Eating disorders Flashcards
Three major types of eating disorders seen in ICD 10
Anorexia nervosa
Bulimia nervosa
Eating disorder not otherwise specified
Percentage of patients with bulimia who have a history of anorexia
25-33%
Eating disorders seen in ICD 11
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Avoidant-restrictive food intake disorder
Pica
Rumination-regurgitation disorder
Other specified feeding or eating disorders
Criteria for anorexia nervosa in ICD 11
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
BMI required for adults with ‘anorexia with significantly low body weight’ in ICD 11
14-18.5
Percentile BMI required for children and adolescents with ‘anorexia with significantly low body weight’ in ICD 11
0.3-5th percentile for BMI for age
BMI required for adults with ‘anorexia with dangerously low body weight’ in ICD 11
<14
Percentile BMI required for children and adolescents with ‘anorexia with dangerously low body weight’ in ICD 11
<0.3rd percentile for BMI for age
Behaviour patterns specified for anorexia nervosa in ICD 11
Restricting pattern
Binge-purge pattern
Unspecified
Definition of binge eating
A discrete period of time during which the individual loses control of their eating and eats notably more or differently than usual
Criteria for bulimia nervosa in ICD 11
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
Most common compensatory behaviour to prevent weight gain in bulimia nervosa
Vomiting
Frequency of binges and compensatory behaviours required for a diagnosis of bulimia nervosa in DSM V
Once weekly
Class distribution of anorexia nervosa
Excess in higher social classes
Class distribution of bulimia nervosa
Even class distribution
Usual age of onset of anorexia nervosa
15-19
Usual age of onset of bulimia nervosa
Young adulthood
Prevalence of anorexia nervosa among teenage girls
0.5-1%
Percentage of patients with anorexia nervosa who also have depression
65%
Eating disorder with the highest heritability
Anorexia nervosa
MZ concordance for anorexia nervosa
55%
MZ concordance for bulimia nervosa
35%
DZ concordance for anorexia nervosa
5%
DZ concordance for bulimia nervosa
30%
Criteria for binge eating disorder in ICD 11
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
Usual length of time symptoms should be present for a diagnosis of binge eating disorder
3 months
Criteria for ARFID in ICD 11
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
Male:female ratio for binge eating disorder
1:3
Definition of fine downy hair seen on the body of patients with EDs
Lanugo
Sign seen in patients with EDs where the knuckles are calloused due to repeated induced vomiting
Russel’s sign
Medical complications of repeatedly induced vomiting
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
Endocrine abnormalities seen in patients with EDs
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)
Thyroid abnormalities seen in patients with EDs
Low T3
Normal T4
Sex hormone abnormalities seen in patients with EDs
Low LH
Low FSH
Low oestradiol
Cortisol abnormality seen in patients with EDs
High cortisol
Growth hormone abnormality seen in patients with EDs
High growth hormone
FBC abnormalities seen in patients with EDs
Normocytic normochromic anaemia
Leucopaenia
Relative lymphocytosis
Thrombocytopaenia
Cholesterol abnormality seen in patients with EDs
High cholesterol
Serum carotene abnormality seen in patients with EDs
High serum carotene
Most effective treatment for bulimia nervosa
CBT
Percentage of patients with bulimia nervosa who make a complete and lasting recovery
33-50%
First choice antidepressant for patients with bulimia nervosa
Fluoxetine
Number of treatments of CBT usually used for patients with bulimia nervosa
16-20
Psychosocial treatments with evidence for anorexia nervosa
CBT
Maudsley anorexia nervosa treatments for adults (MANTRA)
Specialist supportive clinical management
Focussed psychodynamic therapy
Poor prognostic features of anorexia nervosa
Male sex
Late onset
Long duration of symptoms
Low BMI
Purging
Psychiatric comorbidities
Anxiety when eating in front of others
Good prognostic features of anorexia nervosa
Shorter duration of symptoms
Good premorbid functioning
Good parental relationships
Stable life situation
Good family acceptance
Most common cardiac abnormalities in anorexia nervosa
Bradycardia
QT prolongation
Male:female ratio for anorexia
1:10
Eating disorder with the highest rate of spontaneous remission
Binge eating disorder
Core feature of a binge episode
Experience of a loss of control while eating
Sex less likely to seek treatment for bulimia nervosa
Males
Compensatory behaviours more often used by females in bulimia nervosa
Vomiting
Laxative use
Compensatory behaviours more often used by males in bulimia nervosa
Exercise
Steroids
Features of rumination regurgitation disorder
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
Sex with an earlier age of onset of anorexia nervosa
Females
Medical complications of food restriction and very low weight
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
Reason why patients with anorexia nervosa are at higher risk of hepatotoxicity following a paracetamol overdose
They are likely to lack glutathione
Glutathione conjugates benzoquinonimine, which is the hepatotoxic metabolite of paracetamol
Percentage of patients with anorexia nervosa who would be expected to have recovered fully in 30 years
50%
Percentage of patients with anorexia nervosa who would be expected to have recovered partially in 30 years
33%
Percentage of patients with anorexia nervosa who would be expected to have a continuing ED in 30 years
20%
Percentage of patients with anorexia nervosa who would be expected to have died in 30 years
5%
Nutrient deficiency associated with eating clay in pica
Zinc
Features that suggest hospital admission should be considered in anorexia nervosa
BMI <13
Pulse <40
SUSS test score <2
Sodium <130
Potassium <3
Serum glucose <3
QTc >450
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
3
Hours of bed rest per day recommended for a patient with BMI <13 with anorexia nervosa
24
Cause of Takotsubo cardiomyopathy seen in anorexia nervosa
Coronary vasospasm
Features of Takotsubo cardiomyopathy
Rarely seen in anorexia nervosa
Similar presentation to MI
Cardiac enzymes usually raised
Usually mild and self limiting but can cause cardiogenic shock
Substance ingested in the amylophagia form of pica
Starch
First line treatment options for anorexia nervosa
CBT
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
Specialist supportive clinical management (SSCM)
First line treatment for anorexia nervosa in patients <18
Anorexia nervosa focused family therapy
Recommendations on medication treatment as the only treatment for anorexia nervosa
Should not be offered
First line treatment for bulimia nervosa
Evidence-based self-help programme
Second line treatment for bulimia nervosa
CBT
First line treatment for bulimia nervosa in paitents <18
Bulimia nervosa focused family therapy
First line treatment for binge eating disorder
Guided self-help programme
Second line treatment for binge eating disorder
Group CBT
Advice for oral hygiene after vomiting
Avoid brushing teeth
Rinse with a non-acid mouthwash
Effect of laxatives and diuretics on calorie consumption
Little to none
