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Clin Med III - Psych, Genetics > Eating Disorders > Flashcards

Eating Disorders Flashcards

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1
Q

Define anorexia nervosa

A

RID

  • Refuse to maintain normal wt
  • Intense fear of gaining weight
  • Distorted view of body
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2
Q

Epidemiology of anorexia nervosa

A
  • Females

- Bimodal: 12-15 yo and 17-21 yo

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3
Q

MC age of onset for anorexia nervosa

A

14-18 yo

rare before puberty or after 40

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4
Q

Etiologies of eating disorders

A
  • Biological
  • Cultural
  • Genetic
  • Psychological
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5
Q

Comorbidities of anorexia nervosa

A
  • Anxiety disorders (60-65%)
  • Mood disorders (36-68%)
  • Substance abuse (23-35%)
  • Personality disorders (23-35%)
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6
Q

How do anorexia nervosa patients present?

A
  • Underweight
  • Unreliable history
  • Complaint is more for somatic or psych distress than wt loss
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7
Q

Clinical s/s of anorexia nervosa

A
  • Obsessed with weighing, measuring body parts, looking in mirror
  • Hoard food, will not eat in front of others, plays with food, hides food in napkins
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8
Q

What is Russell’s sign?

A

Calluses on the knuckles (from inducing gag reflex at back of throat)

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9
Q

Possible PE findings of anorexia nervosa

A
  • Russell’s sign
  • Muscle wasting
  • Lanugo (fine soft hair)
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10
Q

Treatment of anorexia nervosa

A
  • Acute intensive intervention (rehydrate, correct electrolytes)
  • Restore weight slowly (2-3 lb/wk for hospitalized, 0.5-1 outpatient)
  • Psychotherapy
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11
Q

How to restore weight in anorexia nervosa patients? Target weight?

A
  • 2-3 lb/wk for hospitalized pts
  • 0.5-1 lb/wk for outpatients
  • Female target weight: when normal menstruation returns
  • Male target weight: testicular function returns
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12
Q

What is the most effective treatment for anorexia nervosa patients in maintaining weight and healthy eating?

A

Psychotherapy (recommended for 1-2 yrs after weight has been restored)

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13
Q

Pharm treatment of anorexia nervosa

A
  • Antidepressants
  • SGAs
  • BZDs
  • Olanzapine (may help wt gain)
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14
Q

Prognosis of anorexia nervosa treatment

A
  • 45% pts have overall good outcome

- 50% continue to experience difficulties w/eating behavior and psych problems

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15
Q

What are poor prognostic indicators in anorexia nervosa?

A
  • Presence of bulimia
  • Laxative use
  • Severe wt loss
  • Low socioeconomic status
  • Denial
  • Drug use
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16
Q

What are favorable prognostic indicators in anorexia nervosa?

A
  • Early onset
  • Higher socioeconomic status
  • Less severe wt loss
  • Less denial
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17
Q

Which eating disorders may a patient maintain normal body weight?

A

Bulimia nervosa

Binge eating disorder

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18
Q

Define bulimia nervosa

A

Binge eating combined with inappropriate ways of preventing wt gain

19
Q

Define binge eating

A
  • As much as 3,000 cals in one sitting
  • Lack of control
  • Foods one would normally avoid
  • Secretive
20
Q

Types of bulimia nervosa

A
  • Purging (MC): vomiting

- Non-purging: fasting, excessive exercise, overuse meds

21
Q

Epidemiology of bulimia nervosa

A
  • Females (98-100%)

- Binge eating on its own is fairly common

22
Q

Average age of onset of bulimia

A

18-20 yo

23
Q

Comorbidities of bulimia nervosa

A
  • Mood disorders (24-88%)
  • Anxiety
  • Substance abuse (30%)
  • Personality disorder (20%, MC borderline)
24
Q

How to differentiate anorexia from bulimia?

A

More severe wt loss and amenorrhea in anorexia

25
Q

How to differentiate MDD from bulimia?

A

MDD may overeat in winter time but there are no compensatory behaviors

26
Q

When is inpatient hospitalization indicated in bulimia?

A
  • Electrolyte disturbances or medical complication
  • Depression w/SI
  • Those who have not responded to outpatient tx
27
Q

What psychotherapy shows the best results for uncomplicated bulimia not requiring hospitalization?

A

Residential programs (40 hr/wk)

28
Q

What is the only FDA approved treatment of bulimia?

A

Fluoxetine 60 mg/d

29
Q

What med should be avoided in bulimia and anorexia treatment?

A

Bupropion (associated with increased seizures)

30
Q

Alternative pharm treatments for bulimia

A
  • Topiramate
  • Ondansetron
  • Bright light therapy
31
Q

Prognosis of bulimia

A

Higher rates of partial and full recovery compared with anorexia

32
Q

Poor prognostic indicators of bulimia

A
  • History of substance abuse
  • Longer duration of disorder at presentation
  • SI or hx of suicide attempts
33
Q

Define binge eating disorder (BED)

A

Recurrent binge eating WITHOUT regular compensatory measures

34
Q

What is the MC eating disorder in the US?

A

Binge eating disorder

35
Q

Epidemiology of BED

A
  • Females 60%, males 40%

- Equal in all races/ethnicities

36
Q

Average age of onset for BED

A

Typically begins in adolescence but can begin later in life too

37
Q

Etiology of BED

A
  • None specifically
  • Familial disorder possibly
  • Cultural component
38
Q

How to differentiate obesity from BED?

A
  • Obesity: no success w/psych tx

- BED: psych comorbidities are higher

39
Q

Treatment of BED

A
  • Outpatient psychotherapy
  • SSRIs or Venlafaxine
  • Sibutramine (wt loss agent)
  • Topiramate
40
Q

Prognosis of BED

A
  • Little info available
  • Remission rates are higher than with anorexia or bulimia
  • Crossover to anorexia or bulimia is UNCOMMON
41
Q

Define pica

A

Persistent eating of non-food items over a period of at least 1 month that is severe enough to warrant intervention

42
Q

How old must a patient be to be diagnosed with pica?

A

At least 2 yo

eating must be developmentally inappropriate and not a part of cultural/social norms

43
Q

Define rumination disorder

A
  • Repeated regurgitation of food that has already been swallowed
  • Over a period of at least 1 month, not a/w a medical disorder

Clin Med III - Psych, Genetics (9 decks)

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