive exercise
Purging - self induced vomitting, diuretics/laxatives/appetite supressants/enemas

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6
Q

Comorbidities anorexia

A

Depression
Anxiety
OCD
Personality disorders - avoidant, anankastic

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7
Q

Symptoms of starvation

A

Low mood
Labour mood
Irritability
Anxiety
Extreme distress
Rigidity
Loss libido
Social withdrawal
Poor concentration
Rituals
Compulsive behaviour
Personality changes

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8
Q

Medication for anorexia?

A

Often ineffective
Increased risk side effects

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9
Q

Is there a family history in eating disorders?

A

Yes

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10
Q

Risk factors eating disorders

A

Gender
Early puberty
Type 1 diabetes

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11
Q

Genetic factors

A

Anorexia - genetics affecting hunger hormones eg ghrelin - tolerate hunger better

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12
Q

Psychological risk anorexia

A

Temperament traits - perfectionism
Early experience or attachment
Early feeding behaviours
Life events
Low self esteem
Weight shape concerns

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13
Q

Risk social anorexia

A

Dieting industry
Professions
Upbringing
Acculturation - struggling in new culture
Social media

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14
Q

Which eating disorder has highest mortality of any psychiatric condition?

A

Anorexia

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15
Q

Physical risks of anorexia

A

Starvation
Compensatory behaviours
Falsifying weight
Related to re-feeding syndrome
More chronic problems - osteoporosis
Complications from mismanagement of diabetes

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16
Q

Lagopthalmos

A

Tape eyes to sleep as eye muscles to weak from hydration

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17
Q

Vomiting physical affects

A

Enamel erosion
Swollen parotid glands
Gastric and oesophageal trauma

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18
Q

Bloods when vomiting

A

Low chloride
Low potassium
Metabolic alkalosis
Amylase and bicarbonate increase
Treat hypokalemia

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19
Q

Hypokalemai sumtpksm

A

Muscle cramps
Tingling
Fatugue
Paliptiations
U wave on ECG

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20
Q

Laxatives effects

A

Increased water and electrolyte loss
Dehydration
Electrolyte imbalance - u Musial
Rectal bleeding
Abdominal bleeding
Rebound constipation - pseudo obstruction - reduce by 10% per week

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21
Q

Over exercise signs and symptoms

A

Physical exhaustion
Muscle damage injuries
Elevated Creatinine kinase
Rhabdomyolysis
Cardiac or ECG abnormalities
Bradycardia, heart block

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22
Q

Falsifying weight

A

Weights in shoes/hair/arm purse
Attempts tamper with scales
Excessive fluid

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23
Q

Reason for excess fluid intake

A

Hunger suppress
Anxiety manage
Deliberate weight falsify

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24
Q

What can over hydration cause

A

Hyponatremia

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25
Q

Re feeding syndrome physiology

A

Glucose increases, Insulin secreted
Potassium taken into cells with glucose
Phosphate, magnesium, potassium and thiamine all rapidly depleted
Leads to arrhythmia

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26
Q

What does re feeding syndrome cause

A

Low potassium/phosphate/magnesium
B12 deficiency - wernickes/korsakoffs
Sodium balance - oedema, cardiac failure

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27
Q

Who is re feeding syndrome Particularly high risk for

A

Very low BMI
Complete restriction/ rapid weight loss
Co-morbid alcohol dependence
Co-morbid physical health problems e.g. sepsis, cancer
Parenteral feeding > NG feeding > Oral diet

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28
Q

Risk to self

A

Low mood and hopelessness v common
Suicide - chronic anorexia
Self harm - binge and purge

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29
Q

Other risks eating disorders

A

Driving - difficult concentration, preoccupation with food, mood instability - impulsive
Duties at work
Child care
Activities
Universities - attendance guidance

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30
Q

What BMI shouldn’t drive at

A

<16

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31
Q

Assess physical risk

A

Weight height BMI, rate of weight loss
BP incl postural, pulse, temp
ECG
Sit up/squat test - SUSS
FBC, U+Es, KFY, glucose, bone, Mg

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32
Q

What happens to LFTs in starvation

A

Apoptosis in liver - go up

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33
Q

Sit up test + scoring

A

Patient lies down on floor and sitsup without using hands
0: Unable
1: Able only using hands to help
2: Able with noticeable difficulty
3: Able with no difficulty

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34
Q

Squat test

A

squats down and rises without using hands

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35
Q

Kings college guidelines

A
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36
Q

Symptoms of anorexia/ bulimia

A

Lenugo hair - fine hair all over body (anorexia)
Swollen parotid glands
Russells sign - nodules on knuckles from purging
Globe haemorrhages of eye
Erythema ab igne - laxatives + hot water bottle

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37
Q

Russell’s sign

A

Calluses on hands from vomiting

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38
Q

Erythema ab igne

A

Mottling of skin when use hot water bottle - excess use of laxatives

39
Q

Anorexia recovery

A

50% full recovery
30% improve
20% remain chronically I’ll
Early intervention model - 60% full recovery

40
Q

Why early intervention important

A

Different illness stages 1 brain plasticity and thought compulsion hardwiring

41
Q

Management nutrition

A

Dieticians and OT
Regular eating and snacks
Food prep, soho, cook
Eating in different situations and environments
Psychoeducation

42
Q

Aim weight gain per week

A

0.5-1kg per week

43
Q

Food restrictions to do with eating disorders

A

Vegetarianism’s and veganism
No vegan NG feeding - moral?

44
Q

Set point concept

A

Work towards a threshold that is genetically predisposed
Can go up but can go down
Psychoedycation - teach patient to trust body

45
Q

Management of ED

A

Nutritional
Psychoeducation

46
Q

Medical management anarexia

A

Reseeding syndrome
Monitor physical parameters
Olanzapine - antipsychotic (weight gain is side effect!
No mer for anorexia itself
NG feeding
Bed rest be chair rest
Frequency monitoring bloods/investigations/IBD

47
Q

Important bone investigations

A

DEXA scans, calcium supplements

48
Q

Treatment setting

A

GP, community, day service
Medical ward

49
Q

When admit to ward

A

Medically unstable
High risk re-feeding syndrome
Specialist eating disorders unit

50
Q

Psychological management EDs

A

MANTRA/SSCM
CBT
Psychodynamic therapy

51
Q

MANTRA

A

Maudsley Anorecia Nervosa Treatment

52
Q

Bulimia psychological help

A

Self help
CBT if severe

53
Q

Ego syntonic condition

A

Feel like illness is part of you - ingrained into personality and identity, difficult to challenge

54
Q

Ego dystonic condition

A

Recognised as intrusive/excessive
Don’t want but have it

55
Q

Motivation to chan her

A

Ambivalence - universal
Stages of change - prochaska +

56
Q

Low risk and ready to change

A

Standard treatment

57
Q

High risk and ready to change

A

Intensive treatment

58
Q

Low risk not ready to change

A

Motivational work
Discharge

59
Q

MHA - anorexia detain what need

A

2 doctors and an AMP (mental health social worker)
Risk of self neglect

60
Q

When can medical treatments be given against will

A

Symptom or manifestation treatment - NG feeding
Blood tests
Fluids

61
Q

Anorexia capacity

A

Difficult to assess
Severe anorexia normally don’t have capacity but coherent and articulate
Fluctuates hourly
Irrespective of capacity can be detained and treated under MHA if stay criteria are met

62
Q

MEED

A

Medical emergency eating disorders
BMI of 13
Admit to hospital

63
Q

I’d have eating dirsoder what can sepsis look like

A

V slightly raised WCC and neutrophils and temp - baseline is much lowe than normal so increase

64
Q

What is bulimia Nervosa?

A

Not significantly underweight
Preoccupation with body shape/weight which strongly influences self evaluation
Episodes of binge eating
Recurrent compensatory behaviours

65
Q

How often does a binge have to be to be a disorder

A

Once a week for a month

66
Q

Binge eatind disorder diagnosis

A

Frequent binges
Distressing and accompanied by negative emoitons - guilt/disgust
Not ass with compensatory behaviours
Discrete period of time
Subjective loss of control
More food than ususal

67
Q

Bone density

A

DEXA scan
Osteopenia vs osteoporosis
Calcium supplement
Alendornic acid
Restore bone density need weight restoration

68
Q

Stages of anorexia

A

Beliefs - body image distortion, fear of weight gain
Behaviour - dietary restriction, exercise, purging
Physical consequences - starvation, medical complications

69
Q

What models for stages of change are there?

A

Prochaska and Diclemente

70
Q

Prochaska and diclemente

A

Pre-contemplation - no intention on changing behaviour
Contemplation - aware a problem exists but with no commitment to action
Preparation - intent on taking action to adress problem
Action - active modification of behaviour
Maintenance - sustained change new behaviour replaces old
Relapse - fall back into old patterns of beahviour

70
Q

Prochaska and diclemente

A

Pre-contemplation - no intention on changing behaviour
Contemplation - aware a problem exists but with no commitment to action
Preparation - intent on taking action to adress problem
Action - active modification of behaviour
Maintenance - sustained change new behaviour replaces old
Relapse - fall back into old patterns of beahviour

71
Q

High risk not ready to change

A

Consider use of mental health act

72
Q

What do low WCC, neutrophils, glucose and high ALT, Alkaline Phosphate and normal, U+Es normal, 45 BPM show?

A

Starvation

73
Q

What does low WCC, glucose, potassium and chloride and high bicarb, Creatinine Kinase mean?

A

Vomitting

74
Q

Low WCC, neutrophils, glucose and sodium with normal ECG signal what?

A
75
Q

What do slightly raised WCC, neutrophils, temp 37.8 degrees and 110BPM signal in an anorexic patient?

A

Sepsis - lower baseline to start with

76
Q

Recurrent compensatory behaviours

A

Purging
Restricting
Exercise
Neglect insulin treatment

77
Q

What is ARFID defined as?

A

Abnormal eating/feeding resulting in insufficient quantity/variety of food
Significant weight loss/failure to gain weight
Negatively affective the health of the person/impaired functioning
Not due to concerns about body weight or shape
It isn’t about lack of food availability/effects of meds/substance use/underlying physical health condition

78
Q

What is the criteria for childhood anorexia?

A

BMI for age under fifth percentile in children and adolescents
Prepubertal onset – pubertal events delayed/arrested

79
Q

Men signs of anorexia

A

Loss of sexual interest or potency
Differences in idealised body shape – muscular strength, definition, physical fitness

80
Q

Pscyhological risk factors for eating disorders

A

Temperament traits - Perfectionism
Early experiences/Attachment
Early feeding behaviours
Life events
Low self-esteem
Weight shape concerns

80
Q

Pscyhological risk factors for eating disorders

A

Temperament traits - Perfectionism
Early experiences/Attachment
Early feeding behaviours
Life events
Low self-esteem
Weight shape concerns

81
Q

Social influences on eating disorders

A

Dieting industry
Professions – models, gymnasts, ballet, fashion, acting
Upringing
Acculturation
Social Media – which is worst platform?
Instagram

82
Q

How to nutritionally manage anorexia?

A

Dietiicians and OTs
Regular eating and snacks
0.5-1kg restoration per week aim for
Food prep, cookking, shopping
Psychoeducation

83
Q

Medical management of eating disorders

A

Treatment setting:
GP monitoring / Community / Day Service
Medical Ward (medically unstable, or high risk refeeding syndrome)
Specialist Eating Disorders Unit
Nasogastric feeding
Bed Rest vs Chair Rest
Frequency of monitoring bloods/investigations/obs
Observations
Leave

84
Q

Bone density in eating disorders what do?

A

DEXA scan
Osteopenia/porosis
Calcium supplement
Alendronic acid
-ONLY WAY to restore density is weight restoration

85
Q

What can be used off license for anorexia?

A

Low dose olanzapine

86
Q

Refeeding syndrome - whats importatn

A

Gradual calories but dont underfeed
Potassium, phosphate, magnesium, thiamine, vitamin B

87
Q

How decide if motivation to change?

A

Ambivalence universal - dont preclude treatment
Stages of change - prochaska and diclemente
Motivational enhancement
Externalissation (egosyntric disorder)

88
Q

MANTRA stages treatment anorexia

A

. Getting started and finding motivation for recovery

  1. Working with support, including families and others
  2. Improving nutritional health and dietetics
  3. Understanding anorexia, guided by the vicious flower
  4. Developing treatment goals (SMART)
  5. Understanding and relating to emotions helpfully
  6. Exploring thinking styles, and challenging styles that are rigid, perfectionist, attention to detail
  7. Developing identity outside of the eating disorder
  8. Relapse prevention
89
Q

Phases of SSCM

A

an initial orientation phase, which focuses on identifying target symptoms and
agreeing goals for weight gain and normal eating
a middle phase in which target symptoms are monitored, and support is focused on
encouraging weight gain via normal eating and reduction of other eating-disordered
behaviours
a final phase, which focuses on ending the intervention and planning the future

90
Q

What does specialist supportice clinical management of anorexia look like

A

Knowledge about therapy and purpose
Engagement
Assessment
Pscyhoeducation
Establish and review target symptoms
Monitor weight
Encourage normal eating
Supportive therapy
Maintenance

91
Q

What is rhabdomyolysis and how treat

A

Myocyte destruction
Causes raised CK - 5 x is diagnositc level
Fluid rehydration is treatment

Mental Health (57 decks)

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