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Psychiatry > Eating disorders > Flashcards

Eating disorders Flashcards

1
Q

Describe some cardiovascular complications in A/N

A 
hypotension
arrythmia
bradycardia
prolonged QT
hypercholesterolaemia (HDL)
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2
Q

Describe GI complications A/N

A 
Swollen salivary glands
Dental Caries - erosion of enamel
Delayed gastric emptying
bloating
constipation
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3
Q

Describe metabolic complications A/N

A 
hypothermia
dehydration
electrolyte disturbance - low K+ Mg2+ Ca2+ Po43- 
hypoglycaemia
high LFTs
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4
Q

Describe MSK complications of A/N

A 
cramp
tetany
weakness
osteoporosis
fracture
high CK due to muscle breakdown
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5
Q

Describe endocrine complications of A/N

A 
LOW:
-estrogen
-testosterone
-gonadotrophin
-thyroxine
HIGH:
-cortisol
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6
Q

Describe renal complications of A/N

A

nocturia
acute renal failure
chronic renal failure
psychogenic polydipsia

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7
Q

Haematological complications A/N

A 
Anaemia 
decrease WBC count
Thrombocytopenia
iron deficiency
B12 and folate deficiency
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8
Q

Describe how serotonin systems are affected in A/N

A

serotonin systems implicated in regulation of feeding and mood
remain altered in A/N even after weight recovery

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9
Q

What are the five main eating disorders?

A
  • 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)
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10
Q

describe the 4 different areas concerned with the aetiology of eating disorders

A

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

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11
Q

What are the five diagnostic criteria for Anorexia Nervosa?

A
  • 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)
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12
Q

What are the 7 starvation effects on the brain?

A
  • 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
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13
Q

What are hedonic signals?

A

Reward/pleasure component of eating

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14
Q

What are nutrostat signals?

A

Hunger/satiety

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15
Q

In an anorexic patient why might their HCT/Na+ be low?

A

due to water loading

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16
Q

In an anorexic patient what might be seen on ECG

A

bradycardia and can get sudden death

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17
Q

In an anorexic patient what might be shown on DEXA scan

A

decrease in bone density even after 1 year amenorrhea

18
Q

What is the squat test for anorexic patients?

A

do they have to use their arms to get up?

19
Q

Why is checking core temperature important for anorexic patients?

A

risk hypothermia

20
Q

what BMI consitutes low-moderate/moderate/high/v.high risk?

A

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

21
Q

Describe the risk assessment for a high risk anorexic patient

A 
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
22
Q

What is MARSIPAN?

A

Management of really sick patients with anorexia nervosa

  • RCPsych, RCPhys
  • aim to decrease mortalitiy of starve pt. with AN
23
Q

What is the eden unit?

A

-Psych ward for medically stable pts. (arranged in advance)

24
Q

What is the evidence based treatment for AN in adolescents

A

Family therapy for adolescents

25
Q

What is refeeding? How to prevent?

A

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.

26
Q

For Anorexia nervosa what is:

  • age onset
  • lifetime prevalence females/males
  • F:M
  • mortality
A
  • 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)
27
Q

describe the biological, physiological, psychological and social aetiologies of anorexia nervosa

A 
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)
28
Q

Describe some clinical signs seen in Anorexia Nervosa

A
  • muscle wasting
  • hair loss
  • lanugo hair
  • cold, blue peripheries
  • dry skin
  • hypercarotenaemia
  • bradycardia/hypotension
  • bruising
29
Q

Describe what is involved in the long term treatment of anorexia nervosa

A 
family therapy
dietician
medical monitoring
psychological therapies - CBT
art/drama therapy
30
Q

What are assoc. co-morbidities of anorexia nervosa

A

depression
OCD
substance misuse
DM

31
Q

What is the prognosis for anorexia nervosa?

A
  • the higher the duration and the lower the BMI the worse the prognosis
  • 80% good recovery
  • 30% develop binge eating disorder
  • 20% mortality
32
Q

What are the 4 diagnostic criteria for bulimia nervosa?

A
  • persistant preoccupation with eating
  • irresistable craving for food
  • binges and attempts to counteract them (starvation/vomiting/laxatives)
  • morbid dread of fatness
33
Q

what is the age onset and lifetime prevalence Bulminia nervosa

A

onset - late teens

lifetime prevalence - 1.5-2% females, 0.5% males

34
Q

Describe the physical, psychological and social aetiologies of bulimia nervosa

A

physical - genetic/puberty/childhood obesity
psychological - impulsive personalities
social - cultural factors more relevant/access to large amounts of processed food/wt gain undesirable

35
Q

Describe the signs seen in patients with bulimia nervosa

A

russells sign - calluses on knuckles from induced vomiting with fingers
parotid gland hypertrophy
dental caries - from vomiting

36
Q

What are the medical complications of bulimia nervosa?

A 
oesophageal reflux/tears/ruptures
hypokalaemia
subconjunctival haemorrhage
dehydration
siezures - metabolic abnormalities
37
Q

What is the evidence based treatments for bulimia nervosa?

A
  • guided self help
  • CBT
  • SSRI
38
Q

What is the prognosis for bulimia nervosa

A
  • > 50% good recovery with treatment
  • 10-20% symptomatic up to 10years
  • core cognitive distortions might persist
  • worse with co-morbid substance misuse
39
Q

What is binge eating disorder and why is it different from bulimia/anorexia?

A
  • episodes of compulsive overeating
  • taste and quality food important
  • no compensatory behavior
  • body wt/shape is less important to self-esteem than bulimia nervsa
40
Q

What is the lifetime prevalence of binge eating disorder?

A

3.5% females, 2%males - increasing prevalence

1/3 obese patients

Psychiatry (26 decks)

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