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2. General adult psychiatry > Eating disorders > Flashcards

Eating disorders Flashcards

1
Q

Three major types of eating disorders seen in ICD 10

A

Anorexia nervosa
Bulimia nervosa
Eating disorder not otherwise specified

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2
Q

Percentage of patients with bulimia who have a history of anorexia

A

25-33%

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3
Q

Eating disorders seen in ICD 11

A

Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Avoidant-restrictive food intake disorder
Pica
Rumination-regurgitation disorder
Other specified feeding or eating disorders

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4
Q

Criteria for anorexia nervosa in ICD 11

A

Significantly low body weight (e.g. BMI <18.5) or rapid weight loss (e.g. 20% of body weight in 6 months)
Persistent pattern of restrictive eating or other behaviours aimed at reducing body weight/maintaining low body weight
Excessive preoccupation with body weight or shape

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5
Q

BMI required for adults with ‘anorexia with significantly low body weight’ in ICD 11

A

14-18.5

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6
Q

Percentile BMI required for children and adolescents with ‘anorexia with significantly low body weight’ in ICD 11

A

0.3-5th percentile for BMI for age

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7
Q

BMI required for adults with ‘anorexia with dangerously low body weight’ in ICD 11

A

<14

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8
Q

Percentile BMI required for children and adolescents with ‘anorexia with dangerously low body weight’ in ICD 11

A

<0.3rd percentile for BMI for age

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9
Q

Behaviour patterns specified for anorexia nervosa in ICD 11

A

Restricting pattern
Binge-purge pattern
Unspecified

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10
Q

Definition of binge eating

A

A discrete period of time during which the individual loses control of their eating and eats notably more or differently than usual

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11
Q

Criteria for bulimia nervosa in ICD 11

A

Frequent recurrent episodes of binge eating
Repeated inappropriate measures to prevent weight gain
Excessive preoccupation with body weight or shape
Distress about the pattern of eating
Does not meet criteria for anorexia nervosa

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12
Q

Most common compensatory behaviour to prevent weight gain in bulimia nervosa

A

Vomiting

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13
Q

Frequency of binges and compensatory behaviours required for a diagnosis of bulimia nervosa in DSM V

A

Once weekly

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14
Q

Class distribution of anorexia nervosa

A

Excess in higher social classes

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15
Q

Class distribution of bulimia nervosa

A

Even class distribution

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16
Q

Usual age of onset of anorexia nervosa

A

15-19

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17
Q

Usual age of onset of bulimia nervosa

A

Young adulthood

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18
Q

Prevalence of anorexia nervosa among teenage girls

A

0.5-1%

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19
Q

Percentage of patients with anorexia nervosa who also have depression

A

65%

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20
Q

Eating disorder with the highest heritability

A

Anorexia nervosa

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21
Q

MZ concordance for anorexia nervosa

A

55%

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22
Q

MZ concordance for bulimia nervosa

A

35%

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23
Q

DZ concordance for anorexia nervosa

A

5%

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24
Q

DZ concordance for bulimia nervosa

A

30%

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25
Q

Criteria for binge eating disorder in ICD 11

A

Frequent, recurrent episodes of binge eating
Not regularly accompanied by inappropriate compensatory behaviours aimed at reducing weight gain
Marked distress or impairment in functioning
Not better accounted for by another medical condition

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26
Q

Usual length of time symptoms should be present for a diagnosis of binge eating disorder

A

3 months

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27
Q

Criteria for ARFID in ICD 11

A

Avoidance or restriction of food that leads to inability to meet nutritional requirements, or impairment in functioning or distress
Behaviour not motivated by preoccupation with weight or body shape
Not a result of lack of food, medical condition, other mental disorder, or medication

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28
Q

Male:female ratio for binge eating disorder

A

1:3

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29
Q

Definition of fine downy hair seen on the body of patients with EDs

A

Lanugo

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30
Q

Sign seen in patients with EDs where the knuckles are calloused due to repeated induced vomiting

A

Russel’s sign

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31
Q

Medical complications of repeatedly induced vomiting

A

Russel’s sign
Parotid and submandibular gland swelling (sialadenosis)
Erosion of inner surface of front teeth
QTc prolongation
Slowed GI motility
Oesophagitis or Mallory-Weiss syndrome
Epistaxis
Subconjunctival haemorrhage

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32
Q

Endocrine abnormalities seen in patients with EDs

A

Low LH, FSH, and oestradiol
Low T3, normal T4
High plasma cortisol
High growth hormone
Low glucose
Low leptin (but may be higher than expected for weight)

33
Q

Thyroid abnormalities seen in patients with EDs

A

Low T3
Normal T4

34
Q

Sex hormone abnormalities seen in patients with EDs

A

Low LH
Low FSH
Low oestradiol

35
Q

Cortisol abnormality seen in patients with EDs

A

High cortisol

36
Q

Growth hormone abnormality seen in patients with EDs

A

High growth hormone

37
Q

FBC abnormalities seen in patients with EDs

A

Normocytic normochromic anaemia
Leucopaenia
Relative lymphocytosis
Thrombocytopaenia

38
Q

Cholesterol abnormality seen in patients with EDs

A

High cholesterol

39
Q

Serum carotene abnormality seen in patients with EDs

A

High serum carotene

40
Q

Most effective treatment for bulimia nervosa

A

CBT

41
Q

Percentage of patients with bulimia nervosa who make a complete and lasting recovery

A

33-50%

42
Q

First choice antidepressant for patients with bulimia nervosa

A

Fluoxetine

43
Q

Number of treatments of CBT usually used for patients with bulimia nervosa

A

16-20

44
Q

Psychosocial treatments with evidence for anorexia nervosa

A

CBT
Maudsley anorexia nervosa treatments for adults (MANTRA)
Specialist supportive clinical management
Focussed psychodynamic therapy

45
Q

Poor prognostic features of anorexia nervosa

A

Male sex
Late onset
Long duration of symptoms
Low BMI
Purging
Psychiatric comorbidities
Anxiety when eating in front of others

46
Q

Good prognostic features of anorexia nervosa

A

Shorter duration of symptoms
Good premorbid functioning
Good parental relationships
Stable life situation
Good family acceptance

47
Q

Most common cardiac abnormalities in anorexia nervosa

A

Bradycardia
QT prolongation

48
Q

Male:female ratio for anorexia

A

1:10

49
Q

Eating disorder with the highest rate of spontaneous remission

A

Binge eating disorder

50
Q

Core feature of a binge episode

A

Experience of a loss of control while eating

51
Q

Sex less likely to seek treatment for bulimia nervosa

A

Males

52
Q

Compensatory behaviours more often used by females in bulimia nervosa

A

Vomiting
Laxative use

53
Q

Compensatory behaviours more often used by males in bulimia nervosa

A

Exercise
Steroids

54
Q

Features of rumination regurgitation disorder

A

Intentional bringing up of previously swallowed food to the mouth
Either re-swallowing the food or spitting it out
Regurgitation occurs several times a week

55
Q

Sex with an earlier age of onset of anorexia nervosa

A

Females

56
Q

Medical complications of food restriction and very low weight

A

Renal failure
Peripheral oedema
Bradycardia
QTc prolongation
Pericardial effusion
Valve prolapse
Slowed GI motility and constipation
Hair loss
Dry skin and lanugo hair
Muscular weakness
Hypothermia
Osteoporosis

57
Q

Reason why patients with anorexia nervosa are at higher risk of hepatotoxicity following a paracetamol overdose

A

They are likely to lack glutathione
Glutathione conjugates benzoquinonimine, which is the hepatotoxic metabolite of paracetamol

58
Q

Percentage of patients with anorexia nervosa who would be expected to have recovered fully in 30 years

A

50%

59
Q

Percentage of patients with anorexia nervosa who would be expected to have recovered partially in 30 years

A

33%

60
Q

Percentage of patients with anorexia nervosa who would be expected to have a continuing ED in 30 years

A

20%

61
Q

Percentage of patients with anorexia nervosa who would be expected to have died in 30 years

A

5%

62
Q

Nutrient deficiency associated with eating clay in pica

A

Zinc

63
Q

Features that suggest hospital admission should be considered in anorexia nervosa

A

BMI <13
Pulse <40
SUSS test score <2
Sodium <130
Potassium <3
Serum glucose <3
QTc >450

64
Q

Maximum score in the sit up squat stand test where the patient is able to rise without difficulty and without the use of their hands

A

3

65
Q

Hours of bed rest per day recommended for a patient with BMI <13 with anorexia nervosa

A

24

66
Q

Cause of Takotsubo cardiomyopathy seen in anorexia nervosa

A

Coronary vasospasm

67
Q

Features of Takotsubo cardiomyopathy

A

Rarely seen in anorexia nervosa
Similar presentation to MI
Cardiac enzymes usually raised
Usually mild and self limiting but can cause cardiogenic shock

68
Q

Substance ingested in the amylophagia form of pica

A

Starch

69
Q

First line treatment options for anorexia nervosa

A

CBT
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
Specialist supportive clinical management (SSCM)

70
Q

First line treatment for anorexia nervosa in patients <18

A

Anorexia nervosa focused family therapy

71
Q

Recommendations on medication treatment as the only treatment for anorexia nervosa

A

Should not be offered

72
Q

First line treatment for bulimia nervosa

A

Evidence-based self-help programme

73
Q

Second line treatment for bulimia nervosa

A

CBT

74
Q

First line treatment for bulimia nervosa in paitents <18

A

Bulimia nervosa focused family therapy

75
Q

First line treatment for binge eating disorder

A

Guided self-help programme

76
Q

Second line treatment for binge eating disorder

A

Group CBT

77
Q

Advice for oral hygiene after vomiting

A

Avoid brushing teeth
Rinse with a non-acid mouthwash

78
Q

Effect of laxatives and diuretics on calorie consumption

A

Little to none

2. General adult psychiatry (9 decks)

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