Eating Disorders Flashcards
Anorexia nervosa and bulimia
What are these 2 syndromes characterised by?
What is the psychopathology in these 2 conditions?
-How is a low target weight achieved
- Conscious and deliberate attempts to reduce body weight
- It takes the form of an overvalued idea and is characterised by a dread of fatness leading to the pt imposing a low target weight.
- Achieved through poor calorific intake, self induced vomiting, excessive exercise, drug use
What % lower than normal is body weight maintained at in anorexia?
-What is the BMI below?
-There is evidence of generalised endocrine disturbance, how does this manifest itself?
- 15%
- 17.5kg m2
- Amenorrhoea in post menarch women
- Loss of sexual interest
- Raised GH and cortisol
- Reduced T3
- Puberty events may be delayed or arrested in certain age groups
Bulimia
- What is the pts body weight normally?
- What is the characteristic feature?
- What is this associated with?
- How do pts counteract this
-What is Russels sign?
-Normal
-A preoccupation with eating and an irreversible craving for food
that results in binge eating
-Feeling a lack of control and inevitably feelings of shame and disgust
- They engage in purging (vomiting, laxatives, and diuretic use), fasting or excessive exercise
- Calluses on the back of the hands when the hand has been used to induce vomiting
What is the ICD-10 criteria for anorexia?
-Low body weight BMI
What is the ICD-10 criteria for bulimia?
- Binge eating
- Methods to counteract weight gain
- Overvalued idea
What other symptom is common?
What is a major complication and how should it be treated?
- Low mood and anxiety. May be surrounding eating but can be generalised
- If symptoms are severe enough they are said to be co-morbid to the eating disorder
- Hypokalaemia with repeated vomiting can be life threatening
- Should be treated gradually and the pt should be encouraged to eat potassium rich foods
What differentials should be considered?
- Most medical conditions can lead to weight loss.
- Depression
- OCD
- Psychotic disorders
- Dementia
- Alcohol or substance abuse
What is the female to male ratio of Bulimia and anorexia?
-What is their prevalence?
When is their age of onset?
-10:1
- Bulimia 3-5% incidence of 12.2 per 100 000
- Anorexia 1% incidence of 4.2 per 100 000
- Anorexia; mid to late adolescence
- Bulimia; slightly later at late adolescence to early adulthood
Genetics
- What have twin studies shown incidence to be higher in?
- What is there a higher incidence of in 1st degree relatives?
What neurotransmitter is thought to play a part?
- Higher incidence in monozygotic twins
- Higher incidence of eating disorders and mood disorders
- Serotonin is thought to suppress food consumption, some anorectics have been shown to have increased concentrations
What role does environment play?
- What family behaviour presents as a risk factor?
- Why can sexual maturity present as a conflict to anorexics?
What increases the risk of developing bulimia 8 fold?
What are associated conditions?
- Western culture
- Overprotective, over involved, avoid conflict and are resistant to change
- it leads to a change in body shape so they avoid menstruation
-A past history of dieting
- Perfectionism
- Low self esteem
- Alcohol
- Abuse
- Substance abuse
- Personality disorder
- Depression
Management
-Why are anorexics harder to treat?
-Ambivalence towards treatment and consequences of starvation (poor concentration, lethargy, depression)
-What is the preferred treatment?
What can this be?
-Brief outpt psychotherapy with the encouragement of familt involvement.
- Psychoeducation about nutrition and weight (advice, education, motivation)
- Nutritional management and weight restoration; involves negotiating target weight, eating plans, teaching shopping and cooking skills)
- CBT; 20-24 sessions exploring issues of self control, low self esteem and perfectionism
- IPT; improving social functioning and interpersonal skills
- Family therapy; affective if living with the family and onset before 18
- Psychodynamic psychotherapy; reserved for specialists in eating disorders
In whom is educating pts about nutrition and monitoring of weight most useful?
-Most useful in those who only diet excessively
The threshold is low for referral to a specialist eating disorder, for what groups is it especially low?
-What are poor prognostic factors
- Pts resistant to outpt treatment
- Severe anorexia
- Poor prognostic factors
- Long duration of illness
- Late age of onset
- Very low weight
- Associated bulimic symptoms
- Personality difficulties
- Poor family relationships
- Poor social adjustment
When would you consider hospitalisation?
-Very low weights; BMI
