eating disorders

Question 1

anorexia nervosa

Answer 1

More prevalent in females; overlapping mental disorders are common: depression and social phobia; severity measured in BMI
Restricting: uses dieting, fasting, and/or excessive exercises
Binge-eating/Purging: engaged in recurrent episodes of binge eating and purging behavior

Question 2

bulemia nervosa

Answer 2

More common than anorexia; must rule out Klein-Levin syndrome: includes hyperphagia episodes; severity measured in purging episodes/ week
Recurrent inappropriate compensatory behaviors in order to prevent weight gain

Question 3

binge eating disorder

Answer 3

Not fixated on body shape or weight and generally no purging behavior; seek weight-loss treatment; severity measured in binging episodes/week
Eating an amount of food that is definitely larger than what most people would eat and a sense of lack of control over eating during the episode

Question 4

anorexia nervosa treatment

Answer 4

CBT: focused on therapy to maintain eating behaviors
Inpatient re-feeding: increase by 500kcal/day every 4 days to 3500kcal/day
Pharmacotherapy: No drug therapy is FDA-approved
Small studies indicate fluoxetine and TCAs may be helpful
Pharmacotherapy is not appropriate without CBT
Bupropion is contraindicated

Question 5

bulimia nervosa treatment

Answer 5

CBT is first line and interpersonal therapy to work on relationships
Pharmacotherapy: Fluoxetine is FDA-approved
TCAs, trazodone, MAOIs may be helpful
CBT and medication

Question 6

BED treatment

Answer 6

Goals: reduce binge days, binge-eating episodes, improve psychological features and emotional well-being, and weight loss
Vyvanse approved for the treatment of moderate or severe BED
SSRIs, TCAs, topiramate have been studied
CBT can be useful as monotherapy, IPT, and dialectical behavioral therapy to learn behavioral skills
CBT and medications can be useful

Question 7

refeeding syndrome

Answer 7

Concern in anorexia nervosa
refeeding results in shift from fat metabolism to glucose for energy = sudden increase in glucose levels = increased insulin secretion and hypokalemia
End result: multiple organ failure
Re-feed with care, increase calories slowly

Question 8

medical complications with eating disoders

Answer 8

Electrolyte Imbalances: hypokalemia, hyponatremia, metabolic acidosis and alkalosis; Laxative abuse: non-anion gap acidosis
Cardiac: Anorexia - cardiac muscle wasting, bradycardia, hypotension, fatigue, mitral valve replacement, orthostasis, bradycardia, hypothermia; EKG to show prolonged QT that is secondary to malnutrition; Bulimia - orthostasis, bradycardia, hypothermia
Renal: Decreased GFR, chronic renal failure, Fluid and electrolyte imbalances
GI/ Oropharyngeal: Delayed gastric emptying, Mallory Weiss tears in esophagus from purging behavior
From Caloric Restrictions: Acrocyanosis, brittle nails, bruising/hematomas, hair loss, lanugo hair; Self-Injury: scars, onychophagia (nail-biting); Self-Induced Vomiting: decayed teeth, Russell sign: calloused knuckle from inducing vomiting