Eating Disorders

Question 1

two core psychopathologies of eating d/o:

Answer 1

disturbed eating behavior +

intense preoccupation w/weight and shape

Question 2

mortality rate of >10%

Answer 2

Anorexia n.

starvation, electrolyte imbalance, suicide

Question 3

3 features of anorexia nervosa

Answer 3

refusal to maintain weight
fear of gaining weight
disturbed perception of size/shape of one’s body

Question 4

binge eating w/compensatory methods to prevent weight gain

Answer 4

bulimia n.

less severe course than AN

Question 5

what distinguishes AN from BN?

Answer 5

BN can have normal weight

Question 6

frequent episodes of consuming lg amounts of food and feeling a lack of control over eating

Answer 6

binge-eating d/o

Question 7

ratio of eating d/o among M:F

Answer 7

1:10

Question 8

onset of AN/BN/dieting

co-morbidities of AN?

Answer 8

AN: 14-18, after 40 is rare
BN: late adolescence, early adulthood
dieting onset at puberty

depression (2/3); social phobia (1/3); OCD (1/4)

Question 9

MZ concordance of AN

Answer 9

70%

Question 10

neurochemical changes assoc w AN (NE, 5HT, CRF, cortisol, thyroid)

Answer 10

down NE, thyroid

up 5HT, CRF, cortisol

Question 11

sx of AN improve after administration of what drug?

Answer 11

opioid antagonists

Question 12

rigid, perfectionistic, close but troubled relationships with parents

Answer 12

anorexia nervosa

Question 13

key to AN dx?

Answer 13

discrepancy between actual weight and perceived body image

Question 14

AN includes abuse of which 3 meds? (LDS)

Answer 14

self-induced vomiting

laxatives, diuretics, stimulants

Question 15

sequelae of AN

Answer 15

amenorrhea
low T
hypogonadism
mood/cognition effects

Question 16

criteria for AN: 3 (RFD)

Answer 16

A. Restriction of E intake –> low body weight
B. Fear of gaining weight/becoming fat
C. Disturbance of experience of one’s weight/shape

Question 17

timeline for distinguishing restricting v. binge/purging type of AN

Answer 17

3 months (during this time has individual had binge/purge behavior?)

Question 18

predictors of poor outcome for AN

Answer 18

duration
OLDER age of onset
prior psych hospitalizations
poor adjustment
co-morbid personality d/o

Question 19

complications of purging

Answer 19

hypocalcemia
hypokalemia
met alk
ECG changes
fatty degeneration of liver
parotid gland enlargement
calluses/dental caries/esophageal tears

Question 20

recurrent episodes of binge eating but w/o compensatory behaviors to prevent weight gain

Answer 20

binge eating d/o

episodes followed by embarrassment, disgust, depression or guilt

Question 21

criteria for BN (BCDE)

Answer 21

A. Recurrent binge eating (eating w/in 2-hr period a larger amt of food + sense of lack of control)
B. Inapp compensatory behaviors (vomiting, laxatives, diuretics, fasting, exercise)
C. Binging and compensatory behaviors occur 2x/wk for >3mo
D. Self-evaluation influenced by shape/weight
E. Not occur excl during AN periods

Question 22

goals of eating d/o tx

Answer 22

restore nutrition
modify eating behaviors
change distorted beliefs about wt/wt loss
hospitalize if depression/SI

Question 23

Re-feeding syndrome sx

due to? how to avoid?

Answer 23

resp/cardiac failure, hypotension, arryth/seizures/coma/death
sudden shift from fat–>carbohydrate metabolism
cellular uptake of Pi
avoid via slow initiating w/vitamins,
electrolytes

Question 24

psychosocial interventions for eating d/o

Answer 24

CBT: monitor intake, ID assoc emotions, challenge beliefs about self-image; set goals for eating and weight; behaviors are shaped via positive reinforcement

Interpersonal psychoterapy: targets relational stressors which may trigger binge episodes

Question 25

drugs for eating d/o
1st line for BN?
which are contra-indicated?
what to give for false beliefs?
opioid blocker and app suppr for bulimia?

Answer 25

SSRI: fluoxetine for BN
NO TCA in AN (arryth)
NO bupropion in AN/BN (seizures)
Atypical antipsychotics for delusional beliefs

Naltrexone and ondansetron for bulimia

Question 26

describe the Maudsley method

Answer 26

giving parents permission to set health expectations for anorexic child at each meal

earlier the better