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psychiatry exam 1 > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

Risk factors for eating disorders

A
  • Female
  • Pear shaped body
  • High BMI
  • Sexual abuse (esp BN)
  • Negative feelings about ones body at puberty
  • Family hx of eating disorder
  • Anorexia – more likely to be anxious, inhibited, controlled, obsessive-compulsive; families more likely to be overly controlled, organized, or have weight concerned parent
  • Bulimia – under-controlled, mood labile; families chaotic, conflicted, critical
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2
Q

Personality disorders common to AN

A

Avoidant and obsessive compulsive

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3
Q

Personality disorders common to BN

A

Avoidant and borderline

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4
Q

Nervous system findings in eating disorders (8)

A
  • Cold intolerance
  • Low core body temp
  • Cognitive disturbance
  • Depression/apathy
  • Irritability
  • Fatigue
  • Seizures
  • Mild neuropathies
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5
Q

Cardiovascular findings in eating disorders (6)

A
  • Bradycardia
  • Hypotension
  • Myocardial atrophy
  • Arrhythmias
  • Ventricular tachycardias
  • Death
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6
Q

Dermatologic findings in eating disorders (5)

A
  • Lanugo (fine, baby-like hair)
  • Easy bruising
  • Dry skin
  • Brittle nails/hair
  • Dorsal hand calluses/scars on hands (from self-induced vomiting, Russell sign)
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7
Q

Digestive/GI findings in eating disorders (7)

A
  • Salivary gland/pancreatic inflammation
  • Increase serum amylase
  • Delayed gastric emptying
  • Esophageal erosions
  • Abdominal pain
  • Constipation
  • Bloating
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8
Q

Muscles/Joints findings in eating disorders (4)

A
  • Loss of muscle mass/fat
  • Weakness
  • Fractures
  • Osteoporosis
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9
Q

Reproductive/hormonal findings in eating disorders (6)

A
  • Amenorrhea
  • Growth delay
  • Lack of sexual desire
  • Infertility
  • High risk pregnancy (if becomes pregnant)
  • Low LH, FSH, TSH
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10
Q

Kidney findings in eating disorders (3)

A
  • Renal stones
  • Renal failure
  • Edema
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11
Q

Dental findings in eating disorders (2)

A

Erosion of teeth enamel and decay

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12
Q

Metabolic findings in eating disorders (3)

A
  • Hypokalemic, hypochloremic alkalosis
  • Hypomagnesemia
  • Hyponatremia
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13
Q

AN Criteria

A

Restriction of energy intake relative to reqs –> significantly low body weight for age/sex/dev trajectory/physical health

Intense fear of weight gain/becoming fat even though underweight

Disturbed view of own weight/shape, undue influence of weight/shape on self-eval, or denial of seriousness of low weight

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14
Q

Subtypes of AN (2)

A

Restricting – restricts eating (no binging or purging w/in last 3 mos)

Binge/Purge – regularly engages in binging/purging (i.e. self-induced vomiting, misuse laxatives, diuretics, enemas) in last 3 mos

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15
Q

Safety concerns in AN

A

Suicide rate 55x that of gen pop females

Mortality up to 10%

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16
Q

Good prognostic indicators for AN

A
  • Short duration of illness prior to tx
  • Younger age of onset
  • Close to ideal body weight at discharge
  • Exercising/dieting to lose weight
  • Good parent-child relationship
17
Q

Poor prognostic indicators for AN

A
  • Chronic illness
  • Alcohol/drug use
  • Lower initial weight
  • Vomiting, bulimia, and purgative abuse to lose weight
18
Q

Initial AN Tx

A
  • Gradual weight restoration and medical stabilization are top priority (rapid refeeding is dangerous –> refeeding syndrome can cause hypophosphatemia and cardiac complications)
  • May need hospitalization
  • Meds: Cyproheptadine (increase appetite), SSRIs (once weight restored), sometimes antipsychotics
19
Q

Later AN Tx

A
  • Outpatient
  • Psychotherapy: supportive therapy, psychoeducation, CBT, family therapy
  • Meds: SSRIs (fluoxetine), atypical antipsychotics, cyproheptadine
20
Q

BN criteria

A
  • Recurrent binge eating (excessive amount of food in discrete time period, sense of lack of control on eating)
  • Recurrent inappropriate compensatory behavior to prevent weight gain (e.g. self-vomiting, misuse laxatives/diuretics/enemas/other meds, fasting, excessive exercise
  • Binging/compensatory behavior at least 1x q/wk x 3mos
  • Self eval unduly on body shape/weight
21
Q

BN Subtypes

A

Purging type: self-induced vomiting or use of laxatives

Nonpurging: other compensatory behaviors (fasting, excessive exercise)

22
Q

BN Tx

A
  • Usually outpatient
  • Psychotherapy: supportive therapy, psychoeducation, CBT, family therapy
  • Meds: fluoxetine FDA approved (sometimes atypical antipsychotics)
23
Q

Eating disorder NOS examples

A

Binge eating disorder – no compensatory behavior

Purging disorder – no bingeing (small amount of food)

24
Q

Medication cautions in eating disorders

A

Bupropion – CI in AN and BN bc increases seizure risk

Stimulants – CI due to abuse potential and weight loss

psychiatry exam 1 (9 decks)

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