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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?

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
How is ARFID managed?
Tailored treatment to the individuals needs Nutritional input
26
What is binge eating disorder?
Person feels compelled to overeat on a regular basis
27
Aetiology of binge eating disorder
- Identified in males more often than any other eating disorder - Often associated with obesity - More common in adults, onset 20+
28
How will binge eating disorder usually present?
- Eating - out of control bingeing - Exercise - often avoidant - Relationships - often isolated and/or conflict-avoidant - Common traits - often depressed and anxious
29
How is binge-eating disorder managed?
- Self-help CBT based materials with support sessions - Individual or group CBT
30
What is pica?
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
What is rumination-regurgitation disorder
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
What is orthorexia?
Feeling that you have to eat healthy to a point where there is highly restricted eating
33
What are some other disorders of eating?
- 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
What is re-feeding syndrome?
Potentially fatal metabolic response to too rapid re-feeding after a period of starvation
35
Describe the pathophysiology of re-feeding syndrome
- Body switches from carbohydrate to fats and protein as its energy source - Intracellular minerals become depleted but serum levels may remain normal - Re-feeding stimulates insulin production which causes potassium/magnesium and phosphate to be taken into cells whilst serum levels fall - The rapid change in BMR together with serum electrolyte depletion causes the physical symptoms of re-feeding syndrome
36
What are some symptoms of re-feeding syndrome?
Sudden cardiac death Seizures Hypertension Difficulty breathing Fatigue Weakness Confusion Irregular heartbeat
37
Who is most at risk of re-feeding syndrome
- 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
How is re-feeding syndrome managed?
- 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
How is re-feeding performed?
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
How is re-feeding monitored?
Daily bloods for 5-10 days => K, Mg, PO4, Ca
41
What are some techniques used to ensure the meal plan is followed in re-feeding?
- 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
What are some forms of deception that patients may use when re-feeding?
- 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
What is the last resort re-feeding treatment used in EDs?
NG feeding
44
How is purging managed?
- 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
How may constipation be managed in EDs?
- 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
What medications may be used in ED treatment?
Fluoxetine - Benefit in bulimia nervosa Thiamine + Forceval - Reduced risk of refeeding syndrome Olanzapine and SSRIs used for treatment of comorbid conditions
47

Psychiatry (29 decks)

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