Eating Disorders Flashcards
What is Anorexia according to DSM-5
Intense fear of gaining weight or becoming fat, low body weight, disturbances in the way ones body weight is experienced and denial
What is considered mild anorexia?
BMI >17
What is considered moderate anorexia?
BMI 16-16.99
What is considered Severe anorexia?
15-15.99
What is considered extreme anorexia?
BMI <15Kg
What is Bulimia?
Recurrent episodes of binge eating
Recurrent compensatory behavior to prevent weight gain
Binge eating and compensation 1xweek for 3 months
What are the ways people living with bulimia prevent weight gain?
Laxatives, Vomiting, Diuretics, Diets, Drugs, Exercise
What is considered mild bulimia?
What is considered moderate bulimia?
What is considered Severe bulimia?
What is considered extreme bulimia?
What is an important difference beteween BN and AN in terms of diagnostic criteria?
Does not include a specific BMI as these individuals are usually normal to slightly overweight
With regards to developing health problems which BMI has not highest?
Obese >30
What is Binge eating disorder?
Recurrent episodes of binge eating without compensatory behaviour to prevent weight gain
Lack of control over eating during the episode
What are the criteria for Binge eating disorder?
Eating rapidly
eating untill uncomfortably full
eating large amounts when not hungry
Eating alone from embarrassment
feeling disgusted, depressed or guilty after eating
What is thought to be the physiological state of AN/BN?
Imbalance of neurotransmitters and neuropeptides
What occurs during AN/BN in terms of neurobiological dysfunction?
Increased levels of cortisol is released and this leads to HPA suppression, hypothalamic pituitary thyroid, and hypothalamic pituitary gonadal axes
What does suppression of the Hypothalamic pituitary gonadal lead to?
Decreases in estradiol, progesterone, Luteinizing hormone leading to amenorrhea and decreased libido
What also occurs during Hypothalamic pituitary thyroid suppression?
TSH inhibition reduces conversion of T4 to T3, reduced resting metabolic rate
What neurotransmitter dysfunction occurs during AN/BN?
Da deficiencies leading to decreased energy and decreased feelings of reward
Between AN and BN which has a higher mortality rate?
AN ~10% vs 1-2% BN
What types of diseases may exacerbate death or hospitalizations in BN?
Cardiovascular events
What is the general course and outcome of AN (3)
No recovery after 1st episode
Fluctuating pattern of weight gain and loss
Chronic deteriorating course
What is the Course of BN?
Chronic or intermittent with periods of remission and reoccurrence
What is the general principles of treatment of AN/BN?
Emphasize normalization of eating behaviour.
Developing new coping mechanisms
Forming a treatment alliance
Identify stressors that predispose to eating disorder
What are the issues taht may arise with amenorrhea? (4)
Osteoporosis
Decreased growth
Low libido
Unexpected pregnancies
What was the approximate relapse of eating disorder and pregnancy?
22% had a relapse in eating disorder during pregnancy
When do period return following eating disorder treatment?
Average 6 months of achieving a body wiehgt of 90% of the average age and height ~19-20
Is the return of the menstrual cycle related to body fat?
No, its related with the amount of estrogen in the body
What are the cardiac complications of AN? (2 large ones)
Prolonged QT, Cardiac atrophy from starvation
Why is Myocardial mass important in AN?
Prolonged starvation leads to wasted cardiac muscle
What are some other AN related cardiac complications that may occur
Sinus bradycardia
Cardiac arrythmias
Decreased heart rate variability
Hypotension
What cardiac outcomes are not reversible in AN?
Irreversible myocarditis,
To avoid refeeding induced complications in AN what are the three points?
Refeed slow,
Phosphorus supplement
Clinical surveillance in hospital
What is Gastroparesis?
paralysis of the stomach
What medications can be used to help with gastroparesis?
Domperidone
What is the risk of domperidone?
QT prolongation
What medication similar to domperidone should be avoided?
Metoclopromide as it can lead to EPS
What are the medical treatments for Constipation?
Bowel retraining with Peglyte, milk of magnesia, sennosides
With regards to the liver what may occur during AN? (3)
Hypoalbuminemia
Increased INR (1.5)
Petechiae (Tiny spots on skin and mucous membranes
What renal issues may occur during AN?
BUN elevation, decreased eGFR
What are the 5 ways eating disorders contribute to Osteoporosis
Decreased Nutrition,
Decreased Body weight,
Decreased serum androgen,
Decreased levels of IGF-1
Increased cortisol levels
What is the risk of Osteoporosis and eating disorders?
Usually AN occurs during adolescent therefore higher risk of anorexia when older
What are the possible treatments to preventing/improve bone mass in eating disorders? (4)
Estrogen replacement?
Calcium and Vitamin D
Bisphosphonates
Weight recovery
According to a trial revolving anorexia and woman did estrogen help with BMD?
No
What is the recommendations for calcium intake and Vitamin D?
1200-1500mg, VItmain D 1000 IU
In Teenagers has alendroante shown to benefit BMD?
No
In adult women with anorexia is alendronate shown benefit BMD?
Yes
What is the best way to recover BMD
Gaining weight
What occurs with the skin in eating disorder
Dry scaling skin
Calluses on back of hand
Hair loss
Lanugo hair (Fine hair growing on the skin)
What are the 6 goals of therapy for AN?
What is nutritional rehabilitation?
Restore weight gradually and prevent re-feeding syndrome
What does the caloric intake levels usually start at?
30-40kcal/kg/day and may advance to 70-100kcal/kg/day
What electrolytes should be monitored with regards to nutritional rehabilitation
What is refeeding syndrome?
Occurs when malnourished patients are fed high carbohydrate loads
What symptoms occur due to re-feeding syndrome?
Gastric bloating, nausea, edema
What can refeeding syndrome lead to?
Cardiac changes due to the replenishment of electrolytes and fluid
What is cardiac decompensation the highest during refeeding syndrome?
Initial phase
Next slide is of refeeding syndrome.
What are the non-pharm tx of AN?
Psychotherapy
CBT
What are the AN pharmacological tx? (3)
Pharmacotherapy not really effective in underweight malnourished patients.
Options:
Zinc, AP, Antidepressant
What are the benefits of Zinc?
Zinc deficiency exhibit symptoms similar to AN, therefore foten suggest for nutritional deficiency
Studies indicate Zinc led to weight gain
What may zinc benefit?
Weight, mood/anxiety possibly
Which AP may have benefit for AN?
Olanzapine because of weight gain, but may lead to increase AE such as sedation
What is the overall note on AP in AN?
Did not fix the psychological symptoms, but helped gain weight
What are the AE of AP?
EPS, anticholinergic toxicity, QTc prolongation, tardive dyskinesia
Which Antidepressants are not recommended for ED?
TCAs and Bupropion due to safety
Which antidepressant may help in ED?
SSRI may help with comborbid depression and OCD after weight restoration has occurred, but limited data and mixed efficacy
What is the conclusion about Pharmacotherapy for AN?
Data on the long term efficacy of drus are scarce, and short/long term drugs of anorexia remain challenging
What are the symptoms of purging in BN? (5)
What are the consequences of abused substances such as ipecac, diuretics or laxatives? (3)
What are the 7 goals of therapy in BN/
What are the treatment options for BN?
CBT, Nutritional rehab, pharmacotherapy
What is the goal of CBT and BN?
Superior in efficacy to drug therapy, focuses on change of thought pattern and specific behaviours
What are the medical treatments of BN? (3)
What are the drugs of choice for BN?
SSRIs
Which SSRIs are well studied for BN?
Fluoxetine, citalopram, sertraline
What is the Onset of SSRIs in BN?
2-4 weeks, duration 6-12 months of treatment
What is the duration of treatment with an SSRI in BN?
6-12 months
What is Topiramate and its treatment in for BN?
At mean dose of 100mg/day it has shown efficacy for 10 weeks in decreasing binge/purge episodesW
What is the issue with using topiramate?
The brain fog associated ADE
What are the monitoring requirements for BN? (8)
What does 5ht regulate?
Postprandial satiety, anxiety, sleep mood, impulse control, OCD
