Eating Disorders Flashcards

1
Q

What screening tool can be used for eating disorders?

A

Can pick up eating disorders using the SCOFF questionnaire

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2
Q

Describe the SCOFF questionaire?

A
  • If patient scores 2 or more then an eating disorder likely
    • Do you make yourself Sick because you feel uncomfortable full
    • Do you worry you have lost Control over how much you eat
    • Have you recently lost more than One stone (14 pounds or 6.35kg) in a 3 months period
    • Do you believe yourself to be Fat when others say you are too thin
    • Would you say that Food dominates your life
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3
Q

What are some examples of eating disorders?

A
  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
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4
Q

Anorexia nervosa - pathology

A
  • Restriction of intake to reduce weight
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5
Q

Anorexia nervosa - diagnosis

A
  • Classified anorexia if he/she is 15% below ideal body weight/BMI 17.5
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6
Q

Anorexia nervosa - clinical features?

A
  • Fear of weight gain
  • Absence of menstrual cycle or amenorrhoea in postmenarchal females for greater than 3 cycles
  • Relies on compulsive compensatory behaviours when food cannot be avoided
    • Self-induced vomiting, laxative abuse, excessive exercise, abuse of appetite suppressants, diuretics
  • Signs of restricted calorie intake
    • Cold intolerance
    • Blue hands and feet
    • Constipation
    • Bloating
    • Delayed puberty
    • Primary or secondary amenorrhea
    • Dry skin
    • Fainting
    • Hypotension
    • Lanugo hair
    • Scalp hair loss
    • Early satiety
    • Weakness, fatigue
    • Short stature
    • Osteopenia and osteoporosis
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7
Q

What are signs of restriced calorie intake?

A
  • Cold intolerance
  • Blue hands and feet
  • Constipation
  • Bloating
  • Delayed puberty
  • Primary or secondary amenorrhea
  • Dry skin
  • Fainting
  • Hypotension
  • Lanugo hair
  • Scalp hair loss
  • Early satiety
  • Weakness, fatigue
  • Short stature
  • Osteopenia and osteoporosis
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8
Q

Bulimia nervosa - pathology

A
  • Episodes of binge eating with a sense of loss of control
  • Bing eating is followed by compensatory behaviour of the purging type
    • Self-induced vomiting, laxative abuse, diuretic abuse o
  • Or nonpurging type
    • Excessive exercise, fasting or strict diets
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9
Q

Bulimia nervosa - diagnosis

A
  • Binges and the resulting compensatory behaviour must occur a minimum of 2x per week for 3 months
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10
Q

Bulimia nervosa - clinical features

A
  • Dissatisfaction with body shape and weight
  • Mouth sores
  • Pharyngeal trauma
  • Dental caries
  • Heartburn, chest pain
  • Oesophageal rupture
  • Impulsivity
    • Stealing
    • Alcohol abuse
    • Drugs/tobacco
  • Muscle cramps
  • Weakness
  • Bloody diarrhoea
  • Irregular periods
  • Fainting
  • Swollen parotid glands
  • Hypotension
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11
Q

Binge eating disorder - pathology

A
  • Similar to bulimia nervosa, with absence of purging behaviours
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12
Q

Binge eating disorder - clinical features

A
  • Ongoing and/or repetitive cycles often include
    • Unusually fast eating, eating alone
    • Unusually large amounts consumed
    • Uncomfortably full
    • Embarrassed, shame, guilt, depression
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13
Q

What do you often see in avoidance of calorie intake?

A
  • Diets, becoming vegetarian or vegan
  • Not touching food or grease
  • Developing dislikes, pickiness, even ‘allergies’
  • Eating very slowly
  • Interpreting all symptoms as allergy or indigestion
  • Avoiding parties and social occasions
  • Spoiling or messing of food, bizarre combinations
  • Refusing to eat more than the person who eats least
  • Medication abuse
    • Appetite suppressants
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14
Q

What are some methods used for getting rid of calories?

A
  • Self-induced vomiting
  • Chewing and spitting out
  • Overexercise
  • Over activity
    • Obsessive housework, fidgeting, twitching, never sitting down, fetching one item at a time, carrying heavy loads
  • Cooling
    • Inadequate dress, open windows
  • Blood letting
  • Medication abuse
    • Caffeine, laxatives, pain killers
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15
Q

What medications can be abused to get rid of calories?

A
  • Medication abuse
    • Caffeine, laxatives, pain killers
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16
Q

What is ‘body checking’?

A
  • Body checking
    • Repeated weighing, mirror gazing, self-measurement, self-photographing, try on particularly tight clothes
    • Displaying emaciation to elicit reassuringly shocked attention
    • Cruising ‘pro-ana’ websites
    • Competing with self and others to attain lower and lower targets
    • Compulsive browsing of gossip magazines and websites
    • Deliberate self-harm if ‘rules’ are broken
17
Q

What are possible consequences of eating disorder?

A
  • Psychological consequences
    • Overvaluation of low weight and thin shape
    • Reduced central coherence and narrowed focus of interest
    • Starved person unable to interpret emotion
    • Malnourished brains experience depression, anxiety, obsessionality and loss of concentration
    • Depression at low weight rarely responds to medication
  • Social consequences
    • Normally honest people are forced to lie and cheat, even to steal
    • Withdraw from friendships and lose interest in sexual relationships
  • Physical consequences
    • Starvation causes physical damage, poor repair and resistance, heart damage, reduced immunity to infections, anaemia, bone loss and fertility problems
    • Purging behaviour causes neuro-chemical disruption with special damage to brain (seizures) and heart (arrhythmias)
    • Young people need good nutrition to grow, both body and brain
18
Q

What are the causes of eating disorder?

A

Predisposing factors:

  • Genetic predisposition
  • Perinatal factors
  • Life events and traumas
  • Perpetuating consequences of starvation and of avoidance

Precipitating factors:

  • Puberty
    • Physical effects of hormonal changes on brain, also psychological response to body changes
  • Dieting
  • Increased exercising
  • Stressful life events
    • Neglect, abuse, difficult transition, deaths, family breakup, bullying

Perpetuating factors:

  • Consequences of ‘starvation syndrome’
    • Delayed gastric emptying – sensation of fullness interpreted as fatness
    • Narrowing focus with avoidance of interpersonal interest
    • Obsessionality
19
Q

What are predisposing factors for eating disorder?

A
  • Genetic predisposition
  • Perinatal factors
  • Life events and traumas
  • Perpetuating consequences of starvation and of avoidance
20
Q

What are precipitating factors for eating disorder?

A
  • Puberty
    • Physical effects of hormonal changes on brain, also psychological response to body changes
  • Dieting
  • Increased exercising
  • Stressful life events
    • Neglect, abuse, difficult transition, deaths, family breakup, bullying
21
Q

What are perpetuating factors for eating disorder?

A
  • Consequences of ‘starvation syndrome’
    • Delayed gastric emptying – sensation of fullness interpreted as fatness
    • Narrowing focus with avoidance of interpersonal interest
    • Obsessionality
22
Q

What is a major complication of eating disorders?

A

Complications include:

  • Death
    • Highest mortality rate of any psychiatric disorder
23
Q

What is the treatment for eating disorders?

A
  • Re-feeding
  • CBT
    • Alternatively, IPT or fluoxetine
  • Olanzapine
  • Specialised family work for anorexia nervosa, particularly for younger patients

Remember their illness means they will defend behaviours, The Scottish Mental Health Act gives us responsibility to treat people even in absence of consent to save life or prevent serious deterioration