Eating Disorders Flashcards
1
Q
Obesity: etiology
A
Now a medical disorder;
more than 20% over ideal weight or BMI>30;
- genetic component (leptin receptor mutation, melanocortin 4 receptor mutation)
- Iatrogenic (anti-psychotics and/or anti-depressants; block H1 for increased appetite, Achm that can increase your weight, 5HT2c receptors)
- Lifestyle: sedentary, depends on CARS, increased fat/carb content and processed food
2
Q
Manage and Course of Obesity:
A
- Try commercial dieting and weight loss programs, but ineffective maybe for long term
- Surgery (bariatric and also gastric banding)
- Pharm: amphetamines (decrease appetite), orlistat (lipase inhibitor and can lead to diarrhea that’s foul-smelling), topiramate and zonisamide (anti-convulsants)
- Realistic diet and exercise
3
Q
Anorexia DSM-5 diagnosis and types
A
- refusal to maintain 85% typical weight (DSM-IV)
- Restriction of energy intake requirements = LBW
- Fear of gaining (won’t eat a cheerio)
- Body image disturbance (dysmorphism)
- Missed menstrual cycles at least 3 times (DSM-IV)
Types:
- restricting (won’t eat, won’t purge)
- Binge/purge type (does binge or purge)
- Severity based upon BMI!!!!
4
Q
Some facts about AN:
A
- Female > male (increasing in males thanks to things like Adonis complex)
- Individual socioeconomics unrelated!!!
- Industrialization related, perhaps job related (model or gymnast), media related
- Patients work around food or have expertise
- think TYPE A personality with being rigid, controlling, high-acheving
- Not as high ADDICTION rates, but depression and suicide can occur!!!
5
Q
Etiology of AN:
A
- There is a genetic component (family mood/drug disorders)
- ?Neurepinephrine imbalance-low
- Endogenous opiate imbalance-high
- Media/industry
- Family sacrifice (works three jobs for you to go to Harvard)
- Fears independence and maturation (don’t want to grow up so you look small/thin)
- Lack sense of autonomy/self
- Feel need to take control in life or are being rigidly controlled!!
6
Q
What tends to run with AN (comorbidity)?
A
- Depression 50%
- Suicide increase
- OCD and anxiety disorders
- Think rigid and PERFECTIONISTIC TRAITS
- Denial, minimization, delusion (comes later in unit)
7
Q
List of med issues for AN?
A
- Weight loss and now more sens to 2. hypothermia!!
- Edema (less protein so water leaks out)
- Bradycardia, hypotention, SYNCOPE!!
- Amenorrhea
- Electrolyte imbalance, HYPOKALEMIA!!
- ST, T, QT cardiac changes!!
- Lanugo hair
- Osteoporosis
- Delayed gastric emptying
- Metabolic acidosis
- Organ failure
8
Q
Course of AN:
A
- from spontaneous recovery to gradual starvation and death
- Recovery is partial: food preoccupation, but then poor social relations and depression continue (harm reduction method)
- Have to admit hunger, loss of denial, mature and increase esteem to favor prognosis
- Bulimia aspects COULD contiue
9
Q
Treat AN:
A
HOSPITALIZATION!!
- restore nutritional state if 20% typical weight lost; 2-6 months if 30% lost
- FORCED TUBE FEEDINGS if severe, you see end organ damage, or have electrolyte (hypokalemic) or cardiac findings; maybe patient unwilling to comply!!
- Need FIRM consistency (you need to stay at a certain weight for me or you will be HOSPITALIZED!!)
- Behavioral plan
10
Q
Programming:
A
- AM weights
- I/Os
- Labs
- Inaccessible bathrooms
- Progressive diets yield rewards (token economy if they put weight back on)
Keep treatment going during day, THEN as outpatient if you feel good enough about them
11
Q
Psychotherapy for AN?
A
- Psychodynamic
- CBT (token economy)
- Family (parents might be part of the problem)
12
Q
Bulimia nervosa criteria
A
- recurrent binge eating: eating atypically large amount in discrete period of time disproportionate to typical eating
- Purging vs. non-purging types
- NO ANOREXIA present
- Loss of control (feel compelled)
- Compensatory behaviors!!!: vomiting, laxative use, enemas, diuretics, exercise
- BINGES 1x/week for 3 months
- NEED COMPENSATORY BEHAVIORS to make diagnosis
13
Q
BN facts/etio/comorbid:
A
- Prev: bulimia > anorexia
- Female > male
- Later onset
- Normal to obese premorbidly (NOT SKINNY)
- Think personality disorder and substance abuse (NOT TYPE A personality)
- Maybe serotonin loss (use SSRI’s)
- Increased ENDORPHINS
- Perfectionism (as a society)
- Again dysfunctional family, but less rigid, more conflicted
10: outgoing, angry, impulsive traits, BORDERLINE personality - More addiction and anxiety
14
Q
Medical issues with BN:
A
- poor dentition: ENAMEL LOSS!!
- Abraided knuckles (RUSSELL’S SIGN)
- Normal/overweight
- SEXUALLY ACTIVE (AN not as much)
- Labs: LOW PO4, LOW Mg
- Salivary enlargement (throw up a lot = larger glands)
- Esophagitis/tears in esophagus
15
Q
Course of BN; treat:
A
- better than anorexia
- wax/wane course
- 3 yr follow up: 30% do well
- Individual therapy (CBT, group, family therapy)
- Meds (SSRI’s)
- Thorough med evaluation and follow-up
- Thorough psychiatric evaluation
- hospitalization RARELY needed
