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)
What is the female athlete Triad? Whos at risk of this?
WHat do you look for in diagnosing this?
Tx female athlete triad
Eating disorders
Stress Fx (osteoporosis)
Amenorrhea
Risk:
- appearance related sports
- high performance sports
What to look for:
- weight
- heart rate 40-50
- hypotension
- hypothermia
- parotid swelling
- poor dentition
- overuse injuries (fx)
Tx:
Estrogen replacement
Decrease energy expenditure
Nutritional consultation
Calcium w/ Vit D
Psych Counseling
Avoid NSAIDS
