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Yr 4 - Psychiatry > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

Define anorexia nervosa (AN)

A

An eating disorder where there is a DELIBERATE weight loss that is induced and sustained BY THE PATIENT

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2
Q

What age does highest incidence of AN occur?

A

15-19

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3
Q

What are some at risk professions for AN?

A

Models, dancers, sportspeople

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4
Q

What are some comorbid mental health disorders that sometimes are seen alongside AN?

A

Depression
Anxiety
OCD
Obsessive/perfectionnist personalities

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5
Q

What may be apparent when taking a patient with AN’s history?

A

Preoccupation with food and calories

Starvation via restricting intake, purging (through induced emesis, diuretic or laxative abuse) or excessive exercise

Poor insight (i.e. lack of insight into severity)

Overvalued, intrusive obsession with weight, shape and fear of becoming fat

Weight/calorie goals in mind regardless of their impact on physical health

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6
Q

What BMI defines AN?

A

BMI <17.5 kg/m2

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7
Q

How does a definitive BMI separate AN and BN?

A

AN - BMI <17.5 kg/m2

BN - where there may be many similar features, but the BMI is normal (a key distinguishing feature)

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8
Q

Give some signs of AN on examination

A
  • Hypotension
  • Bradycardia
  • Enlarged salivary glands
  • Lanugo hair (fine hair covering skin)
  • Amenorrhoea (hypogonadotropic hypogonadism)
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9
Q

Blood test results in AN?

A

deranged electrolytes – typically low calcium, magnesium, phosphate and potassium

low sex hormone levels (FSH, LH, oestrogen and testosterone)

leukopenia

raised growth hormone and cortisol levels (stress hormones)

hypercholesterolaemia

metabolic alkalosis

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10
Q

What electrolyte abnormalities are typically seen in AN?

A

Typically low calcium, magnesium, phosphate and potassium

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11
Q

How are the sex hormones affected in AN?

A

Low sex hormone levels (FSH, LH, oestrogen and testosterone)

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12
Q

How is the white cell count affected in AN?

A

Leukopenia - decreased

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13
Q

How are GH and cortisol (stress hormones) affected in AN?

A

Raised

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14
Q

How is cholesterol affected in AN?

A

Hypercholesterolaemia

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15
Q

What causes metabolic alkalosis in AN?

A

Due to vomiting or use of diuretics

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16
Q

What pharmacological drug may be used in management of AN?

A

SSRIs - these have not been shown to be effective at treating the AN directly, but may be effective for comorbid mental health issues, commonly depression and anxiety

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17
Q

Psycohological management for AN?

A

Treatment involves aiming to return to a healthy weight and using psychological therapies, such as eating disorder-focused CBT for eating disorders (CBT-ED), to treat the underlying thought processes

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18
Q

What is refeeding syndrome?

A

A potentially fatal disorder that occurs when nutritional intake is resumed too rapidly after a period of low caloric intake

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18
Q

What increases the risk of refeeding syndrome?

A

The lower the BMI and the longer the period of malnutrition, the higher the risk.

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19
Q

What occurs in refeeding syndrome?

A

Metabolism in the cells and organs dramatically slows during prolonged periods of malnutrition. After feeding, rapidly increasing insulin levels lead to shifts of potassium, magnesium and phosphate from extracellular to intracellular spaces:

  • Hypomagnesaemia
  • Hypokalaemia
  • Hypophosphataemia

These NEED to be replenished.

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20
Q

Symptoms of refeeding syndrome?

A
  • Oedema
  • Confusion
  • Tachycardia

Can lead to:
- Heart failure
- Cardiac arrhythmias
- Fluid overload

21
Q

What drug can be administered as a preventative method for refeeding sydrome?

A

Pabrinex

22
Q

What is Pabrinex?

A

A high potency dose of vitamins (mainly B vitamins)

23
Q

How can refeeding be managed to reduce risk of refeeding syndrome?

A

Slowly reintroducing food with restricted calories (NICE recommends no more than 50% of calorie requirement in ‘patients who have eaten little or nothing for more than 5 days’)

Magnesium, potassium, phosphate and glucose monitoring along with other routine bloods

Fluid balance monitoring

ECG monitoring may be required in severe cases

Supplementation with electrolytes and vitamins, particularly B vitamins and thiamine

24
Q

What is a long term complication of AN?

A

Osteoporosis

25
Q

What ECG signs are typically seen in AN (NOT refeeding)?

A

Bradycardia
Prolonged QTc

26
Q

How does a patient’s age at presentation affect prognosis of AN?

A

Negative prognostic indicator if presentation after the age of 20 years – difficult to reverse fixed beliefs

27
Q

Give some negative prognostic indicators of AN

A
  • Presentation after the age of 20 years
  • BMI <16 kg/m2
  • Marked anxiety when eating in front of others, which indicates issues with socialisation
    -Bingeing/vomiting responds less well to CBT than starvation
28
Q

Define bulimia nervosa (BN)

A

Bulimia nervosa is an eating disorder marked by recurrent episodes of binge eating followed by compensatory behaviours, typically self-induced vomiting or laxative abuse.

29
Q

What is a distrnguising feature between AN and BN?

A

In BN, patients often have a normal BMI (>17.5)

30
Q

What is the female:male ratio for BN?

A

10:1

31
Q

Give some pyschological symptoms see in BN

A
  1. Binge eating
  2. Purging
  3. Body image distortion
32
Q

What is purging?

A

Binge episodes often lead to feelings of shame and guilt, leading to attempts to ‘undo the damage’ through behaviours such as induced vomiting, misuse of laxatives or diuretics, and excessive exercise

33
Q

What is binge eating?

A

Characterized by a loss of control, consumption of enormous amounts of food with high caloric content, often with a sense of urgency and compulsion

34
Q

Give some physical signs seen in BN

A
  1. Dental erosion
  2. Parotid gland swelling
  3. Russell’s sign
  4. Mouth ulcers
35
Q

What salivary gland is affected in BN?

A

Parotid gland typically swollen

36
Q

What is Russell’s sign?

A

Scarring on the back of the hand or knuckles caused by repeated self-induced vomiting (where knuckles have scraped against teeth)

37
Q

What metabolic imbalance is seen in BN?

A

Alkalosis

38
Q

What causes alkalosis in BN?

A

Due to vomiting hydrochloric acid from the stomach

39
Q

A teenage girl with a normal body weight presents with swelling to the face or under the jaw (salivary glands), calluses on the knuckles and alkalosis on a blood gas. The presenting complaint may be abdominal pain or reflux.

What is diagnosis?

A

BN

40
Q

Investigations in BN?

A

A detailed medical history –> To evaluate for recurrent episodes of binge eating and compensatory behaviours

A comprehensive physical examination –> To identify potential physical signs of bulimia, including dental erosion, parotid gland swelling, or Russell’s sign

Psychological assessments –> To evaluate for associated psychological conditions and body image distortion

41
Q

Management of BN?

A

Specialist referral

Cognitive-behavioral therapy (CBT): CBT is the first-line treatment for bulimia nervosa and focuses on altering destructive eating behaviours and thought patterns, as well as improving body image and self-esteem

42
Q

What is binge eating disorder (BED)?

A

Frequent, recurrent episodes of binge-eating

NO regular compensatory behaviours

43
Q

Who is BED typically seen in?

A

Often normal weight, overweight, or obese

44
Q

What is avoidant-restrictive food intake disorder (ARFID)?

A

Avoidance/restriction of food leading to insufficient quantity or variety of food to meet nutritional requirements

45
Q

What is the difference between AN and ARFID?

A

ARFID is NOT motivated by preoccupation with body weight or shape where AN is

46
Q

What are the 3 main profiles typically seen in ARFID?

A

1) Apparent lack of interest in eating or food

2) Avoidance based on the sensory characteristic of food

3) Concern about aversive consequences of eating (vomiting/choking/discomfort/traumatic association)

47
Q

Biological risk factors for eating disorders?

A
  • Genetics (adoption studies show a significant link)
  • Perinatal factors – low levels of Vit D, maternal drug use etc
  • Oestrogen surge in puberty – younger age of menarche linked with disorder eating
  • Autoimmune disorders (T1DE)
48
Q

How is age of menarche implicated in EDs?

A

younger age of menarche linked with disorder eating

49
Q

Sociocultural factors in EDs?

A
  • Family dynamics
  • Early life
  • Body objectification
  • Social support and comparison
  • Bullying
  • Adverse life event
  • Hobbies/professions which emphasise weight
  • Religion
  • Tripartite influence mode
50
Q

Psychological factors in EDs?

A
  • Body Dissatisfaction
  • Perfectionism
  • Low self-esteem
  • Negative affectivity
  • Impulsivity and urgency
  • Comorbid psychiatric disorders
  • Emotional trauma
51
Q
A

Yr 4 - Psychiatry (17 decks)

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