Eating Disorders Flashcards
What are the clinical diagnostic criteria for anorexia nervosa
BMI 17.5 or less Self induced weightloss (oe strict dieting, vomiting, excessive exercise, medications) Disturbed body image Fear of fatness Amenorrhoea
What effects does starvation have on the brain
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
What are some physical consequences of anorexia
sensitivity to cold constipation hypotension bradycardia hypkalaemia and alkalosis secondary to vomiting
How can the risk of a patient with anorexia be assessed
BMI Rate of weight loss Bloods Circulation Muscle strength - squat test Temperature ECG
What is the BMI criteria for risk assessing a patient with anorexia nervosa
Low- moderate = 17.5-16
Moderate = 16-15
High=14.9-13
Very high = less than 13
When is the average age of onset of anorexia
9-24 years
What is the mortality associated with anorexia
up to 20 percent
-half due to suicide
What is the aetiology of anorexia
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
What are the physical signs of anorexia
muscle wasting hair loss lanugo hair cold peripheries dry skin hypercarotenaemia Bradycardia, hypotension bruising
What cardiovascular problems can arise in AN
Hypotensio Bradycardia Prolonged QT Arrythmias Hypercholesterolaemia
What metabolic complications occur in AN
Hypothermia dehydration Electrolytes - low K, Mg, Ca, Phos Hypoglycaemia Raised LFTs
What are the haematological complications of AN
anaemia Low WBC thrombocytopaenia iron deficiency B12 and folate deficiency
What are the renal complications in A
nocturia
acute or chronic renal failure
psychogenic polydipsia
what are the endocrine complications in AN
low sex hormones, oestrogen, testosterone
low thyroxine
raised cortisol
what are the GI complications in AN
swollen salivary glands dental caries erosion of enamel delayed gastric empyting bloating constipation
what msk complications can occur in AN
cramp tetany muscle weakness osteoporosis fractures
what features would make a patient with anorexia high risk?
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
What is refeeding syndrome and how is it prevented?
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
What conditions are common alongside AN
depression
OCD
substance misuse
diabetes
What is bulimia nervosa
Episodes of uncontrolled excessive eating ‘binges’ accompanied by means to lose weight
What is the diagnostic criteria for bulimia
Persistnent preoccupation with eating Irresistible craving for food binges Attemps to counter binges eg starvation, vomiting, lacitives Fear of fatness
when is the usual onset of bulimia
late teens
more common in females (as with AN)
What physical signs may be apparent in BN
calluses on knuckes - russells sign
parotid hypertrophy
dental caries
what medical complications are more common in bulimia
reflux oesophageal tears hypokalaemia Subconjunctival haemorrhage dehydration seizures
What is binge easting disorder
episodes of compulsive overeating
taste and quality if food important
no compensatory behavious
shape and weight less important to self esteem than in bulimia
how may obese pts are estimated to have BED
1/3
Name the other types of eating disorders
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
When may drug treatment be useful in EDs
SSRIs- fluoxetine in bulimia
Not shown to be effective for anorexia
