Eating disorders

Question 1

What is anorexia

Answer 1

Anorexia nervosa is a severe psychiatric disorder characterized by extreme dietary restriction, an intense fear of gaining weight, and a distorted body image

Question 2

How is anorexia diagnosed

Answer 2

ICD 11 criteria
- significantly low body weight
- fear of gaining weight
- distorted body image
- restrictive eating
DSM 5
- restriction of energy intake
- intense fear of gaining weight
- body image disturbance

Question 3

Types of anorexia

Answer 3

Restrictive Subtype - minimal food intake and excessive exercise

Bulimic Subtype:- episodic binge eating followed by compensating behaviors like laxative use or induced vomiting.

Question 4

Clinical features and symptoms of anorexia

Answer 4

• starvation - low BMI
• poor insignt
• preoccupation of food/calories
• hypotension
• bradycardia
• lanugo hair (fine hair covering skin)
• amenorrhoea
• metabolic alkalosis, pitted teeth if bulimic

Question 5

Blood tests and results for anorexia

Answer 5

Deranged electrolytes - low calcium, magnesium, phosphate and potassium
Low sex hormones
Leukopenia
Raise stress hormones (growth hormone and cortisol)
Metabolic acidosis if vomiting or using diuretics

Question 6

Management of anorexia

Answer 6

CBT
MANTRA - maudsely model of anorexia nervosa treatment for adults
SSCM - specialist supportive clinical management

Question 7

Complications of anorexia

Answer 7

Refeeding syndrome
Cardiac arrhythmias
Osteoporosis

Question 8

What is bulimia

Answer 8

Bulimia nervosa, an eating disorder, is characterized by recurrent binge-eating episodes followed by compensatory behaviors, such as self-induced vomiting, laxative abuse, diuretics, fasting, or excessive exercise.

Question 9

Bulimia clinical findings

Answer 9

Unlike anorexia nervosa, individuals may maintain a normal or slightly above average BMI

• loss of control during eating
• guilt / shame
• body image distortion
• amenorrhoea
• dental erosion
• russel’s sign (scarring on hand from self induced vomiting
• vomiting complication e.g. mallory weiss tear

Question 10

What is refeeding syndrome

Answer 10

Refeeding syndrome is a potentially fatal condition that can occur in malnourished patients, including those suffering from anorexia and alcoholism, or those who undertake prolonged fasting

Question 11

Clinical signs of refeeding syndrome

Answer 11

low phosphate - muscle weakness, resp failure, delirium, seizures

low magnesium - muscle weakness, cardiac arrhythmias

low potassium levels - muscle weakness, paralysis, cardiac arrhythmias

hyperglycemia - increased thirst, urination, fatigue, blurred vision

Question 12

Management of refeeding syndrome

Answer 12

slow re-introduction of food and fluids, to avoid sudden shift in electrolytes

frequent blood monitoring

thiamine replacement for all at-risk patients to prevent wernicke’s encephalopathy