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Mental health > Eating disorders > Flashcards

Eating disorders Flashcards

1
Q

Describe three types of eating disorders

A
  • Anorexia Nervosa
    • Restricted food intake; persistent interfered weight gain
    • Associated body image disturbance; fear of weight gain
  • Bulimia Nervosa
    • Recurrent uncontrolled eating of abnormal quantity
    • Followed by compensatory behaviour eg. vomiting
  • Binge eating disorder
    • Recurrent binge eating; marked by lack of control
    • Absence of compensatory behaviours
  • Atypical eating disorders: do not precisely meet above criteria
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2
Q

How is BMI calculated?

A

Weight (kg) / Height (m) 2

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3
Q

What tool can be used to screen for eating disorders?

A

SCOFF questionnaire

2+ postive answers is suggestive of AN/BN

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4
Q

Name four risk factors for eating disorders

A
  • Adolescence and early adulthood
    • Rare in women over 30
  • Female (10:1)
  • Overweight as a child
  • FHx of eating disorder; mental illness; substance use
  • Personality traits: obsessive compulsive, perfectionism
  • Anxiety; depression; low self-esteem; body image issues
  • Life events: bullying, stress etc.
  • Societal pressure
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5
Q

When should emergency admission be considered for eating disorders?

A
  • Severely compromised physical health, including:
    • BMI/weight below safe range
    • Cardiovascular instability eg. HR <40bpm; long QT
    • Hypothermia
    • Electrolyte imbalance; hypoglycaemia
  • Risk of refeeding syndrome
  • Acute mental health risk
    • Risk of suicide attempt
    • Serious self-harm
  • Lack of support at home
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6
Q

Request five investigations for suspected eating disorders

A
  • FBC; ESR (organic cause); U+E; LFTs; glucose
  • Urinalysis
  • ECG
  • Ca2+; Mg3+; PO4-
  • B12; folate; ferritin
  • TFTs
  • FSH; LH; PrL
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7
Q

Outline the diagnostic criteria for anorexia nervosa

A

DSM-5

  • A: BMI <17.5 or 15% below expected weight (children)
  • B: Extreme fear of becoming fat; self-induced weight loss
    • eg. Vomiting, exercise, laxatives
  • C: Body image distortion
    • Overvalued ideas
    • Imposed low weight threshold
    • Lack of insight

Endocrine disorders: Amenorrhoea; reduced libido

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8
Q

Describe how anorexia nervosa differs between sexes

A
  • Female (10:1)
    • 0.3% of young women
  • Mean age of onset:
    • Female 16-17
    • Male 12
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9
Q

What endocrine abnormalities are seen in Anorexia nervosa?

A
  • High:
    • Cortisol
    • Growth hormone
  • Low:
    • FSH
    • LH
    • Oestrogen
    • Testosterone
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10
Q

What are the effects of starvation?

How do these maintain anorectic behaviour?

A
  • Delayed gastric emptying and slower GI motility
    • Early satiety, not wanting to eat
  • Reduced leptin, increased restlessness
    • Urge to be active and exercise
  • Preoccupation with food
    • Fear of overeating, increased dietary control
  • Increased thought rigidity and obsessions
    • Rigid dietary rules, ritualised eating
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11
Q

What is sick euthyroid syndrome, and why does it appear in Anorexia nervosa?

A

Low T4, normal TSH

Biological adaptation to low body weight

Attempted reduction of metabolic rate and energy expenditure

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12
Q

What are medical complications of Anorexia nervosa a result of?

A

Medical complications of AN are the negative consequences of starvation that appear when body systems are unable to adapt to the low body weight.

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13
Q

Suggest five complications of anorexia nervosa

A
  • Psychological: anxiety; social withdrawal; low mood; suicidal ideation
  • Social: disrupted relationships; isolation; employment; financial
  • Family/carer stress
  • CV: arrhythmias; hypotension; peripheral oedema; sudden death
  • MSK: muscle weakness; low BMD; fractures; growth restriction
  • Endocrine: thyroid abnormalities; poor 2o sexual characteristics; amennorhoea; hypothermia
  • GI: slow motility; constipation; mallory-weiss tears; abnormal LFTs
  • Haem: low WCC; thrombocytopenia
  • Metabolic: dehydration; electrolyte disturbance; refeeding syndrome
  • Cognitive impairment
  • Renal failure
  • Dry skin; alopecia; lanugo hair
  • Infertility; sexual dysfunction; miscarriage; IUGR; preterm birth
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14
Q

Why is anorexia nervosa difficult to treat?

A

Ego syntonic disorder ➔ behaviour is acceptable to the goals of the patient

Deliberate weight loss provides a sense of control and achievement

Giving up anorexia can be experiences as a failure/loss.

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15
Q

Outline the management of Anorexia nervosa

A

Eating disorder clinic with specialist psychological intervention

  • Biological
    • ​Weight restoration; correction of electrolyte disturbances
    • Dietary counselling; vitamin and mineral supplements
  • Psychotherapy, any of:
    • ​ED-focused CBT (CBT-ED)
    • Maudsley AN treatment for adults (MANTRA)
    • Specialist supportive clinical management (SSCM)
    • AN-focused family therapy (FT-AN): CAMHS
  • Social
    • Adaptation to life without functional aspects of anorexia
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16
Q

What is the prognosis of Anorexia nervosa?

A
  • Highest mortality rate of any psychiatric disorder (6%)
    • Half due to suicide
    • Half due to medical complications
  • 20% recover completely
  • 20-30% develop chronic presentation
17
Q

Which patients are most at risk of serious medical conditions of Anorexia nervosa?

A
  • BMI <14
  • Rapid weight loss
  • High levels of self-induced vomiting
18
Q

Outline the DSM-5 diagnostic criteria for Bulimia nervosa

A
  • Recurrent episodes of binge eating, requiring both:
    • Eating an abnormal quantity in a discrete period of time
    • Sense of lack of control over eating during the episode
  • Recurrent inappropriate compensatory behaviour
  • Both occur, on average, at least once a week for 3/12
  • Self-evaluation is influenced by body shape and weight
  • Disturbance does not occur exclusive during AN episodes
19
Q

Name three medical complications associated with purging in Bulimia nervosa

A
  • Gum disease and dental erosion
  • Oesophagitis; oesophageal tears; Mallory-Weiss tears
  • Aspiration pneumonitis
  • Russell’s sign: knuckle calluses from induced vomiting
  • Hypokalaemia
    • Muscles cramps, tetany, cardiac dysarrhythmia
  • Dehydration; obesity (30% of BN are/become obese)
20
Q

Name three behavioural changes that occur in Bulimia nervosa

A
  • Binge-purge cycling
  • Eating in secrecy
  • Loss of control when eating
  • Frequent use of bathroom after eating
21
Q

Describe the vicious cycle of Bulimia nervosa

A
  1. Trigger - damaged self esteem
  2. Strict dieting rules with goal of weight loss
  3. Hunger ➔ Binge-eating
  4. Guilt and compensatory behaviours
  5. Repeat from step 2
22
Q

Outline the management of Bulimia nervosa

A

Most are distressed about bulimia nervosa & motivated to recover, unlike anorexia nervosa

  • Psychotherapy
    • BN-focused self-help
    • CBT-ED
    • Family therapy (FT-BN): CAMHS
23
Q

Define refeeding syndrome

A

The potentially fatal shifts in fluids and electrolytes that can occur in malnourished patients receiving artificial refeeding

Metabolic disturbances: may result in organ failure

  • Hypophosphataemia
  • Hypokalaemia
  • Hypomagnesaemia: risk of torsades de pointes
  • Abnormal fluid balance
24
Q

Name three patient groups at high risk of refeeding syndrome

A
  • Anorexia nervosa
  • Chronic alcoholism
  • Cancer
  • Elderly patients with comorbidites
  • Uncontrolled diabetes mellitus
  • Chronic malnutrition: marasmus
25
Q

How can refeeding syndrome be prevented?

A
  • Patients who have eaten little or nothing for >5 days
    • Start at no more than 50% of energy requirements
  • Increase rate if no refeeding problems detected
  • K+, PO4-, Ca2+, Mg3+ supplements as needed
    • Check electrolytes daily
  • Vitamin supplementation
  • Treat hypoglycaemia with IV glucose and/or oral sucrose

Mental health (27 decks)

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