Eating Disorders Flashcards
what has the highest mortality rate of all the mental illness?
anorexia nervosa
what is the relapse rate at one year?
50%
what population is more likely to anorexia nervosa?
mostly females 12-30 years
what is anorexia nervosa?
refusal to maintain a minimally normal weight for age and height
less than 85% of expected/BMI < 17.5
extreme fear of obesity/weight gain- even though underweight/emaciated
deny seriousness of disorder
gross distortion of body image
preoccupation with food
peculiar handling of food
what are specifics of anorexia nervosa?
restricting type
binge-eating/purging type
partial or full remission
what is the restricting type of anorexia nervosa?
not engaging in binge eating or purging behavior
diet, fast, rigorous exercise
what is the binge-eating/purging type of anorexia nervosa?
primarily restricts but does engage in some binge eating or purging behavior
what is considered full remission from anorexia nervosa?
not considered in full remission until healthy BMI and no thoughts of not eating; very hard to reach
what are the clinical presentation of anorexia nervosa?
low weight
amenorrhea; infertility, atrophy of breasts
yellow/orange hue to skin
lanugo; thinning hair, dry skin
cold extremities, hypothermia
peripheral edema
muscle weakness, loss of muscle mass, low bone density
constipation; rectal tears due to straining
hypotension, bradycardia, abnormal heart rhythms
renal insufficiency
low potassium, magnesium, calcium, and sodium/abnormal thyroid function
decreased bone density
anemic pancytopenia
what is the cause of low weight?
caloric restriction/excessive exercise
what is the cause of amenorrhea, infertility, and atrophy of breasts?
low weight
what is the cause of yellow/orange hue to skin?
hypercartenemia
what is the cause of lanugo and thinning hair and dry skin?
starvation
what is the cause of peripheral edema?
hypoalbunimeia and refeeding
what is the cause of muscle weakness, loss of muscle mass, and low bone density?
starvation and electrolyte imbalance
what is the cause of constipation and rectal tears?
starvation
what is the cause of hypotension and bradycardia as well as abnormal heart rhythm?
starvation
dehydration
electrolyte imbalance
what is the cause of renal insufficiency?
dehydration
what is the cause of the electrolyte/metabolic/endocrine imbalanaces?
starvation
what is the cause of decrease bone density?
estrogen deficiency
low calcium intake
what is the cause of anemic pancytopenia?
starvation
what are the medical complications of anorexia nervosa?
lymphocytosis
osteoporosis
elevated cholesterol levels
fatty degeneration of liver
proteinuria
what are the comorbidities of anorexia nervosa?
depression/anxiety
compulsive behaviors/OCD
when is the onset of bulimia nervosa?
late adolescence or early adulthood
what is the repeated, episodic, uncontrolled, compulsive rapid ingestion of large quantities of food over a short period of time, usually within 2 hours?
binging
what is follow by inappropriate compensatory behaviors to rid body of excess calories?
purging
which food is usually consumed during binging?
food consumed during a binge usually are sweet, high caloric, soft or smooth so can be eaten rapidly
how many times does the binging and purging need to happen to be considered bulimia nervosa?
once a week for 3 months
what are the compensatory mechanisms that follow binging?
self-induced vomiting
misuse of laxatives, diuretics, enemas
fasting
excessive exercise
what is tied into weight with those that have bulimia nervosa?
self-worth
what is considered mild anorexia nervosa?
BMI greater than or equal to 17
what is considered moderate anorexia nervosa?
BMI 16-16.99
what is considered severe anorexia nervosa?
BMI 15-15.99
what is considered extreme anorexia nervosa?
BMI less than 15
how is the bulimia nervosa severity based?
it is based on the times a week compensatory behaviors are used
what is considered mild bulimia nervosa?
1-3 episodes per week
what is considered moderate bulimia nervosa?
4-7 episodes per week
what is considered severe bulimia nervosa?
8-13 episodes per week
what is considered extreme bulimia nervosa?
14 or more episodes per week
what are the comorbidity of bulimia nervosa?
MDD
bipolar depression
anxiety
borderline personality disorder
histrionic personality disorder
substance abuse, especially with amphetamines and alcohol
what are medical complications with bulimia nervosa?
weight fluctuations common- most within normal weight limit (which allows them to hid it well)
dehydration/electrolyte imbalance- which can lead to EKG changes and arrhythmias
tooth enamel erosion
dental caries
loss of dental arch
tears in esophagus due to utilizing foreign objects
enlarged parotid glands- increased amylase levels
gastric dilation/rupture
abdominal calluses from frequent digital pressure to purge
loss of gag reflex
aspiration pneumonia
frequent heartburn/indigestion
Russell’s sign
cardiomyopathy
ipecac intoxication
what is Russell’s sign?
is the scraps and blisters on the patient’s knuckles from trying to induce vomiting; teeth marks on their hands
what happens over time with the gag reflex for those that have bulimia nervosa?
once utilizing fingers and objects to induce vomiting does not work, then they will thrust objects against their abdomen leading to callouses and bruises on their abdomen
what are the genetic risk factors for anorexia/bulimia?
anorexia has a linkage to chromosomes 1, 2, and 13
what are the neuro-endocrine abnormalities that could be a risk factor for bulimia and anorexia?
possible primary hypothalamic dysfunction in anorexia nervosa
elevated cortisol levels in CSF
what regulates the body’s ability to recognize when hungry, not hungry, and when sated?
hypothalamus
what is the difference with the dorsolateral prefrontal cortex with those with anorexia nervosa?
a self-control center of the brain; it acts like a brake system to curb impulse behaviors; in anorexics, it may work overtime to keep people from giving in to the temptation to eat
what is the difference with the visual cortex with those with anorexia nervosa?
processes visual information; compared with health people, it may be more active when thinking about eating food or performing cognitive tasks
what is the difference with the ventral striatum with those anorexia nervosa?
part of the brain’s reward circuitry; may be hypersensitive to flavors healthy people find pleasurable, such as sugar; this oversensitivity could affect patient’s enjoyment of food
what is the difference with the insula with those anorexia nervosa?
involved in self-awareness of body states, such as pain and hunger; is the first brain region to register the taste of sweets; it may not correctly detect sweets and other signals
what are the neurochemical risk factors of bulimia and anorexia?
anorexia- impaired dopamine regulation; release of dopamine in dorsal striatum triggers anxiety rather than pleasure
high levels of endogenous opioids in spinal fluid; some gain weight when given naloxone
bulimia- serotonin and norepinephrine
vomiting- increases plasma endorphin levels; feelings of well-being
which type of medications can be helpful in bulimia?
SSRIs
what are the differences in the brains of those with bulimia?
increased grey matter- medial orbitofrontal cortex
more likely to have ADHD- inattention/impulsivity/poor emotional regulation
what are the epigenetics with bulimia/anorexia?
hypodopaminergic paths- epigenetically activated by malnourishment
estrodial activity in adolescent girls- epigenetically activates risk factors for anorexia
what are psychodynamic influences/risk factors for those with bulimia and anorexia?
disturbances in mother-infant interactions
parents respond to emotional needs with food- very common in other cultures, such as Hispanics and Italians
family influences- enmeshed boundaries
conflict avoidance - tertiary gains for family
power/control- often triggered by stressor/traumatic life event
passive father/domineering mother/overly dependent child- perfectionism valued
parental criticism promotes obsessive/perfectionist
what is a primary gain?
get to avoid
what is a secondary gains?
get attention
what is a tertiary gain?
shift areas of conflict
what is an example of tertiary gains?
if the child saw the parents fighting, then they said their sick, so the parents stop fighting and turn their attention
what are genetic traits linked with eating disorders?
perfectionism
avoidant
interceptive awareness
anxiety
intolerance of uncertainty
obsession
thought sticking
impulsive/compulsive
competitive
what are repeated episodes of uncontrolled binge eating with significant distress and eating rapidly, uncomfortable full, and large amounts when not hungry and alone?
binge eating disorder
what are the feelings that one feels with binge eating disorder?
they feel alone, embarrassed, disgusted, depressed guilty
what are the genetic causes of binge eating disorders?
runs in families- addictive influences
what are the psychological/environmental factors/causes of binge eating disorders?
low self-esteem/body dissastisfaction
reduced coping
adverse childhood events, especially sexual abuse and social pressures
what is persistent eating of substance with no nutritional value, such as dirt, paint, paper clips and undigested objects-dangerous, and intestinal blockage?
pica
what is the treatment for pica?
close monitoring
reward appropriate eating
what is undigested food being returned to mouth, re-chewed, re-swallowed, or spit out?
rumination disorder
what is the treatment for rumination disorder?
distraction
what is restricting insulin to lose weight?
eating disorder-diabetes mellitus type 1
what increases risk of death and escalation of medical complications of diabetes?
eating disorder- diabetes mellitus type 1
what are eating disorder treatments?
- restore nutritional status- weight restoration program; may require medical unit admit before psych, alleviate emaciation, dehydration, electrolyte imbalance
- behavior modifications- they must perceive control of treatment for it to be successful; contract for privileges based on weight gains
what is the complication of the weight restoration program?
refeeding syndrome
what are the complications from refeeding syndrome?
imbalance of electrolytes/fluid shifts- can occur when a malnourished individual begins to eat normally- eat carbs- rapid discharge of insulin
what happens when people who have been starving get foods with high carbohydrates can cause the glucose to increase leading to electrolyte imbalance to heart dyrhytmias?
refeeding syndrome
what increases the risk for refeeding syndrome?
rapid weight loss or profound weight loss
little or no food for 5 days
abnormal EKG/low phosphate as baseline
history of diuretic, laxative or insulin
what are the signs and symptoms of refeeding syndrome?
weakness
swelling legs/feet
difficulty breathing
altered mental status
seizures
heart failure
can lead to death
what uses concepts of cognitive, behavioral, and eastern mindfulness practices; wise minded?
dialectical behavior therapy
what are the goals of dialectical behavior therapy?
helps target problem behaviors that interfere with life and relationships
increase ability to manage distress, improve interpersonal effectiveness skills, and increase quality of life
what is not the therapy of choice for eating disorders and used when underlying psychological problems contributing to behaviors?
individual therapy
what happens during registered dietitian counseling?
assess food likes/dislikes
assess food triggers
review symptoms
weigh them blindly
make a food plan- very structured in beginning with high fiber, low sodium, limit high fat, and gassy foods in beginning; avoid caffeine
MVI/mineral supplements daily
what is the psychopharmacology for anorexia nervosa?
no medications are FDA approved for Anorexia nervosa and research does not support use of meds to treat core symptoms
what are medications that have been tried with some success for anorexia nervosa?
fluoxetine
clomipramine
cyproheptadine
chlorpromazine
olanzapine
what is the psychopharmacology for bulimia nervosa?
fluoxetine- usually a higher dose
impiramine
despiramine
amitriptyline
nortriptyline
phenelzine
what is the psychopharmacology for binge eating disorder?
topiramate
fluoxetine- higher dose
lorcaserine
topirmate/phentermine
lisdexamfetmaine
dimesylate
what are the nursing diagnoses for eating disorders?
imbalanced nutrition
deficient fluid volume
imbalanced nutrition
disturbed body image
anxiety
what are the nursing interventions for eating disorders?
structured milieu/promote therapies
consistent and therapeutic communication
positive approach- promote self-esteem; allows for sense of control
weigh blind and watch for attempts to inflate wait
realistic goals for weight
enforce restrictions if lose weight
monitor vitals
watch for refeeding syndrome
establish good eating patterns- sit with during meals- distract
monitor closely during and after meals/snack for one hour
may need therapeutic “lock out”
monitor exercise, intake and output, electrolytes, and EKG
help identify emotions and non-food related coping strategies (self-monitoring journal, distraction, relaxation)
relapse prevention strategies
patient/family teaching
