Eating disorders

Question 1

What is the mortality of anorexia nervosa?

Answer 1

Approx. 10%

Question 2

What is the average age of onset of anorexia nervosa in girls?

Answer 2

16-17y/o

Question 3

What is the average age of onset of anorexia nervosa in boys?

Answer 3

Younger than girls - around 12y/o

Question 4

Is anorexia ego-syntonic or ego-dystonic?

Answer 4

Ego-syntonic - ideas are in-keeping with one’s self-image

Question 5

What are the RFs for anorexia nervosa?

Answer 5

1. Genetics
2. Personality (anankastic)
3. Occupation - models/dancers
4. Socio-cultural factors
5. Family dynamics

Question 6

What are the Dx features required for an anorexia nervosa Dx?

Answer 6

1. Loss of >15% body weight/BMI<17.5
2. WL by avoidance of food + at least one of self-induced vomiting/purging, over-exercising or diuretic/stimulant misses
3. HPG abnormality - e.g. TFT dysfunction or amennorhoea
4. Body image distortion
5. Pubertal events delayed (in event of onset prior to puberty)

Question 7

What are the neurological Sx of AN?

Answer 7

Headaches
Seizures
Lethargy
Peripheral neuropathy

Question 8

What are the cardiovascular Sx of AN?

Answer 8

Long QT
Bradycardia
Dysrhythmia
Hypotension

Question 9

What are the GI Sx of AN?

Answer 9

Melanosis coli
Bowel obstruction (AN emergency, from constipation)
Oesophagitis + dental erosion (if purging)

Question 10

What are the musculoskeletal Sx of AN?

Answer 10

Osteoporosis
Loss of muscle mass
Breast atrophy
Hypothermia - cold hands and feet

Question 11

What are the metabolic Sx of AN?

Answer 11

Hypoglycaemia
Hypokalaemia
Hypercholestraemia
Hypernatraemia

Question 12

What are the dermatological Sx of AN?

Answer 12

Brittle nails/hair
Dry skin
Hyperkarotaemia
Russell sign
Lanugo hair

Question 13

What are the endocrine Sx of AN?

Answer 13

Amenorrhoea
Parotid enlargement
Low testosterone in men
Low T3
Increased GH

Question 14

What are the haematological Sx of AN?

Answer 14

Leucopenia

Pallor (from mixed anaemia)

Question 15

What are the non-physical Sx of AN?

Answer 15

1. Depression
2. Irratibility
3. Low self-esteem
4. Poor concentration
5. Insomnia
6. Social withdrawal
7. (Baggy clothing)
8. (Cooking excessively or others)

Question 16

What are the indications for inpatient management in AN?

Answer 16

1. Failure of OP treatment
2. Severe psychiatric co-morbidity - e.g. suicidal ideation
3. Very low weight (BMI 13-13.5) or rapid WL
4. Serious physical complications - e.g. electrolyte disturbance (low K+), cardiovascular disease (e.g. fainting due to low BP) or hypothermia (T<36 degrees)

Question 17

How do bulimia and AN differ?

Answer 17

1. Bulimia = normal weight
2. Bulimia = normal menses
3. Bulimia = loss of control around food

Question 18

What drug is contraindicated in bulimia and AN, and why?

Answer 18

Bupropion - can cause seizures

Question 19

Is bulimia ego-syntotic or ego-dystonic?

Answer 19

Ego-dystonic - ideas are not in-keeping with an individuals self-image (hence why ego-dystonic individuals are more likely to seek help)

Question 20

What are the physical signs of bulimia

Answer 20

1. Parotid enlargement
2. Dental erosion
3. Russell’s sign
4. Metabolic alkalosis (from vomiting)

Question 21

At what dose is fluoxetine prescribed in bulimia?

Answer 21

Usually at a higher dose than in depression - usually 60mg/day