Eating disorders Flashcards
define russells sign
*-what elser can also be present
characterisitc abrasion, small lacerations and calluses on back of hand overlying the knuckles
-caused by repeated contact of the fingers with teeth during self-induced vomiting episodes
-common in bulimia
*-discolouration of the teeth
criteria for bulimia nervosa diagnosis 4
recurrent episodes of overeating
-twice a week for three months
self perception of being too fat and intrusive dread of fatness
persistent preoccupation with food
attempts to counteract fattening aspect of food by:
-self induced vomiting
-purgative abuse
-alternating periods of starvation
-use of drugs
mainstay of management of bulimia nervosa for adults 1
bulimia nervosa focused guided self help programmes
-CBT self help materials for eating disorders
-if unefffective consider eating disorder focused CBT (CBT-ED)
what should eating disorder CBT (CBT-ED) consist of 4
20 sessions over 20 weeks
first phase
-engagement and education
-establish regular eating and provide encouragement advice and support
follow by psychopathology
towards end of treatment spread out appointments and focus on maintaining risk of relapse
if appropriate involve significant others to help
mainstay of management of bulimia nervosa in children and young people 1
bulimia nervosa focuse faimily therapy
describe bulimia nervosa focused family therapy 4
18-20 sessions over 6 months
establish good tehrpeytic relationship w person and family
support and encourage family to help person recover
include info about regulating body weight etc
support developing a level of independence and relapse prevention
*_if unacceptable, CI or ineffective consider CBT-ED
aspects of CBT 5
[32]
what category does binge eating disorder fall under
ICD 10 other eating disorder
define binge eating disorders 5
regular binge eating
3/5 of:
-eating much more quickly than usual
-eating until uncomfortably full
-eating a lot when not hungry
-eating alone because of embarrassment
-feeling very bad or guilty after eating
management of bing eating disorder 2
CBT self help material
focus on adherence to self help programme
-supplement self help programme w brief supportive sessions
if guided self help unacceptable, CI or ineffective after 4 weeks- offer group CBT-ED
criteria for anorexia diagnosis 4
weight loss (or in children lack of weight gain)
-leading to body weight AT LEAST 25% BELOW NORMAL OR EXPECTED FOR AGE AND HEIGHT
weight loss self induced by avoidance of fattening foods
self perception of being too fat
-leads to self imposed low weight threshold
widespread endocrine disorder involving hypothalamic-pituitary-gonadal axis
-manfests as amenorrhea
-in men as loss of sexual interest and potency
gender bias for anorexia and prognosis
M:F 1:10
5% mortailty rate
50% recover with treatment
define atypical eating disorders
also known as eating disorder not otherwise specified
-affects approx half of all people with an eating disorder
called atypical if they do not fit exactly into diagnostic categories
-for example person may have but syx of anorexia or bulimia but not all
-may have syx of both conditions
-may move from one condition to another
management of atypical eating disorders
recommened that the clinican considers following the guidance on treatment of eating problem that most closely resembles individual patients eating disorder
main physical complciatoins of anorexia nervosa 6
bradycardia
amenorrhea
constipation
<eGFR
anaemia, hair loss
refeeding syndrome
what are risks of refeeding syndrome and who gets it 6
if have more than 20 consecutive days of negligible nutrient intake
occurs within 10 days of starting to feed
patients can develop:
-fluid and electrolyte disorders (esp hypophosphatemia)
-hypocalcamiea and hypomagnaeisa can also occur
-cardiac arrhythmia most common cause of death
-confusion
-coma
-convulsions
-cardiac failure
basic pathophys of refeeding syndrome
shifting of electorlytes and fluid balance increases cardiac workload and heart rate
O2 consumption also decreased with strains the respiratory system and can make weaning from ventilation more difficult
management of anorexia nervosa for adults 2
CBT-ED
-Maudsley anorexia nervosa treatment for adults (MANTRA)
if unacceptable
-try one of the others or eating disorders focused focal psychodynamic therapy
aspects of indivudal CBT-ED for anorexia
Consist of up to 40 sessions over 40 weeks with twice weekly sessions in the first 2-3 weeks
Aim to reduce the risk to physical health and any other symptoms of eating disorder
Encourage healthy eating and reach a healthy body weight
Consider nutrition, cognitive restructuring, mood regulation, social skills, body image concern, self esteem and relapse prevention, create a personalised treatment plan, explain risks of malnutrition, enhance self efficacy, self monitoring of intake and thoughts and feelings, homework
management of anorexia nervosa in children and young people 1
anorexia nervosa focused family therapy
aspects of anorexia nervosa focused family therapy 6
18-20 sessions
emphasis role of family in helping them recover
psychoeducaiton about nutrition and malnutrition
establish good therapeutic alliance with the person
latterly support the person to establish a level of independence
relapse prevention
describe MARSIPAN for anorexia
: Management of Really Sick Patients with Anorexia Nervosa
Concerns that a number of patients with severe anorexia nervosa were being admitted to general medical units and sometimes deteriorating and dying
Focus on patients with BMI<15
Contains guidance for clinicians looking after MARSIPAN patients on acute medical wards and psychiatric wards, but also includes service recommendations e.g. most MARSIPAN patients should be admitted to a SEDU, treated by local expert physician with interest in nutrition/ nutrition team
physical risk assessment in patients with eating disorders 6
BMI and rate of weight loss
CV risk- BP, pulse, ECG
Glucose level/ albumen level
electrolyte abrnomalites
liver function abnormlaites
bone marrow abnormalites
what electrolytte abnormalities could be caused by eating disorders 3
low sodium
low potassium
altered eGFR
what bone marrow abnormlaites can be found in eating disorders 3
low WCC
low Hb
low platelets
what particular concern can happen in patients with eating disorders after discharge and how is the address
can often have a low potassium
this can recucr after discharge with sometimes fatal results
if patient had IV replacement
-bloods should be checked frequently thereafter including post discharge
overview of refeeding syndrome
[33]
criteria for patients athigh risk of developing refeeding problems 6
BMI <16
weight loss >15% in last 3-6mnths
little or no nutritional intake for more than 10 days
low K, phosphate or Mg prior to feeding
Hx of alcohol abuse or drugs
presecn of purging behaviours
management of refeeding
oral thiamine, vit B and balance multivitamim
-before and during first 10 days of feeding
start at 20kcal/kg/day then gradulay increase caloric intake dependent on daily bloods
monitoring of refeeding 6
daily regular bloods
-close monitor Mg, K and phosphate
ECG
fluid balance
bowels
monitor for oedema, BP, pulse, sats
other consideratinos for inpatient care of patients with eating disorders
Consider bed rest (BMI<13) and DVT prophylaxis, partial bed rest (BMI 13-15)
Supervised washes only (BMI<13), supervised showers (BMI 13-15)
Tissue viability risk assessment, airflow mattress
Fluid input/ output charts
Access to toilets/ taps
Meal and snack supervision and post meal and snack supervision
Leave
Frequency of physical observations
Frequency of BMs
ALERT on Kardex regarding low BMI: For dose reductions for symptomatic relief and cautious use of sedative medication
