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Psychiatry > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

Anorexia Nervosa

A

Eating disorder characterised by deliberate weight loss and intense fear of fatness, distorted body image and endocrine disturbances

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2
Q

Predisposing factors Biological AN

A
  • genetics
  • Fix
  • Female
  • Early Menarche
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3
Q

Predisposing psych AN

A
  • Sexual abuse
  • Preoccupation with slimness
  • Dieting behaviours in adolescence
  • Low self esteem
  • Premorbid anxiety or depressive disorder
  • Perfectionism
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4
Q

Predisposing Social AN

A
  • Western society
  • Bullying at school
  • Stressful life events
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5
Q

Precipitating bio AN

A

Adolescence and puberty

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6
Q

Precipitating psych AN

A
  • Criticism regarding eating, body shape or weight
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7
Q

Precipitating social AN

A

Occupational or recreational pressure to be slim

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8
Q

Perpetuating biological AN

A

Starvation leads to neuroendocrine changes that perpetuate anorexia

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9
Q

Perpetuating psych AN

A

Perfectionism or obsessional personality

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10
Q

Perpetuating social AN

A
  • Occupation
  • Western Society
  • Social Media
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11
Q

Symptoms AN

A

FEED PP SS

  • Fear of weight gain
  • Endocrine disturbance - amenorrhoea and loss of sexual interest
  • Emaciated - BMI <17.5
  • Deliberate weight loss - dec food intake or inc exercise
  • Distorted body image
  • Physical - hypothermia, bradycardia, arrhythmia, peripheral oedema
  • Preoccupation with food - dieting
  • Socially isolated and sexually feared
  • Symptoms of depression and obsessions
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12
Q

Criteria of symptoms to be diagnosed with AN

A

Present for at least 3 months with absence of 1. recurrent episodes of binge eating or preoccupation with eating or craving to eat.

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13
Q

MSE AN

A

Appearance - Thin, weak, slow, anxious, may try to disguise emaciation with baggy clothes or makeup. Dry skin, lanugo hair

Speech - may be slow, slurred or normal

Mood - can be low with co-morbid depression or euthymic

Thought - preoccupation with food, overvalued ideas about weight and appearance

Perceptions - No hallucinations

Cognition - Either normal or poor if physically unwell with complications

Insight - Often poor

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14
Q

BN

A

Recurrent episodes of binge eating and compensatory behaviour - vomiting, fasting or excessive exercise in order to prevent weight gain

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15
Q

Binge eating disorder

A

Recurrent episodes of binge eating without compensatory behaviour

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16
Q

EDNOS

A

one third of pt. Closely resembles one of the three disorders but does not meet all diagnostic criteria

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17
Q

Ix AN

A
  • BT
    • FBC - anaemia, thrombocytopenia and leukopenia
    • U+E - creatinine if dehydrtaed is raised
    • LFT - dec albumin
    • Lipid - inc cholesterol
    • Inc cortisol
    • Dec sex hormones
    • Dec glucose
  • VBG - metabolic alkalosis (vomiting), metabolic acidosis (laxatives)
  • DEXA Scan - to rule out osteoporosis
  • ECG - Arrhythmias such as sinus bradycardia and prolonged QT are associated with AN
  • Questionnaires - Eating attitudes test EAT
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18
Q

Biopsychosocial treatment AN

A
  • RA for suicide
  • Psychological treatment for at least 6 months
  • Inpatient if really emaciated is to gain 0.5-1kg per week or if outpatient 0.5kg a week
  • Refeeding syndrome
  • Hospitalisation if BMI <14
  • MHA or children act may be required when insight is clouded.
  • SSRI
  • Treatment of electrolyte disturbances
  • Psycho-education about nutrition
  • CBT
  • Family therapy
  • Interpersonal psychotherapy
  • Voluntary organisations
  • Self-help groups
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19
Q

DDX AN

A
  • Bulimia nervosa
  • Eating disorder not otherwise specified
  • Depression
  • OCD
  • Schizophrenia
  • Alcohol or substance misuse
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20
Q

AN vs BN

A

AN
- Underweight
Endocrine abnormalities
Do not have strong cravings
Do not binge eat
Compensatory weightloss behaviours

BN
- Normal / overweight
Less likely to have endocrine abnormalities
Strong cravings
Recurrent episodes binge eating
Compensatory weight loss behaviours.

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21
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A
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22
Q
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23
Q

Endocrine complications AN

A

Inc cortisol, inc growth hormone, dec T3 and T4, Dec LH FSH. Amenorrhoea. Dec testosterone in men

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24
Q

GI complications AN

A

Enlarged salivary glands, pancreatitis, constipation, PUD, hepatitis

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25
Q

CV complications AN

A

Cardiac failure, ECG abnormalities, arrhythmias, Dec BP, bradycardia, peripheral oedema

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26
Q

Renal complications AN

A

renal failure and renal stones

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27
Q

Neurological complications AN

A

seizures, peripheral neuropathy, autonomic dysfunction

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28
Q

Haem complications of AN

A

iron deficiency, thrombocytopenia, leucopenia

29
Q

MSK complications of AN

A

Proximal myopathy, osteoporosis

30
Q

Other complications of AN

A

hypothermia, dry skin, brittle nails, lanugo hair, infections, suicide.

31
Q

What is referring syndrome

A

Life threatening syndrome results from food intake after prolonged starvation or malnourishment, due to changes in phosphate, magnesium and potassium

32
Q

Why does referring syndrome occur

A

IT OCCURS DUE TO INSULIN SURGE FOLLOWING INCREASED FOOD INTAKE.

33
Q

What does biochemically change during refeeding syndrome

A

Hypokalaemia, hypomagnaesaemia, hypophosphaetaemia and abnormal glucose metabolism

Phosphate depletion can lead in reduction of cardiac muscle activity and cardiac failure

34
Q

Prevention of referring syndrome

A

measure serum electrolytes prior to feeding and monitor referring bloods daily. Start at 1200 cal a day and gradully increase every 5 days and monitor for tachycardia or oedema,

35
Q

Bulimia Nervosa Symproms

A
  1. Sense of compulsion to eat
  2. Binge eating
  3. Fear of fatness
  4. Compensatory mechanisms
36
Q

Predisposing bio BN

A
  • Genetics
  • Fhx
  • Female
  • Early Menarche
  • T1DM
  • Childhood obesity
37
Q

Predisposing psych BN

A
  • Sexual abuse
  • Preoccupation with slimness
  • Dieting behaviours in adolescence
  • Low self esteem
  • Premorbid anxiety or depressive disorder
  • High expectations from parents
  • Parental obesity
38
Q

Predisposing social BN

A
  • Western society
  • Bullying at school
  • Stressful life events
  • Profession - actors, models, dancers, athletes
  • Difficulty resolving conflicts
39
Q

Precipitating Bio BN

A

Adolescence and puberty and early onset puberty

40
Q

Precipitating Psych BN

A

Criticism regarding eating, body shape or weight and pressure of being thin from surrounding society

41
Q

Precipitating Social BN

A
  • Occupational or recreational pressure to be slim
  • Family dieting
  • Environmental stressors
42
Q

Perpetuating Bio BN

A

Starvation leads to neuroendocrine changes that perpetuate anorexia

43
Q

Perpetuating psych BN

A
  • Low self esteem
  • Obsessional personality
44
Q

Perpetuating Social BN

A
  • Occupation
  • Western Society
  • Social Media
45
Q

Compensatory Symptoms of BN

A

Compensatory behaviours:

  • Vomiting
  • Laxatives
  • Exercising excessively
  • Alternating periods of starvation
46
Q

MSE Bn

A

Appearance - Depression and anxiety

Speech - slow or normal

Mood - Low

Thought - preoccupation with body size and shape and of eating and guilt

Perception - normal

Cognition - either normal or poor

Insight - Usually has good insight

47
Q

ICD10 Classification BN

A

Bulimia Patients Fear Obesity

Behaviours to prevent weight gain - compensatory

Preoccupation with eating - compulsion which leads to bingeing

Fear of fatness - self perception of being too fat

Overeating - at least two episodes a week over a period of 3 months

48
Q

Common signs of bulimia

A

Normal weight

Depression

Irregular periods

Signs of dehydration - dec BP, dry mucous membranes, Inc capillary refill time, dec skin turgor and sunken eyes.

Consequences of repeated vomiting and hypokalaemia

49
Q

Types of BN

A

Purging - self-induced vomiting or laxatives, diuretics or enemas

Non-purging - much less common and uses excessive exercise or fasting.

50
Q

Ix BN

A
  • BT
  • Venous blood gas
  • ECG
51
Q

Treatment BN

A

Biological - Fluoxetine and if needed potassium replacement

Psychological - Psychoeducation and CBT // Interpersonal psychotherapy

Social - Food diary to monitor eating / puging patterns with techniques to avoid bingeing.

RA for suicide

Inpatient treatment - suicide risk or electrolyte imbalances

MHA is not usually required as they have good insight

52
Q

Ddx BN

A
  • Anorexia
  • EDNOS
  • Kleine-levin syndrome
  • Depression
  • OCD
  • Organic causes - gastric outlet obstruction.
53
Q

Epidemiology EDs

A

BN - Spread between SES

AN - usually in higher SES

54
Q

Common mental co-morbidities BN

A
  • Depression
  • Anxiety
  • Deliberate self-harm
  • Substance misuse
  • Emotionally unstable - Personality disorder
55
Q

Bulimia vs anorexia acronyms

A

Amenorrhoea
No friends
Obvious weight loss
Restriction of food
Emaciated
Xerstomia
Irrational fear of fatness
Abnormal hair growth

Binge eating
Use of drugs to prevent weight gain
Low potassium
Irregular periods
Mood disturbances
Irrational fear of fatness
Alternating periods of starvation

56
Q

CV - Complications of repeated vomiting

A

arrhythmias, mitral valve prolapse and peripheral oedema

57
Q

Gi Complications of repeated vomiting

A

MW tears, inc salivary gland size - esp parotid

58
Q

Metabolic Complications of repeated vomiting

A

dehydration, hypokalaemia, renal stones and failure

59
Q

Dental Complications of repeated vomiting

A

permanent erosion of dental enamel secondary to gastric acid.

60
Q

Endocrine Complications of repeated vomiting

A

AMENORRHOEA, irregular menses, hypoglycaemia, osteopenia

61
Q

Derm Complications of repeated vomiting

A

russels sign

62
Q

Pulmonary Complications of repeated vomiting

A

Aspiration pneumonoitits

63
Q

Neuro Complications of repeated vomiting

A

cognitive Impairment and peripheral neuropathy and seizures.

64
Q

SCOFF Method

A
  • 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 (14 lb
    or 7.7 kg) in a three month period?
    ● Do you believe yourself to be Fat when others say
    you are thin?
    ● Would you say that Food dominates your life?
65
Q

Immediate risks of ED

A

Death from health complications
Refeeding syndrome
Anemia
Seizure
Thyroid problems
Low potassium levels in the blood
Decrease in white blood cells
Abnormally low blood pressure and heart rate, which can
lead to heart failure
Kidney problems
Suicide
Osteoporosis

66
Q

IX for ED

A

Blood Pressure, Temperature, Respiration
Sit up–Squat–Stand (SUSS) test - assessing muscle power
Full Blood count
Us&Es
Calcium
Magnesium
Phosphate
Serum proteins
Liver function tests
Potassium
Urinalysis
ECG

67
Q

Link of phosphate in refeeding syndrome

A

Phosphate - ATP in Krebs cycle
Not much in ED and need some for basic metabolic function.
Draw on already unavailable phosphate in plasma when trying for digestion.
Can lead to cardiac arrest.

68
Q
A
69
Q
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Psychiatry (17 decks)

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