Eating Disorders Flashcards
DSM V criteria: Anorexia Nervosa
Restriction of energy intake relative to requirements leading to:
-significantly low body weight
Fear of weight gain
Severe body image disturbance in which body image is the predominant measure of self-worth with denial of the seriousness of the illness.
What are the subtypes of Anorexia Nervosa?
Restricting: restriction of intake to reduce weight
Binge eating/purging: may binge/purge to control weight
What body weight is considered to be anorexic?
15% below ideal body weight
Sign and Sx of Anorexia Nervosa
- dry skin
- cold intolerance
- blue hands and feet
- constipation
- bloating
- delayed puberty
- primary or secondary amonorrhea
- fainting
- orthostatic hypotension
- lanugo hair
- scalp hair loss
- early satiety
- weakness, fatigue
- short statures
- osteopenia
- breast atrophy
- atrophic vaginitis
- pitting edema
- cardiac murmurs
- sinus bradycardia
- hypothermia
DSM V criteria: Bulimia
A.) Recurrent of binge eating, which is characterized by..
- eating in a discrete period of time, an amount of food that is definately larger than what most would eat in a similar period of time under similar circumstances.
- a sense of lack of control over eating during the episode
B.) Recurrent inappropriate compensatory behaviors in order to prevent weight gain such as:
- self induced vomiting
- misues of laxatives, diuretics
- fasting
- excessive exercise.
C.) binge eating and inappropriate compensatory behaviors both occur at least once a week for 3mo
D.) Self evaluation is unduly influenced by body shape and weight
E.) The disturbance does not occur exclusively during periods of anorexia nervosa.
Bulimia Signs and Sx
- mouth sores
- pharyngeal trauma
- dental caries
- heartburn and chest pain
- esophageal rupture
- impulsivity: stealing, ETOH abuse, drugs/tobacco
- muscle cramps
- weakness
- bloody diarrhea
- bleeding or easy bruising
- irregular periods
- fainting
- swollen partoid glands
- hypotension
- russells sign (callus on knuckles from repeated self-induced vomiting.
Binge Eating disorder Criteria
–eating in a discrete period of time, an amount of food that is definately larger than what most would eat in a similar period
- a sense of lack of control over eating during the episode
- occurs 2 days per week for 6mo
- Must have at least 3 of the 5 criteria:
- -eating much more rapidly than normal
- -eating until uncomfortably full
- -eating large amounts of food when not feeling physically hungry
- -eating alone because of embarrassment
- -feeling disgusted, depressed or very guilty over overeating.
Eating Disorder NOS DSM V criteria
- all criteria for anorexia nervosa except has regular menses
- all criteria for anorexia nervoas except weight still in normal range
- all criteria for bulemia nervosa except binges less than 2x/wk for less than 3mo
- pt with normal body weight who regularly engage in inappropriate compensatory behavior after eating small amounts of food
- a pt who repeated chews and spits out large amounts of food without swallowing
What is the SCOFF questionnaire?
screening tool for eating disorders
- do you make yourself feel SICK b/c you feel uncomfortably full?
- do you worry you have lost CONTROL over how much you eat?
- have you recently lost more than 14lbs or ONE stone in three month period?
- do you believe yourself to be FAT when others say you are too thin?
- would you say that FOOD dominates your life?
What is ESP?
Eating disorder Screen for Primary care
- are you satisfied with your eating patterns?
- do you ever eat in secret?
- does your weight affect the way you feel about yourself
- have any of your family members suffered with an eating disorder?
- do you currently suffer with or have you ever suffered in the past with an eating disorder?
PE findings in Anorexia nervosa? Bulemia?
- orthostatic hypotension
- skin dryness, bruiising, lanugo
- bradycardia, arrhythmia, mitral valve prolapse
Bulemia: all previous elements PLUS:
- parotid gland hypertrophy
- erosion of the teeth enamel
Complications of eating disorders
- hypokalemia
- hyponatremia
- hypochloremic alkalosis
- elevated BUN
- inability to concentrate urine
- Decreased GFR
- Ketonuria
- osteopenia
- amenorrhea (menses resumes within 6mo of achieving 90% IBW)
- mitral valve prolapse
- Long QT interval
- Risk of heart failure is greatest in first 2wks of refeeding**
Treatment of Anorexia
CBT
anxiolytics may be helpful before meals to suppress anxiety associated with eating
(zyprexa)
Regain 90-92% of IBW;
- oral liquid nutrition
- NG feedings
- gradual caloric increases with regular food
- parenteral nutrition (rare)
When to hospitalize anorexia nervoas pts?
- severe malnutrition (less than 75% ideal body weight)
- dehydration
- electrolyte disturbances
- cardiac dysrhythmia
- arrested growth and development
- failure of outpatient tx
- acute psych emergencies
Bulimia Tx
- CBT
- Prozac
- TCAs
- Topiramate (Topamax)
- Ondansetrom (zofran)
