Eating Disorders Flashcards
How is obesity defined? What are possible etiologies? How is it managed?
> 20% over ideal weight; BMI > 30. Etiology: Genetic (leptin receptor muttion, melanocortin 4 receptor mutation), Iatrogenic (antipsychotics &/or antidepressants –> increase prolactin via D2 receptor block; block H1, Achm, 5HT2c receptors), Lifestyle (sedentary, diet, etc.). Management: realistic dieting & weight loss (commercial programs are usually ineffective in long term), surgery (bariatric, gastric bypass), pharmacologic (amphetamines [incr. app.], orlistat [lipase inhibitor], topiramate & zonisamide [antiepileptics]).
Diagnose anorexia nervosa. Define “restricting” & “binge-purge” types. What are the severities & what are they based on? When does anorexia usually start? What sex gets it more? Is this a serious disease?
Refusal to maintain 85% typical weight + fear of gaining + body image disturbance (dysmorphism). Restrictng = does not eat, does not purge. Binge/Purge = binge or purge. Severity: Mild, Moderate, Severe, Extreme, based on BMI. Usually starts in mid-teens-20s. Female 20X> Men. Very serious: Mortality near 18%.
What is the etiology of anorexia nervosa?
Biopsychosocial approach (twin studies, sibling studies). NE imbalance? (low); Endogenous opiate imbalance? (high). Social factors: media, industry family sacrifice, fear of independence/maturation, lack of sense of autonomy/self, need control in life or are being rigidly controlled.
What comorbidities do anorexics have? What is the major medical issue? What is the course of disease?
Comorbidities: depression (50%), suicide, OCD, anxiety, rigid/perfectionist traits, delayed psychosexual development. Medical issue: Risk of MI, organ failure (lanugo hair!). Course: Variable, from spont. recovery to gradual starvation & death. Recovery may be partial, bulimia aspects may continue.
What are the treatments for anorexia nervosa?
Hospitalization – restore nutritional state once 20% weight lost, admit for 2-6 months if 30%…may need forced tube feedings if severe. Programming: progressive changes, maybe use token economy. Day treatment, then outpt. Psychotherapy: psychodynamic, CBT, family. Medications? Nothing really works.
Diagnose bulimia nervosa. What two types are there?
Recurrent binge eating: eating an atypically large amt. in discrete period of time disproportionate to typical, without anorexia, with binges 1X/wk for 3 months, with compensatory behaviors (vomiting, laxatives, enemas diuretics, exercise) and a general loss of control. Purging vs. non-purging types.
Is anorexia or bulimia more common?
Bulimia
What sex does bulimia affect more? When is onset? What do these people weigh? What are common comorbidities? What is possible etiology? What is the course of the disease?
Female 10X> males. Later onset. Normal to obese. Personality disorders, substance abuse, anxiety. Serotonin loss? Perfectionism as a society, dysfunctional family. Course: better than anorexia, 50+% improve with a wax/wane course.
What are common medical complications of bulimia?
poor dentition, enamel loss, cavities, abraided knuckles (Russell’s Sign), sexually active, salivary enlargement, esophagitis/tears, labs: low PO4, low Mg, high amylase.
What is tx for bulimia? Is hospitalization needed?
Medication: SSRI. Individual tx: CBT, group, family. Hospitalization is rarely needed.
What is a disorder that essentially is anorexia nervosa but does not meet full criteria?
Avoidant/Restrictive Food Intake Disorder
What is a disorder with binges, lack of control, for 1X/wk for 3 months, but without purges or compensations?
Binge Eating Disorder
