Eating Disorders Flashcards
what is the BMI for obesity?
> 30 (>20% over ideal weight)
what is the genetic etiology of obesity?
- leptin receptor mutation
- melanocortin 4 receptor mutation
what is the iatrogenic etiology of obesity?
- antipsychotics and/or antidepressants
- blocking H1, AChm, 5HT2c receptors
- increase PRL by D2 receptor blockade
what is the lifestyle etiology of obesity?
- sedentary lifestyle
- dependence on automobiles
- increase in fat/carb content, processed food
what is the management and course of obesity?
- commercial dieting and weight loss programs may be ineffective for long-term
- bariatric surgery or gastric banding
- pharmacologic amphetamines (decrease appetite), orlistat (lipase inhibitor), topiramate/zonisamide (anti-convulsant)
- realistic diet and exercise
what are diagnostic criteria for anorexia nervosa?
- refusal to maintain 85% typical weight
- restriction of energy intake requirements –> low body weight
- -restricting type: does not eat or purge
- -binge/purge type: does binge/purge, but not bulimic
- fear of gaining weight
- body image disturbance (dysmorphism)
- missed menstrual cycle x3 (although men can get it too)
what is anorexia severity based on?
BMI
what is the epidemiology of anorexia?
- starts mid-teens to 20s; female > male (20:1), but increasing in males (potential Adonis complex)
- individual socioeconomics unrelated, but industrialization and media related
- -potentially job related
- mortality up to 18%
what is the personality profile of anorexic patients?
- work around food, or have expertise
- rigid, controlling, and high achieving
- addiction rates are lower
- depression and suicide occur
- fear of independence and maturation
- lack sense of autonomy/self
- need control in life, or are being rigidly controlled
what is the etiology of anorexia?
- biopsychosocial approach
- twins and sibling positive
- family mood/drug disorders (family sacrifice)
- neurepinephrine imbalance (low)
- endogenous opiate inbalance (high)
comorbidity of anorexia
- depression (50%)
- suicide increase
- OCD
- anxiety disorder
- rigid and perfectionistic traits
- delayed psychosexual development
- denial
- minimization
- delusion
medical issues of anorexia
- weight loss
- hypothermia
- edema
- bradycardia, hypotension, syncope
- amenorrhea
- end-stage heart attacks
- -electrolyte imbalance (low K+)
- -ST, T, QT cardiac changes
- lanugo hair (fine white hair)
- osteoporosis
- delayed gastric emptying
- metabolic acidosis
- organ failure
what is the course of anorexia?
- varies from spontaneous recovery to gradual starvation and death
- recovery is partial
- -food preoccupation, poor social relations, and depression continue
- -bulimia aspects may continue or replace anorexia
- admitting hunger, loss of denial, maturation, and esteem increases are favorable
hospitalization for anorexia?
restore nutritional stage once 20% of typical weight is lost; 2-6 mo if 30%
-forced tube feedings, especially if severe, end organ damage, electrolyte or cardiac findings, or patient unwilling to comply
must have firm consistency and behavioral plan
what is the programming structure for anorexia
- AM weigh-ins
- input/output
- labs
- inaccessible bathrooms
- progressive diets yield rewards
- continue as day treatment, then as outpatient
