Eating Disorders

Question 1

Aetiology of anorexia nervosa

Answer 1

58-76% genetic
Neurological disturbances 
-disturbance of hypothalamic function 
-increased serotonin 
Perfectionism and low self esteem
Sexual abuse
Difficult family relationships -> over protectiveness

Question 2

Aetiology of bulimia nervosa

Answer 2

Similar to AN
FH of depression
History of childhood obesity
Past exposure to dieting behaviour

Question 3

Clinical features AN ICD 10 criteria

Answer 3

BMI restrict intake, excessive means of loss
Over valued ideas/distorted body image -> dread of weight gain
Endocrine dysfunction
-amenorrhea/impotence
-loss of libido
-delayed menarche
-lanugo hair

Question 4

Clinical features of BN ICD 10 criteria

Answer 4

Usually have normal body weight 
Binge eating 2xpw 3m
Strong cravings for food
Methods to counteract weight gain 
Over valued ideas -> dread of fatness

Question 5

Differentials of low weight

Answer 5

AN
BM
Medical causes
OCD
Body dystrophic disorder
Psychosis
Depression
Alcohol/substance abuse
Dementia

Question 6

Assessment of AN/BN history

Answer 6

Focus on general life initially 
Eating behaviours 
-methods of wt loss
-body image 
-binging
Physical symptoms
-periods/sexual dysfunction 
-starvation symptoms
-vomiting symptoms
Psychological functioning 
-effect on life
-screen for other psych

Question 7

Symptoms of starvation

Answer 7

Emancipation 
Cardiomyopathy
Constipation
Cold intolerance
Bradycardia
Peripheral oedema
Proximal myopathy
Osteoporosis
Seizures

Question 8

Symptoms of vomiting

Answer 8

Dental erosion
Enlargement or salivary glands
Calluses on back of hands-> Russell’s sign
Oesphageal tears

Question 9

Assessment of AN/BN investigations

Answer 9

Bloods
-FBC- decreased Hb, WBC, platelets 
-U+E -hyponatremia, hypokalemia, hypophosphatemia
-hypoglycaemia
-decreased T4, FSH, LH
-increased cortisol and GH
-hypercholesterolemia 
ECG 
Physical risk assesment
-circulation
-squat text
-temperature

Question 10

Management of psychological

Answer 10

Motivational interviewing 
Psychoeducation 
Psychotherapies * include family 
-CBT 20-24 sessions-> control, self esteem
-interpersonal therapies 
-family therapy 
-psychodynamic psychotherapy

Question 11

Management of AN biological

Answer 11

Weight monitoring
Compilation monitoring
Nutritional management 
-target weight 
-eating plan 
Re feeding and electrolytes 
SSRI's for depression, OCD

Question 12

Management of AN social

Answer 12

Self help groups and charities
Involve family
Consider effect on ADL’s

Question 13

Consider admission if :

Answer 13

Significant physical complications *electrolytes
High suicide risk
Rapid weight loss
BMI

Question 14

Management of BN psychological

Answer 14

Psychoeducation
Self help manuals
Self help groups
CBT
Interpersonal therapy 
Specialist of severe 
Treat comorbid psych

Question 15

Management of BN biological

Answer 15

Treat complications
Monitoring
High dose SSRI’s for bingeing/purging

Question 16

Prognosis of AN

Answer 16

Slow recovery rates
1/3 3 years
1/3 3-6 years
Recovery unlikely after 15 years 
50% recovered at 10 years 
Eating habits and attitudes to body shape remain abnormal

Question 17

Poor prognostic factors for AN

Answer 17

Very low body weight 
Late onset
Bulimic features
Family difficulties
Personal difficulties
Poor social adjustment
Longer illness duration

Question 18

Prognosis BN

Answer 18

50-70% recovery in 10 years

1% mortality

Question 19

Epidemiology of eating disorders

Answer 19

F:M 10:1
14-25 peak at 18
Anorexia nervosa 0.6-1%
Bulimia 1%