Eating disorders Flashcards
Definition of anorexia nervosa?
Defined by the ICD-10 as an eating disorder where there is deliberate weight loss that is induced and sustained by the patient.
Epidemiology of anorexia nervosa?
The incidence of anorexia nervosa is 6/100,000, with the highest incidence occurring between age 15-19.
Causes of anorexia nervosa?
Biological factors include the presence of family history and genetic influence
Psychological: Presence of co-morbid mental health disorders, such as anxiety, depression, obsessive-compulsive disorders or obsessive/perfectionist personalities
Social: Maternal encouragement of weight loss or at risk professions such as models, dancers or sportspeople
Typical history of patient with anorexia nervosa?
Preoccupation with food and calories
Starvation via restricting intake, purging (through induced emesis, diuretic or laxative abuse) or excessive exercise
Poor insight
Overvalued, intrusive obsession with weight, shape and fear of becoming fat
Weight/calorie goals in mind regardless of their impact on physical health
Clinical characteristics of anorexia nervosa?
BMI <17.5 kg/m2 (contrast with bulimia nervosa, where there may be many similar features, but the BMI is normal, a key distinguishing feature)
Hypotension
Bradycardia
Enlarged salivary glands
Lanugo hair (fine hair covering the skin)
Amenorrhoea (hypogonadotropic hypogonadism)
Treatment (psychological) for anorexia nervosa?
Treatment involves aiming to return to a healthy weight and using psychological therapies, such as eating disorder-focused cognitive behavioural therapy (CBT)/CBT for eating disorders (CBT-ED), to treat the underlying thought processes
Treatment (medicinal) for anorexia nervosa?
SSRI’s (selective serotonin re-uptake inhibitors) i.e. fluoxetine is not effective for directly treating the anorexia but it can be effective for the co-morbid health issues associated i.e. depression and anxiety.
Some complications of anorexia nervosa?
Cardiac arrhythmias:
These patients are at higher risk of arrhythmias and an ECG should be performed periodically, especially if they are complaining of cardiac symptoms (eg. palpitations, fainting episodes or dizzy/light-headed spells)
Bradycardia and prolonged QTc are often seen
Osteoporosis – a long-term complication
Definition of bulimia nervosa?
Bulimia nervosa is a psychiatric disorder characterized by recurrent episodes of binge eating (eating a large amount of food in a short period of time with a sense of loss of control) followed by inappropriate compensatory behaviours to prevent weight gain.
Examples of inappropriate compensatory behaviours for weight gain in bulimia?
Self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
What is a difference between anorexia nervosa and bulimia nervosa?
In bulimia nervosa, patients still may maintain a BMI of above 17.5. .
Who does bulimia nervosa typically affect?
Bulimia nervosa predominantly affects adolescents and young adults, with onset commonly in late adolescence or early adulthood.
It is significantly more prevalent in females, with female to male ratio estimated to be approximately 10:1.
Bulimia nervosa presents with both physical and psychological symptoms. True/false?
True
Psychological symptoms of bulimia nervosa?
Binge eating: Characterized by a loss of control, consumption of enormous amounts of food with high caloric content, often with a sense of urgency and compulsion
Purging: 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
Body image distortion: Patients may have a distorted perception of their body, often perceiving themselves as overweight despite maintaining a normal or slightly above average weight.
Physical symptoms of bulimia nervosa?
Dental erosion: Resulting from recurrent self-induced vomiting
Parotid gland swelling: Resulting from recurrent self-induced vomiting
Russell’s sign: Scarring on the back of the hand or knuckles caused by repeated self-induced vomiting and scraping of teeth
What investigations can be done for bulimia nervosa?
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
What is first line treatment for bulimia nervosa?
CBT (cognitive behavioural therapy)
What is binge eating disorder?
Characterised by episodes where the person excessively overeats, often as an expression of underlying psychological distress.
This is not a restrictive condition like anorexia or bulimia, and patients are likely to be overweight.
What may binges involve?
- A planned binge involving “binge foods”
- Eating very quickly
- Unrelated to whether they are hungry or not
- Becoming uncomfortably full
- Eating in a “dazed state”
Management of binge eating disorders?
- Self help resources
- Counselling
- Cognitive behavioural therapy (CBT)
- Addressing other areas of life, such as relationships and past experiences
SSRI’s can be used by a specialist in child and adolescent mental health.
What is refeeding syndrome?
Occurs in people that have been in a severe nutritional deficit for an extended period, when they start to eat again. Patients are at higher risk if they have a BMI below 20 and have had little to eat for the past 5 days.
The lower the BMI and the longer the period of malnutrition, the higher the risk.
Underlying mechanism of refeeding syndrome?
Metabolism in the cells and organs dramatically slows during prolonged periods of malnutrition.
As the starved cells start to process glucose, protein and fats again they use up magnesium, potassium and phosphorus. This leads to:
Hypomagnesaemia
Hypokalaemia
Hypophosphataemia
These patients are also at risk of cardiac arrhythmias, heart failure and fluid overload.
Treatment for refeeding syndrome?
Management will be according to the local protocol under specialist supervision:
Slowly reintroducing food with restricted calories
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
Assessments for refeeding syndrome?
General history (concurrent disease)
Physical examination:
BMI (weight-loss trajectory)
Bradycardia
Hypothermia
Sit-up and Squat Tests
Electrolyte and energy issues in refeeding syndrome?
Reduced intake of carbohydrate
Reduced secretion of insulin
Main sources of energy are fat and protein
Reduced intracellular phosphate
Extracellular phosphate may be normal
Low expenditure of energy due to lethargy/lack of physical activity
Atrophic gut, heart, muscles
Low micronutrient reserves
What is the SCOFF questionnaire?
a five-question screening tool designed to clarify suspicion that an eating disorder might exist rather than to make a diagnosis.
Questions in the SCOFF questionnaire?
Do you make yourself sick because you feel uncomfortably full?
Do you worry you have lost control over how much you eat?
Have you recently lost more than one stone in a three-month period?
Do you believe yourself to be fat when others say you are too thin?
Would you say that food dominates your life?
Assessment for disordered eating should be part of the routine review of patients with Type 1 Diabetes . true/false?
True
There is a specific BMI associated with fitness to drive. true/false?
False
There is no BMI associated with fitness to drive
what eating disorder symptoms cause an impairment in driving?
Lack of muscle tone and strength (sit-up and squat tests)
Osteopenia/Osteoporosis
Hypoglycaemia
Hypokalaemia
Hypothermia
