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Eating Disorders Flashcards

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1
Q

What is the most common cause of admissions to child and adolescent psychiatric wards?

A

Anorexia Nervosa

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2
Q

What are leading causes of death in anorexia nervosa?

A

starvation and suicide

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3
Q

PACES: Prognosis in anorexia nervosa

A

1/3 recover, 1/3 partial, 1/3 chronic

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4
Q

What is anorexia defined as?

A

A disorder characterised by:

Deliberate weight loss (restricted dietary choice, excessive exercise, purging and use of appetite suppressants/diuretics)

Morbid dread of being overweight (intrusive overvalued idea)

Disturbance of bodily function (endocrine and metabolic)

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5
Q

Triad in anorexia nervosa

A

Deliberate weight loss

Morbid dread of being overweight

Disturbance of bodily function

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6
Q

Specific features of anorexia nervosa

A

Significant weight loss that is self-induced
Perception of being too fat, with an obsessional dread of becoming fat
Endocrine disturbance

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7
Q

Endocrine abnormalities seen in anorexia nervosa

A

Amenorrhoea
Loss of Libido

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8
Q

Investigations for anorexia nervosa

A

Examination: weight, height, lanugo hair, BP, squat test
Bloods and UDS
Low: ESR, Hb, Plt, WCC, Na, K, Ph, T4
High: GH, cortisol, cholesterol, LFT
ECG: bradycardia, arrhythmia, prolonged QT
DEXA: osteoporosis (if > 2-year history)
Rating Scale – eating attitudes test

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9
Q

PACES: What rating scale do you use in anorexia nervosa?

A

eating attitudes test

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10
Q

What is raised on the bloods in anorexia nervosa?

A

GH, cortisol, cholesterol, LFT

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11
Q

What is low on the bloods in anorexia nervosa?

A

ESR, Hb, Plt, WCC, Na, K, Ph, T4

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12
Q

What may be seen on examination of anorexia nervosa?

A

weight, height, lanugo hair, BP, squat test

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13
Q

What comorbid psychiatric illnesses often coincide with anorexia nervosa?

A

Depression, OCD and substance misuse are common

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14
Q

Management of anorexia nervosa

A

Engagement

Psycho-education

Treat comorbid psychiatric illness
Depression, OCD and substance misuse are common
Nutritional management and weight restoration

Psychotherapies
Overview of 1st Line Options
CBT-ED
Maudsley Anorexia Nervosa Treatment in Adults (MANTRA)
Specialist Supportive Clinical Management (SSCM)

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15
Q

1st line options for psychotherapy in patients with anorexia nervosa

A

CBT-ED
Maudsley Anorexia Nervosa Treatment in Adults (MANTRA)
Specialist Supportive Clinical Management (SSCM)

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16
Q

1st line management in children with anorexia nervosa

A

1st line: Family Therapy
Review 4 weeks after treatment, then every 3 months

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17
Q

When is medical treatment needed in anorexia nervosa?

A

Particularly important if there are physical complications, rapid weight loss or BMI < 13.5

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18
Q

When is inpatient treatment necessary for anorexia nervosa?

A

May be necessary if:
BMI < 13 or extremely rapid weight loss
Serious physical complications
High suicide risk

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19
Q

When may the mental health act be needed in anorexia nervosa?

A

Mental Health Act may be needed to enable compulsory feeding

20
Q

What is a huge complication of feeding management in anorexia nervosa? How do we try and prevent this?

A

Refeeding syndrome, prevent by advising gradual weight gain of 0.5-1kg a week

21
Q

What is refeeding syndrome caused by?

A

an intracellular shift of ions due to switching to carbohydrate metabolism

22
Q

Clinical features of refeeding syndrome

A

fatigue, weakness, confusion, high blood pressure, seizures, arrhythmia, heart failure

23
Q

What features of anorexia nervosa would suggest a severe referral pathway? What is the severe referral pathway?

A

Features: BMI < 15, rapid weight loss, evidence of system failure

SEVERE 🡪 Urgent referral to CEDS (community eating disorder service)

24
Q

What features of anorexia nervosa would suggest a moderate referral pathway? What is the moderate referral pathway?

A

Features: BMI 15-17, no evidence of system failure

Moderate 🡪 Routine referral to CEDS

25
Q

What features of anorexia nervosa would suggest a mild referral pathway? What is the mild referral pathway?

A

Features: BMI > 17, no additional co-morbidity

Mild 🡪 monitor/advice/support for 8 weeks, recommend support from BEAT, routine referral to CEDS if failure to respond

26
Q

Biochemical hallmark of refeeding syndrome

A

Hypophosphataemia

27
Q

What is bulimia nervosa characterised by?

A

Repeated bouts of overeating (bingeing)
Excessive preoccupation with the control of body weight, leading to a pattern of overeating followed by vomiting or using purgatives
Overconcern with body shape and weight

28
Q

Cycle of bulimia nervosa

A

Prodrome
Often preceded by a background of dieting in an attempt to lose weight
Preoccupation with being too fat

Bingeing Episode
Eating excessive amounts of food in one sitting without control due to hunger, depression, anxiety, loneliness or boredom.

Compensation
Punishment for failing ‘dietary rules’ with attempted counteraction of fattening effects of food by vomiting, alternating periods of starvation, use of drugs (e.g. appetite suppressants, laxatives and diuretics)

Cycle Repetition
Feelings of shame and guilt which prompt further dietary restriction

29
Q

Signs on examination specific to purging

A

Purging Signs (e.g. scarring of hands (Russell’s sign), dental caries)

30
Q

What is Russel’s sign?

A

Scarring of hands due to purging

31
Q

Investigations for bulimia nervosa

A

Examination: weight, height, lanugo hair, BP, squat test
Bloods and UDS
ECG
Rating Scale – eating attitudes test

32
Q

PACES: What rating scale is used for bulimia nervosa?

A

eating attitudes test

33
Q

Management of bulimia nervosa

A

Treat medical complications
Consider Bulimia Nervosa-Focused Guided Self-Help Programme for adults
If unacceptable or ineffective after 4 weeks, consider individual CBT-ED
SSRIs (Fluoxetine)
Reduce bingeing and purging by enhancing impulse control
Treat comorbid psychiatric illness
Depression, self-harm and substance misuse are common

34
Q

Management of bulimia nervosa in children

A

offer family therapy (FT-BN)

35
Q

What programme can be considered for adults with bulimia nervosa?

A

Bulimia Nervosa-Focused Guided Self-Help Programme

36
Q

What features warrant a severe referral in bulimia nervosa? What is the severe referral process?

A

Features: daily purging with significant electrolyte imbalance, comorbidity

SEVERE –> Urgent referral to CEDS

37
Q

What features warrant a moderate referral in bulimia nervosa? What is the moderate referral process?

A

Features: frequent binging and purging (>2/week), no significant electrolyte abnormality, some medical consequences (e.g. chest pain)

Moderate –> monitor/advice/support for 8 weeks, recommend self-help, consider SSRI, routine referral to CEDS if failure to respond

38
Q

What is the mild referral process in bulimia nervosa?

A

Mild 🡪 recommend self-help, recommend BEAT, monitor/advice/support for 3 months, routine referral to CEDS if no improvement/deterioration

39
Q

Summary of bulimia nervosa management

A

Referral for specialist care is appropriate in all case
BN-focused guided self-help for adults
If unacceptable, contraindicated or ineffective after 4 weeks, consider ED-focused CBT (CBT-ED)
Children should be offered BN-focused family therapy (FT-BN)
Consider a trial of high-dose fluoxetine

40
Q

What SSRI may be used in bulimia nervosa? Why?

A

Fluoxetine, reduces bingeing and purging by enhancing impulse control

41
Q

What biochemical sign is a tell tale sign of bulimia nervosa?

A

Hypochloraemia

42
Q

How does weight differ in anorexia to bulimia?

A

Anorexia is low weight, bulimia is normal weight

43
Q

How often do symptoms need to appear for in order to meet the criteria for bulimia?

A

To meet criteria for Bulimia, behaviour has to occur at least once a week for three months

44
Q

What gland is enlarged in bulimia? What is this known as?

A

Enlarged parotid gland, sialadenosis

45
Q

What is binge eating disorder?

A

Compulsive overeating excessively large amounts of food

46
Q

What is the management of binge eating disorder?

A

Psychotherapy 1st line or CBT

47
Q

What medications can be used for binge eating disorder?

A

Meds that can be used include lisdexamfetamine (ADHD stimulant) and topiramate (seizure medication)

Psych (11 decks)

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