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Psychiatry > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

What are the clinical diagnostic criteria for anorexia nervosa

A 
BMI 17.5 or less
Self induced weightloss (oe strict dieting, vomiting, excessive exercise, medications)
Disturbed body image
Fear of fatness
Amenorrhoea
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2
Q

What effects does starvation have on the brain

A 
loss of grey and white matter
increased compulsive behaviour
enhances respnce to hedonic or nutrostat signal
reduced social skills
focus on food
poor concentration and decision making
new learning stunted
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3
Q

What are some physical consequences of anorexia

A 
sensitivity to cold
constipation
hypotension
bradycardia
hypkalaemia and alkalosis secondary to vomiting
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4
Q

How can the risk of a patient with anorexia be assessed

A 
BMI
Rate of weight loss
Bloods
Circulation
Muscle strength - squat test
Temperature
ECG
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5
Q

What is the BMI criteria for risk assessing a patient with anorexia nervosa

A

Low- moderate = 17.5-16
Moderate = 16-15
High=14.9-13
Very high = less than 13

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6
Q

When is the average age of onset of anorexia

A

9-24 years

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7
Q

What is the mortality associated with anorexia

A

up to 20 percent

-half due to suicide

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8
Q

What is the aetiology of anorexia

A 
Gentetic - 50-75 percent heritability, 10 x risk in affected families
Puberty 
Weight loss
advere childhood events/abuse
Relationship and family problems
Low self esteem
Personality- perfectionist, 'black and white' thinking
Pressure- academic, societal
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9
Q

What are the physical signs of anorexia

A 
muscle wasting
hair loss
lanugo hair
cold peripheries
dry skin
hypercarotenaemia
Bradycardia, hypotension
bruising
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10
Q

What cardiovascular problems can arise in AN

A 
Hypotensio
Bradycardia
Prolonged QT
Arrythmias
Hypercholesterolaemia
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11
Q

What metabolic complications occur in AN

A 
Hypothermia
dehydration
Electrolytes - low K, Mg, Ca, Phos
Hypoglycaemia
Raised LFTs
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12
Q

What are the haematological complications of AN

A 
anaemia
Low WBC
thrombocytopaenia
iron deficiency
B12 and folate deficiency
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13
Q

What are the renal complications in A

A

nocturia
acute or chronic renal failure
psychogenic polydipsia

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14
Q

what are the endocrine complications in AN

A

low sex hormones, oestrogen, testosterone
low thyroxine
raised cortisol

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15
Q

what are the GI complications in AN

A 
swollen salivary glands
dental caries
erosion of enamel
delayed gastric empyting
bloating
constipation
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16
Q

what msk complications can occur in AN

A 
cramp
tetany
muscle weakness
osteoporosis
fractures
17
Q

what features would make a patient with anorexia high risk?

A

BMI less than 12, wt loss more than 1kg per week
long QT, HR less than 40, Syst BP less than 80
TEMP less than 34 degrees
unable to rise from squat without using arms
cognitive impairement

18
Q

What is refeeding syndrome and how is it prevented?

A

Metabolic disturbances arising with food consumtion after a period of starvation - caused by depletion of already inadequate stores of various electrolytes which are quickly used up as the body start to repair itself

Prevention - blood monitoring and slow pace of initial refeeding

19
Q

What conditions are common alongside AN

A

depression
OCD
substance misuse
diabetes

20
Q

What is bulimia nervosa

A

Episodes of uncontrolled excessive eating ‘binges’ accompanied by means to lose weight

21
Q

What is the diagnostic criteria for bulimia

A 
Persistnent preoccupation with eating
Irresistible craving for food
binges
Attemps to counter binges eg starvation, vomiting, lacitives
Fear of fatness
22
Q

when is the usual onset of bulimia

A

late teens

more common in females (as with AN)

23
Q

What physical signs may be apparent in BN

A

calluses on knuckes - russells sign
parotid hypertrophy
dental caries

24
Q

what medical complications are more common in bulimia

A 
reflux
oesophageal tears
hypokalaemia
Subconjunctival haemorrhage
dehydration
seizures
25
Q

What is binge easting disorder

A

episodes of compulsive overeating
taste and quality if food important
no compensatory behavious
shape and weight less important to self esteem than in bulimia

26
Q

how may obese pts are estimated to have BED

A

1/3

27
Q

Name the other types of eating disorders

A

EDNOS=eating disorder not otherwise specified- deranged eating but does not fit criteria for AN, BN or BED
ARFID= avoidant/restrictive food intake disorder - ‘picky’ eater - will only be able to eat certain foods
Orthorexia nervosa- obsession with eating healthy foods

28
Q

When may drug treatment be useful in EDs

A

SSRIs- fluoxetine in bulimia

Not shown to be effective for anorexia

Psychiatry (18 decks)

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