Eating disorders Flashcards
Describe some cardiovascular complications in A/N
hypotension arrythmia bradycardia prolonged QT hypercholesterolaemia (HDL)
Describe GI complications A/N
Swollen salivary glands Dental Caries - erosion of enamel Delayed gastric emptying bloating constipation
Describe metabolic complications A/N
hypothermia dehydration electrolyte disturbance - low K+ Mg2+ Ca2+ Po43- hypoglycaemia high LFTs
Describe MSK complications of A/N
cramp tetany weakness osteoporosis fracture high CK due to muscle breakdown
Describe endocrine complications of A/N
LOW: -estrogen -testosterone -gonadotrophin -thyroxine HIGH: -cortisol
Describe renal complications of A/N
nocturia
acute renal failure
chronic renal failure
psychogenic polydipsia
Haematological complications A/N
Anaemia decrease WBC count Thrombocytopenia iron deficiency B12 and folate deficiency
Describe how serotonin systems are affected in A/N
serotonin systems implicated in regulation of feeding and mood
remain altered in A/N even after weight recovery
What are the five main eating disorders?
- anorexia nervosa
- bulimia nervosa
- EDNOS (eating disorder not otherwise specified - features of ED’s but not in any category)
- Binge eating disorder
- ARFID (avoidant/restricted food intake disorder- only eat narrow/restricted range of food)
describe the 4 different areas concerned with the aetiology of eating disorders
Genetic:
-influence of variant genes on control appetite and feeding via hypothalamus (leptin/ghrelin)
-personality type e.g. anorexia and controlling pers.
-10X risk in families with affected individual
Environmental
-in utero nutrition
-childhood adverse experiences
Developmental (puberty)
Brain chemistry
What are the five diagnostic criteria for Anorexia Nervosa?
- BMI of 17.5 or less
- Self induced weight loss (strict dieting/vomiting/excessive exercise/medication)
- Body image disturbance
- Fear of fatness (egosyntonic emaciation)
- Amenorrhea (this can occur befor significant weight loss and gonadotropin abnormalities can persist after weight recovery)
What are the 7 starvation effects on the brain?
- loss grey/white matter
- increase in compulsive behavior
- decrease in social skills
- enhanced response to hedonic/nutrostat signals
- Focus on food
- Poor conc/decision making
- New learning stunted
What are hedonic signals?
Reward/pleasure component of eating
What are nutrostat signals?
Hunger/satiety
In an anorexic patient why might their HCT/Na+ be low?
due to water loading
In an anorexic patient what might be seen on ECG
bradycardia and can get sudden death
In an anorexic patient what might be shown on DEXA scan
decrease in bone density even after 1 year amenorrhea
What is the squat test for anorexic patients?
do they have to use their arms to get up?
Why is checking core temperature important for anorexic patients?
risk hypothermia
what BMI consitutes low-moderate/moderate/high/v.high risk?
Low/mod: BMI 16-17.5 - safely managed as outpt
Mod: BMI 15-16 - often independant lives
High: BMI 13-14.9
V. high: BMI <13 - inpatient
Describe the risk assessment for a high risk anorexic patient
BMI <13, wt loss >1kg a week Prolonged QT, HR <40, sys BP <80 Core temp. <34 Unable to rise from squat without using arms Cognitive impairment
What is MARSIPAN?
Management of really sick patients with anorexia nervosa
- RCPsych, RCPhys
- aim to decrease mortalitiy of starve pt. with AN
What is the eden unit?
-Psych ward for medically stable pts. (arranged in advance)
What is the evidence based treatment for AN in adolescents
Family therapy for adolescents
What is refeeding? How to prevent?
Caused by depletion of already inadequate stores of nutrients which are used up quickly as body tries to repair itself
Prevented by frequent blood monitoring and slow pace refeeding.
For Anorexia nervosa what is:
- age onset
- lifetime prevalence females/males
- F:M
- mortality
- onset 9-24yrs
- lifetime prevalence 1-2.2% females, 0.2-0.3% males
- 10:1 F:M
- mortality up to 20%, (50% of these due to suicide)
describe the biological, physiological, psychological and social aetiologies of anorexia nervosa
Biological -genetic (50-75% heritability, 10Xrisk in affected families) -puberty -wt loss -starvation effects Physiological (improves with refeeding) -decreased memory/attention -brain atrophy -hypothalamic dysfunction Psychological -low self esteem -perfectionist/obsessional -black/white thinking -adolescence -child sexual abuse Social - western culture and expectations -family environment -school (bullying/academic pressure)
Describe some clinical signs seen in Anorexia Nervosa
- muscle wasting
- hair loss
- lanugo hair
- cold, blue peripheries
- dry skin
- hypercarotenaemia
- bradycardia/hypotension
- bruising
Describe what is involved in the long term treatment of anorexia nervosa
family therapy dietician medical monitoring psychological therapies - CBT art/drama therapy
What are assoc. co-morbidities of anorexia nervosa
depression
OCD
substance misuse
DM
What is the prognosis for anorexia nervosa?
- the higher the duration and the lower the BMI the worse the prognosis
- 80% good recovery
- 30% develop binge eating disorder
- 20% mortality
What are the 4 diagnostic criteria for bulimia nervosa?
- persistant preoccupation with eating
- irresistable craving for food
- binges and attempts to counteract them (starvation/vomiting/laxatives)
- morbid dread of fatness
what is the age onset and lifetime prevalence Bulminia nervosa
onset - late teens
lifetime prevalence - 1.5-2% females, 0.5% males
Describe the physical, psychological and social aetiologies of bulimia nervosa
physical - genetic/puberty/childhood obesity
psychological - impulsive personalities
social - cultural factors more relevant/access to large amounts of processed food/wt gain undesirable
Describe the signs seen in patients with bulimia nervosa
russells sign - calluses on knuckles from induced vomiting with fingers
parotid gland hypertrophy
dental caries - from vomiting
What are the medical complications of bulimia nervosa?
oesophageal reflux/tears/ruptures hypokalaemia subconjunctival haemorrhage dehydration siezures - metabolic abnormalities
What is the evidence based treatments for bulimia nervosa?
- guided self help
- CBT
- SSRI
What is the prognosis for bulimia nervosa
- > 50% good recovery with treatment
- 10-20% symptomatic up to 10years
- core cognitive distortions might persist
- worse with co-morbid substance misuse
What is binge eating disorder and why is it different from bulimia/anorexia?
- episodes of compulsive overeating
- taste and quality food important
- no compensatory behavior
- body wt/shape is less important to self-esteem than bulimia nervsa
What is the lifetime prevalence of binge eating disorder?
3.5% females, 2%males - increasing prevalence
1/3 obese patients
