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Behavioral Dynamics Exam 3 > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

Anorexia Nervosa epidemiology

A
  • Predominately Female → >90%
  • 0.5 – 1.0% lifetime prevalence in the USA
  • Lowest of the eating disorders, but the deadliest
  • Bimodal peaks in adolescence
  • 12-15 yo
  • 17-21 yo
  • Median age of onset = 17 yo
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2
Q

Anorexia Nervosa is a disease of

A

self-perception

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3
Q

Anorexia Nervosa Early warning signs

A
  • Persistent dieting
  • Arrest in weight gain during puberty
  • Social isolation: Fear eating in public
  • Compulsive exercise
  • Preoccupation with Thinness & body image, Food
  • Frequently involved in food prep or
    related professions
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4
Q

Anorexia Nervosa
Clinical Presentation(s)

A
  • Typically, brought in by a loved one
    concerned about malnourishment
    &/or perceived severe weight loss
  • Pre-menarchal girls upon review of
    height/weight chart progress
  • Persistent food restriction
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5
Q

Average length of history at
presentation of anorexia nervosa is ___

A

5 years

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6
Q

T/F Amenorrhea is required for a diagnosis of Anorexia Nervosa

A

F

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7
Q

Anorexia Nervosa Screening (SCOFF)

A

S: Do you make yourself Sick because you feel uncomfortably full?
C: Do you worry you have lost Control over how much you eat?
O: Have you recently lost Over 10 lbs in a 3 month period?
F: Do you believe yourself to be Fat when others say you are too thin?
F: Would you say that Food dominates your life?

2 or more positive answers suggest eating disorder

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8
Q

Anorexia Nervosa
Physical Exam

A
  • Gen: cachexia, ↓ vital signs,
    hyperactivity despite malnutrition
  • HEENT: (Hx of vomiting)
  • Skin - Dry skin, lanugo hair, yellow skin, signs of self harm, hair pulling
  • CV: Bradycardia, Hypotension
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9
Q

Anorexia Nervosa specific types

A

Binge-eating/purging type
Restricting type

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10
Q

Anorexia Nervosa
Diagnosis by BMI severity

A
  • Mild: BMI ≥ 17 kg/m2
  • Moderate: BMI ≥ 16-16.99 kg/m2
  • Severe: BMI ≥ 15-15.99 kg/m2
  • Extreme: BMI < 15kg/m2
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11
Q

Anorexia Nervosa
Diagnostic Testing

A

HCG in ♁ patients with
amenorrhea

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12
Q

When to hospitalize in anorexia nervosa

A
  • Weight is < 75-85% of ideal body weight &/or if patient is unstable &
    decompensating
  • Complications: electrolyte abnormalities, arrhythmias, acute food refusal, failed out pt. therapy, hematemesis, suicidal ideation, acute mental status change
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13
Q

Weight at which normal menses resumes

A

~90% of avg BMI

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14
Q

Tx recommended for Anorexia Nervosa

A
  • Cognitive behavioral & Family Therapy
  • Aids in maintaining healthy weight
    (once restored) & healthy eating
  • Long term tx recommended
  • 1 year
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15
Q

Cautions in refeeding syndrome

A
  • Hypophosphatemia
  • Hypomagnesemia
  • Hypocalcemia
  • Fluid Retention
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16
Q

Diet treatment goals in Anorexia Nervosa

A
  • Follow strict protocols
  • 30-40 kcal/kg/day
  • Goal= 2-3 lbs/week (In pt.)
  • Goal= 0.5-1 lbs/week (Out pt.)
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17
Q

Refeeding Syndrome (Explain)

A

Slide 24

18
Q

Anorexia Nervosa
Medication usage

A
  • Medication is most likely to be benefit comorbid psychiatric illness
19
Q

Complications of Anorexia Nervosa

A
  • Metabolic disturbances
  • Hypokalemia
  • Hypophosphatemia
  • Endocrinopathy
  • Hypothermia
  • Cognitive changes secondary to cortical
    gray matter loss
  • Comorbid Major Depression
  • Infertility
  • Delayed physical growth & development
20
Q

~___% of pts with a restriction pattern of AN convert to a binge eating/purging pattern & meet criteria for Bulimia Nervosa

A

50

21
Q

What if the patient meets the diagnostic criteria for anorexia nervosa
* except for the weight criterion?
* or who do not have amenorrhea?

A

EATING DISORDER, NOT OTHERWISE SPECIFIED (NOS)
Care plan should be similar to those with DSM-5 diagnosable anorexia nervosa

22
Q

Bulimia Nervosa

A

Eating disorder characterized by
* Repetitive binge eating
* During which there is a sense of loss of control
* & compensatory behaviors (purging) to prevent weight gain

23
Q

Bulimia Nervosa Epidemiology

A
  • Usually, normal weight
  • Less commonly-overweight
24
Q

Bulimia Nervosa HPI/PMH

A
  • May c/o bloating, fatigue, constipation,
    abdominal pain, swelling of hands or
    feet, irregular menses
  • Most pts have comorbid mood d/o
  • Minority of pts have comorbid personality d/o
25
Q

Binge episodes

A

Large amount of calories, discreet time frame
* Excessive food for the situation or considered
excessive by the patient
* Ie. ~2000-3000 kcal/40 min

26
Q

Triggers for purging

A

dysphoric mood, interpersonal stress, dietary restraint with ensuing hunger pangs, or dissatisfaction with body shape or size

27
Q

Bulimia Nervosa
Psychological Testing

A

Bulimia Nervosa
Psychological Testing
* Eating Disorders Inventory (paid)
* Eating Attitudes Test
* Both helpful in monitoring response to treatment, but not required to make the diagnosis

28
Q

Bulimia Nervosa
Physical Exam: HEENT

A
  • Teeth may be discolored or
    changed in shape
  • Dental enamel may be eroded 2°
    recurrent vomiting
  • Salivary & parotid glands may be
    enlarged
29
Q

Bulimia Nervosa
Physical Exam: Extremities

A
  • Calluses on back of hands (Russell’s sign)
  • 2° inducing vomiting
  • Edema of extremities may be present in
    patients abusing laxatives or diuretics
30
Q

Bulimia Nervosa
Testing:

A

Consider electrolytes
* Hypochloremia (secondary to vomiting HCl -)
* Hypokalemia (secondary to vomiting HCl -)
* Hypophosphatemia (secondary to laxative abuse/chronic diarrhea)
* Hyponatremia (secondary to laxative abuse/chronic diarrhea)
* Metabolic acidosis (secondary to laxative abuse/chronic diarrhea)
* ECG

31
Q

Bulimia Nervosa
Complications

A
  • Dental erosions
  • Fluid & electrolyte imbalance
  • Loss of gag reflex
  • GERD
  • Esophageal tears/perforation
  • Arrhythmias
  • Edema
  • Amenorrhea
32
Q

Most common eating disorder in the United States

A

Binge-Eating Disorder

33
Q

Binge-Eating Disorder
Epidemiology

A
  • Women > Men (3:1)
  • Early 20s age of set (median = 21 yo)
  • Can present in childhood
34
Q

Binge-Eating Disorder
Etiology and risk factors

A
  • Eating to cope with stress
  • Depression
  • ↑ impulsivity
  • Emotional dyregulation
    Risk Factors:
  • Family history
  • Black, Hispanic, Asian Americans
  • Eating, weight, & shape concerns by age 14
35
Q

T/F Patients are typically ashamed of their binging & attempt to conceal symptoms

A

T

36
Q

Binge-Eating Disorder
Fam Hx/Social Hx

A
  • Family history of obesity or eating disorder
  • Substance-use d/o
  • Frequent comorbitiy of binge-eating disorder
  • CAGE Questionaire or AUDIT-C (←Links)
37
Q

Binge-Eating Disorder screening tool

A

Binge Eating Disorder Screener-7 (BEDS-7)

38
Q

First question on BEDS-7

A
  1. During the last 3 months, did you have any episodes of excessive overeating (i.e.,
    eating significantly more than what most people would eat in a similar period of
    time)?
    * Yes or No
    *NOTE: IF “NO” TO QUESTION 1, STOP. THE REMAINING QUESTIONS DO NOT APPLY
39
Q

Mifflin St. Jeor Equation (Replaces Harris-Benedict Equation)

A

For men: BMR = 10 x weight (kg) + 6.25 x height (cm) – 5 x age (years) + 5
For women: BMR = 10 x weight (kg) + 6.25 x height (cm) – 5 x age (years) – 161

Calculate Basal Metabolic Rate

40
Q

Binge-Eating Disorder Diagnosis (DSM-5 criteria) - Specify current severity

A
  • Mild: 1-3 binge eating episodes per week
  • Moderate 4-7 binge eating episodes per week
  • Severe: 8-13 binge eating episodes per week
  • Extreme: 14 or more binge eating episodes per week
41
Q

Binge-Eating Disorder
Management

A
  • Referral to a specialized in-patient
    eating-disorders center can be helpful
  • Typically, can be treated outpatient
  • Cognitive-Behavioral Therapy,
    Interpersonal Therapy & Dialectical
    Therapy all appear effective
  • Consider Psychology/Psychiatry
    referral, especially in refractive
    cases
  • Fluoxetine (Prozac®) or other SSRIs
  • Lifestyle modification
  • Pharmacological management (weight loss medications - Semaglutide)

Behavioral Dynamics Exam 3 (5 decks)

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