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Psychiatry > Eating disorders > Flashcards

Eating disorders Flashcards

1
Q

What is anorexia nervosa?

A

Significantly low body weight or rapid weight loss not due to an underlying physical condition, but as a result of a preoccupation with weight, construed as either a fear of fatness or a pursuit of thinness

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2
Q

Aetiology of anorexia nervosa

A

Females
15-19 y/o

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3
Q

How does anorexia nervosa present?

A
  • Low body weight (BMI < 18 or 98%)
  • Over-controlled eating
  • Obsessive exercise
  • Isolated, conflict-avoidant
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4
Q

What are some common traits in those with anorexia nervosa?

A

Anxious
Obsessional
Risk avoidant
Avoid independence

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5
Q

What investigations are required in anorexia nervosa?

A

ESR and TFTs to screen for other causes
MARSIPAN scoring system to asses physical risk

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6
Q

1st line management of anorexia nervosa in those under 18

A

Anorexia-nervosa-focused family therapy

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7
Q

Management of severe anorexia nervosa (E.g. malnutrition, very low BMI)

A

Inpatient treatment

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8
Q

Management of anorexia nervosa in adults?

A

Psychological treatment

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9
Q

What are some psychological treatments for anorexia nervosa?

A
  • Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
  • Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
  • Specialist supportive clinical management (SSCM)
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10
Q

Complications of anorexia nervosa?

A
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11
Q

Prognosis of anorexia nervosa

A
  • Mean duration of illness to recovery is 7years
  • 50% recover completely
  • 30% partial recovery
  • 20% remain severely ill
  • 30+% will require readmission to hospital
  • Mortality 5.1 per 1,000 person years, 20% ofdeaths in anorexia nervosa are by suicide
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12
Q

What is bulimia nervosa?

A

Eating disorder characterised by repeated episodes of uncontrolled overeating (binges) followed by compensatory weight loss behaviours (Purges), with normal or high body weight (AN if low)

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13
Q

Aetiology of bulimia nervosa

A

Age 15-25 years

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14
Q

How does bulimia nervosa present?

A
  • Binge-Purge cycles
  • Out of control eating followed by purging behaviour such as forced vomiting
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15
Q

What are some common traits of those with bulimia nervosa?

A

Conflict-attracted
Impulsive
Obsessional
Independant high achievers
Pursue heightened mood states

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16
Q

What is a common blood test finding in bulimia nervosa?

A

Low serum potassium

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17
Q

What are some management options used in adults with bulimia nervosa

A

Guided self-help
ED focussed CBT
Fluoxetine
Inpatient treatment (If severe)

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18
Q

Management of bulimia nervosa in those under 18

A

Bulimia-nervosa-focused family therapy

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19
Q

What are some possible complications of purging in bulimia nervosa?

A
20
Q

What does ARFID stand for?

A

Avoidant/Restrictive Food Intake Disorder

21
Q

What is ARFID?

A

Avoidance and/or restriction of certain foods or types of foods

22
Q

What are some conditions associated with ARFID?

A

ASD, anorexia, bulimia, and anxiety disorder

23
Q

What are some possible impacts of ARFID?

A

Failure to grow
Weight loss
Social impacts (E.g. Food-based social events)

24
Q

What are the 3 main types of ARFID?

A

Sensory - Avoidance of textures or smells etc

Consequencial - Concerned about the consequences of eating certain foods (E.g. fear of vomiting)

Uninterested - Little interest in eating, little recognition or hunger

25
Q

How is ARFID managed?

A

Tailored treatment to the individuals needs
Nutritional input

26
Q

What is binge eating disorder?

A

Person feels compelled to overeat on a regular basis

27
Q

Aetiology of binge eating disorder

A
  • Identified in males more often than any other eating disorder
  • Often associated with obesity
  • More common in adults, onset 20+
28
Q

How will binge eating disorder usually present?

A
  • Eating- out ofcontrolbingeing
  • Exercise - often avoidant
  • Relationships- often isolated and/or conflict-avoidant
  • Common traits - often depressed and anxious
29
Q

How is binge-eating disorder managed?

A
  • Self-help CBT based materials with support sessions
  • Individual or group CBT
30
Q

What is pica?

A

Regular consumption of non-nutritious substances, severe enough to require medical attention (Not caused by underlying physical condition) E.g. eating soil, eating clay

31
Q

What is rumination-regurgitation disorder

A

Intentional and repeated bringing up of previously swallowed food into the mouth which may be re-chewed and swallowed or spat out in those ≥2 years old

32
Q

What is orthorexia?

A

Feeling that you have to eat healthy to a point where there is highly restricted eating

33
Q

What are some other disorders of eating?

A
  • Diabulimia
  • T1DE- type 1 diabetes and disordered eating
  • Pregorexia
  • Drunkorexia
  • Anorexia Athletica
  • Bigorexia
  • Orthorexia
  • FAT - Female Athlete Triad
  • REDS - Relative Energy Deficiency in Sport
  • Food addiction
  • Anorexia by proxy
  • Emotional eating
  • Reverse anorexia
  • Picky/fussy eating
34
Q

What is re-feeding syndrome?

A

Potentially fatal metabolic response to too rapid re-feeding after a period ofstarvation

35
Q

Describe the pathophysiology of re-feeding syndrome

A
  • Body switches from carbohydrate to fats and protein as its energy source
  • Intracellular minerals becomedepletedbut serum levels may remain normal
  • Re-feeding stimulates insulin production which causes potassium/magnesium andphosphate to be taken into cells whilst serum levels fall
  • The rapid change in BMRtogether with serum electrolyte depletion causes the physical symptoms of re-feeding syndrome
36
Q

What are some symptoms of re-feeding syndrome?

A

Sudden cardiac death
Seizures
Hypertension
Difficulty breathing
Fatigue
Weakness
Confusion
Irregular heartbeat

37
Q

Who is most at risk of re-feeding syndrome

A
  • Severe malnutrition <70% weight for height or BMI<13
  • Rapid weight loss >1-2kg/week
  • 15% weight loss in 3 months – remember may still be in ‘normal’ weight range
  • Low wcc <3.5
  • Comorbid medical conditions e.g. pneumonia, serious infection
  • Prolonged low intake – little/no intake for 4 days
  • Previous history of refeeding syndrome
38
Q

How is re-feeding syndrome managed?

A
  • Start with low level energy replacement, with high phosphate content e.g. milk, and build up every 2-3 days
  • Supplement with multivitamin e.g. forceval and thiamine for at least 10 days
  • Daily monitoring of bloods
  • Correct electrolyte and fluid imbalances e.g. phosphate sandoz, sando K
    • IV replacement may be necessary but careful monitoring of bloods and patient’s physical presentation should allow early treatment
39
Q

How is re-feeding performed?

A

Meal plan at 1400kcals/day (Not told to patient)
Plan high is phosphate (E.g. milk)
Increase calories by 200kcals every 1-2 days

40
Q

How is re-feeding monitored?

A

Daily bloods for 5-10 days => K, Mg, PO4, Ca

41
Q

What are some techniques used to ensure the meal plan is followed in re-feeding?

A
  • Patients should be supervised throughout the meal and for 1hour post main meal (30mins post snacks)
  • Motivational techniques to encourage eating
  • Use of motivational place mats
42
Q

What are some forms of deception that patients may use when re-feeding?

A
  • Dropping food/spills, pushing food around on plate, food put up sleeve/into pocket etc
  • Remember it is the illness which is trying to deceive you not the person
43
Q

What is the last resort re-feeding treatment used in EDs?

A

NG feeding

44
Q

How is purging managed?

A
  • Electrolytes should ideally be replaced orally
  • Stopping purging can cause rebound oedema/fluid retention
  • Aldosterone increases with purging – can take several weeks without purging to return to normal
  • Treat with gentle rehydration. Avoid rapid iv fluid replacement
45
Q

How may constipation be managed in EDs?

A
  • Reduced intake = reduced output
  • Nasogastric feeding – tends to be low residue
  • Bowels become sluggish and may require several months to recover normal peristalsis.
  • Low residue diet recommended during refeeding. Overuse of laxatives can worsen the problem
  • If laxative required use stool softener e. g. Lactulose. Avoid stimulants. Suppository e.g. Glycerine may be required to empty lower bowel
46
Q

What medications may be used in ED treatment?

A

Fluoxetine - Benefit in bulimia nervosa

Thiamine + Forceval - Reduced risk of refeeding syndrome

Olanzapine and SSRIs used for treatment of comorbid conditions

47
Q
A

Psychiatry (20 decks)

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