Eating Disorders

Question 1

etiology of obesity

Answer 1

genetic component: leptin receptor or melanocortin 4 receptor mutation

iatrogenic: anti-psychotics/antidepressants block H1, AChm, 5HT2c receptors, increase prolactin by blocking D2 receptor
lifestyle: sedentary lifestyle, dependence on automobiles, increased food intake etc

Question 2

management of obesity

Answer 2

bariatric surgery, gastric banding, amphetamines (decreases appetite)/orlistat (lipase inhibitor)/topiramate and zonisamide (anti-convulsants). realistic diet and exercise

Question 3

anorexia nervosa DSM-5

Answer 3

refusal to maintain 85% of typical weight. restriction of energy intake -> low body weight. fear of gaining. body image disturbance. severity based on BMI

Question 4

restricting type of Anorexia

Answer 4

does not eat, does not purge: classic type

Question 5

binge/purge type of anorexia

Answer 5

does binge or purge, but has DSM-5 qualities of anorexia

Question 6

personality type of someone with anorexia

Answer 6

more rigid and controlling and high achieving. this makes it harder to treat

Question 7

medical issues with anorexia

Answer 7

weight loss, hypothermia, edema, heart attacks, electrolyte imbalance, lanugo hair, osteoporosis, delayed gastric emptying, metabolic acidosis, organ failure

Question 8

anorexia treatment

Answer 8

restore nutritional state once 20% typical weight is lost. 2-6 months if 40% of weight is lost. forced tube feedings. be firm, and have a behavioral plan. Psychodynamic, family therapy, and CBT can help

Question 9

meds for anorexia?

Answer 9

tricyclic antidepressants (watch for heart problems), SSRI, ECT if depressed. treat all comorbidities. weight gain cocktails (mirtazapine, olanzapine)

Question 10

bulimia nervosa DSM-5

Answer 10

recurrent bing eating. purging and non purging types present. no anoreia present. loss of control. compensatory behavior (vomiting, laxatives, exercise). binges once a week for 3 months. compensatory behaviors needed for diagnosis

Question 11

etiology of bulimia

Answer 11

serotonin loss? increased endorphins. perfectionism, not as a trait but as a society. dysfunctional family, less rigid and more conflicted. outgoing, angry, impulsive traits. borderline personality. less ego control

Question 12

medical problems with bulimia

Answer 12

poor teeth, enamel loss. abraided knuckles (Russell’s sign), normal/overweight. sexually active. lab changes: low PO4, low Mg, high amylase. salivary enlargement. esophagitis/tears

Question 13

treatment of bulimia: therapy

Answer 13

individual therapy using CBT and dynamic therapy, as well as group and family therapy

Question 14

treatment of bulimia: meds

Answer 14

SSRIs are approved. imipramine, desipramine, trazodone, MAOi have data.

Question 15

avoidant/restrictive food intake disorder

Answer 15

failure to meet diet/energy needs. weight loss, nutritional deficiency, supplementation needed. psychosocial distress. essentially doesnt meet full anorexia criteria

Question 16

binge eating disorder

Answer 16

binges. lack of control. ego dystonic. once a week for 3 months. no purges or compensations

Question 17

rumination

Answer 17

repeated regurgitation and chewing of food. no weight gain. not medical or from intellectual disability or autism. often diagnosed before 6 years old