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Psychiatry > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

Define anorexia

A

Eating disorder characterised by a relentless pursuit of thinness resulting in low body weight and a body image disturbance.

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2
Q

What are the causes of anorexia?

A 
Phobia of normal body size & weight
Body image disturbance- mirror imaging
Perfectionism
Low self-esteem
Lack of close friends
Biological causes
Fhx- Genetics
Anxiety
Culture/society
Puberty
Stress
Family pressure
Bereavement
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3
Q

What are the signs & symptoms of anorexia?

A 
Dietary restriction- <85% of expected body weight for age
Weight loss &amp; Decreased subcut fat
Fear of gaining weight
Reduced calorie intake/misuse of laxatives/enemas/diuretics
Amenorrhoea
Body dysmorphia: Feeling fat/bloated
Cold intolerance
Hair loss
Fatigue
Bruising
Hypotension
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4
Q

What are the signs of starvation?

A

Low metabolic rate, cold peripheries, alopecia, bradycardia, osteopenia, skin changes, lanugo hair, amenorrhoea, vit & electrolyte disturbances, ankle oedema, low plasma proteins, falsely low T3

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5
Q

What investigations should be carried out for anorexia?

A

BLOODS: FBC (Normocytic normochromatic anaemia, thrombocytopenia, mild leukopenia), Serum chemistry/ U&E,Creatinine Kinase, (hypoK-V&lax, met acid/alkalosis, hypoCa, hypoMg, ↑urea, hypoN), TFTs (↓T3, normal TSH & T4), LFTs (↑ALT & AST, ↓ ALP), Glucose, Zinc
BMI
ECG
URINALYSIS & pregnancy test: May show ketonuria

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6
Q

How is anorexia managed?

A 
ONGOING: Structured eating plan w/oral nutrition
Psychotherapy: Body awareness therapy, CBT, nutritional rehabilitation, family intervention, psychodynamic
Potassium repletion (65mmol orally/day)
MEDICALLY UNSTABLE: Oral/enteral/parenteral nutrition, Fluid intake correction, Potassium/magnesium/calcium/sodium repletion, meds may be used to suppress behaviours
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7
Q

What are the complications of anorexia?

A

Highest mortality rate of all psychiatric disorders
Re-feeding syndrome
Osteopenia/osteoporosis
Infertility
Primary amenorrhoea
Peripheral oedema secondary to re-feeding

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8
Q

What are the types of anorexia?

A

RESTRICTIVE: No episodes of binge-purging in the preceding 3months, weight loss achieved by exercising/dieting/fasting
BINGE-PURGE: Recurrent episodes of binge/purge in the preceding 3months

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9
Q

What are the mechanisms of anorexia?

A 
Restricting calorie intake
Over-exercise
Use of laxatives
Vomiting
Use of diuretics
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10
Q

Define bulimia

A

An eating disorder characterised by severe preoccupation about weight & body shape. Includes recurrent episodes of binge eating with compensatory mechanism such as self-induced vomiting.

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11
Q

What ages do anorexia & bulimia tend to occur? Which is more common?

A

Bulimia more common
A: 14-15 peak 18
B: Early 20s

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12
Q

What are the signs & symptoms of bulimia?

A 
x2-3 more common than anorexia 
Recurrent binge eating episodes w/loss of control- 7000-8000calories in one meal 
Dental erosion
Russell’s sign
Arrhythmia
Parotid hypertrophy
Depression &amp; low self-esteem
Concern about weight &amp; body shape
Purging
Vomiting
Appetite suppression
Laxative abuse
Diuretic abuse
Body weight higher than in anorexia
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13
Q

How is bulimia managed?

A

CBT or IPT
Nutritional & meal support
SSRI: Fluoxetine 60mg daily (try to interrupt binge-purge cycle)
Other psychotherapies (family support, self-help groups)
Glycaemic control
Immediate referral for specialist evaluation/A&E assessment

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14
Q

What are the classifications of severity for bulimia?

A

Mild: 1-3episodes/week
Moderate: 4-7episodes/week
Severe: 8-13episodes/week
Extreme: >14episodes/week

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15
Q

What differentials should be considered related to an eating disorder?

A 
Depression
OCD
Somatoform disorders
Hypopituitarism
Addison's
Thyrotoxicosis
IBD
DM
TB
Cancer
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16
Q

What electrolyte imbalances can be seen with the different behaviours occurring in an eating disorder?

A 
Starvation = HypoG
Vomiting= HypoK
Water-loading = HypoN
Laxatives = HypoN, HyperK
Diuretics = HypoK, HyperN
Thyroxine misuse = ↑T3/T4, ↓TSH
Refeeding = HypoPhos, HypoK, HypoCa, HypoMg
Proximal myopathy = ↑ CK, ↑ LFTs
17
Q

What questions does the SCOFF screening questionnaire consist of?

A

S- Do you are yourself SICK because you feel uncomfortably full?
C- Do you worry you have lost CONTROL over how much you eat
O- Have you recently lost >1 STONE in a 3m period?
F- Do you believe yourself to be FAT when others say you are thin?
F- Would you say FOOD dominates your life?

Positive response >2 GP referral

18
Q

What forms of psychotherapy can be offered in eating disorders?

A
  • Guided Self-help: Brief, low intensity, 1st line CBT, educational, inc awareness & responsibility, structured eating, promotes self-management, clinician acts as source of support
  • Motivational enhancement: 4-6sessions, inc motivation to change, benefits in initial phase promotes responsibility & commitment to change
  • Motivational interviewing: Guiding > directing, honours a person’s autonomy, open ended questions
  • Structured eating: Adequate nutrition, stop purge behaviour, reduce excessive exercise, meds, education, individual/group therapy
19
Q

How is anorexia diagnosed?

A

Must have all 4:

1) BMI <18.5 /body weight 15% below expected
2) Endocrine disturbance: Amenorrhoea, lanugo hair, pubertal delay
3) Morbid fear of being fat (overvalued idea rather than delusion)
4) Self induced weight loss (dieting, exercise, vomiting)

20
Q

How is Bulimia diagnosed?

A

Must have all 3:
1) Regular binge/purge x1/week
2) Method to prevent weight gain: Vomiting, purging, diuretic/laxative abuse
3) Morbid fear of being fat (overvalued idea not delusion)
Other: BMI >18.5

21
Q

How is an eating disorder investigated?

A 
Bloods: U&amp;Es, FBC, LFT, Glucose
BMI
BP
Muscle power
Pulses
22
Q

What is the main physical risk associated with Anorexia & Bulimia?

A

A: Hypotension, Sudden death, Bradycardia
B: Arrhythmia, Cardiac failure, Sudden death

23
Q

How does binge eating stop?

A
  • Food source finished
  • Stomach distension causes physical feeling of sickness which prompts purging
  • Feelings of guilt about binge = purge
24
Q

What are the components of the physical risk assessment in eating disorders?

A
  1. Hx & Ex: Rapid ↓weight >1kg/week, CVS exam, irregular pulse, postural hypoT, medical review, assess proximal myopathy
  2. BMI
  3. ECG: T wave changes (hypoK)
    Bradycardia <40 = strict bed rest & re-feeding
    Prolonged QTc = Tx: re-feeding
  4. Bloods
25
Q

What are the severities of BMI in anorexia?

A

<18.5 Anorexia
<15 Moderate risk- Can still be treated in the community
<13 High risk- Hospital admission

26
Q

What are the risk factors for anorexia?

A

High social class
Caucasian
Academic prowess
Interests: Modelling, ballet

Psychiatry (19 decks)

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