Eating Disorders

Question 1

epidemiology

Answer 1

F»M (9x); onset 15-22, peak 18
AN 0.6-1%; BN 1% prevalence
culture; middle/upper class; private school; models/ballet

Question 2

AN - aetiology

Answer 2

genetics: MZ >DZ
neuroendo: hypothal, 5HT, atrophy; reversible

perfectionism, self-esteem (weight loss = control/success)
sexual development/abuse; personality disorder
parental overprotection/involvement/conflict avoidance
avoiding separation/independence/sexual dev
cultural ideals

Question 3

AN - features

ICD-10: weight, deliberate, endocrine, overvalued idea

Answer 3

BMI

Question 4

ED - DDx

Answer 4

medical: cancer, hyperthyroid, malabsorption, DM TI, CCF
depression/stress/OCD
body dysmorphic disorder
psychosis: poisoning

Question 5

AN - assessment

Answer 5

‘I FAMINES’
immediate changes: clothes, lanugo, dizzy, weak, cold
fasting/calories/exercise/vom
ameno; med abuse;
Image/BDD; no puberty; extremely low BMI;
stressors/triggers

comorbidity: check heart, lungs, endocrine; substances; DSH/SI
high vs. mod risk incl. sit-squat-stand test

Question 6

AN - management

Answer 6

mod risk: weekly monitoring; ?IP; encourage carer involvement
high risk: ?Ax/MCA/MHA

OPD: MI, education, comorbidities; support, psychotherapy and weight
-weight: goals, diary; aim 0.5kg/wk

IPD: high risk, rapid weight loss, BMI

Question 7

BN - aetiology

Answer 7

prevalence 1%, increasing; recent (1970s)
onset 15-22yo, peak 18yo

neurochemical (5HT), genetics less (MZ = DZ)
psychosocial: perfection, control, sex, self-esteem, family, culture

Question 8

BN - features

ICD-10: binges, cravings, compensatory behaviour, overvalued idea

Answer 8

binge-eating: craving and loss of control; >2/w for 3/12
can be any weight

compensatory behaviours: shame/guilt; purge/meds/exercise/fast

distorted body image, preoccupation, overvalued idea (fat, target weight, dread)

Question 9

BN - management

Answer 9

treat medical complications: dehydration; hypoK hypoCl met alk
treat psych comorbidities
SSRI: fluoxetine (HD) for binge/purge
CBT: 4-5 months; 
?IPT longer duration required

Question 10

BN - prognosis

Answer 10

70% recover

Question 11

AN - prognosis

Answer 11

slow recovery: 1/3 3y, 1/3 3-6y
10y: 50% recovered, 10% mort (1/3 SI), 40% ongoing (incl/ BN)
recovery unlikely if >15y duration

poor factors: very low BMI, bulimic features, late onset, family/personality issues, longer duration

Question 12

ED assessment

Answer 12

• eating behaviour: methods, typical day, body image, binge/compensate
• physical effects: periods, sexual, endocrine, bone, vitals, bowels
• psychosocial function: education/career, relations, social, psychiatric screen

-investigations: FBC, EUC, LFT, BM, lipids, TFT, ESR
ECG (bradyC, arrhythmia), BP

-physical risk: nutrition, circulation, MSK, temp, bloods/ECG

Question 13

test restults

Answer 13

low Hb (normocytic), hypoNa, hypoK, low PO4, hypoK hypoCl met akl
^LFT/bilirubin, hypoG, hyperchole, hyperacrotenaemia