Eating Disorders Flashcards
What is are the screening questions for anorexia nervosa?
SCOFF
- Do you ever make yourself Sick because you feel uncomfortably full?
- Do you worry you have lost Control over how much you eat?
- Have you recently lost more than One stone in a three month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?
Anorexia is often found in individuals and families which exhibit which conditions?
- OCD
- Anxiety disorders
- Autistic Spectrum disorders
- Compulsive exercise
What are some methods which people with eating disorders use?
- Self-induced vomiting
- Chewing & spitting out
- Overexercise – often secret
- Overactivity – obsessive housework, fidgeting, twitching, never sitting down, fetching one item at a time, carrying heavy loads
- Cooling – inadequate dress, open windows
- Blood letting
- Deliberate self harm when anorexic rules are broken
- Medication abuse – including alternative,
- over the counter & over the internet medications, excessive caffeine and stimulant consumption – laxatives, ipecac, pain killers to allow exercise despite damage.
- Failing to take prescribed medication that can cause weight gain – insulin, steroids, anticonvulsnats – or overdosing on prescribed medicines that cause weight loss - thyroxine
How can people with an eating disorder avoid food?
- diets – becoming vegetarian, vegan
- not touching food or grease
- developing dislikes, pickiness, even ‘allergies’
- Interpreting all symptoms as allergy or indigestion
- Eating very slowly, only eating at certain times
- Avoiding parties and social occasions
- Spoiling or messing of food, bizarre combinations
- Refusing to eat more than the person who eats least, rules about always finishing last etc
- Medication abuse - Appetite suppressants – including gum, cigarettes - alternative, OTC & www medications
What are the psychological consequences of having an eating disorder?
Malnourished brains experience
- depressiona
- anxiety
- obsessionality
- loss of concentration on anything but food.
Depression at low weight rarely responds to medication.
People who rely on eating-disordered behaviour to ‘solve’ their problems fail to develop other ways to cope with life, tolerate distress or feel rewarded and fulfilled
What are the social consequences of having an eating disorder?
- Eating disorders turn other people into mere obstacles to the eating disorder!
- Normally honest people are forced to lie and cheat, even to steal about eating disorder concerns.
- Sufferers withdraw from friendships and lose interest in sexual relationships.
‘I could summarise my experience of anorexia in a single word – ISOLATION’
How can exercise cause psychological harm?
- Compulsive exercise/activity distracts from other thoughts, leaves sense of obligation to be active
- Competitive exercise may lead to circumscribed conditional measures of self-esteem & sees others as rivals not friends
- Sacrifice of social occasions to exercise programmes, competitive exercise may interfere with friendliness to others
- solitary exercise makes people loners
- Inability to stay still – or even sit down – interferes with social life, travel, school, studying, work, therapy
What physical effects do eating disorders have on the body?
Starvation causes
- physical damage
- poor repair and resistance
- heart damage
- reduced immunity to infections
- anaemia
- bone loss
- fertility problems
Purging behaviours cause
- neuro-chemical disruption with special damage to brain (seizures)
- heart (arrhythmias - long QT syndrome). Potassium is only one crude measure of the problem
Young people need good nutrition to allow growth –
- height
- pubertal development
- brain growth and development (especially frontal lobe growth)
- so re-nutrition is more urgent the younger the patient
How can too much physical exercise cause physical harm?
- Using up too much energy
- fatigue,
- amenhorroea, infertility,
- Osteoporosis (brittle bones)
- heat stroke dehydration, or
- over-drinking, collapse
- injury (fractures, head injuries, soft tissue injuries) or overuse damage (arthritis, deformity),
- worsening any previous illness or weakness (diabetes, heart conditions
- Substance abuse – steroids, painkillers
How does mortality from eating disorders compare with other psychiatric conditions?
- Highest mortality rate of any psychiatric disorder
- Patients hospitalised with anorexia nervosa and followed up for 40 years, 20% died prematurely as a result of Anorexia (Theander et al)
- Average life expectancy for Scottish hospital patients with anorexia nervosa: 39
Death from anorexia is unusual
in adolescence – but more common
in the transition from CAMHS to
adult services
What is the prognosis for bulimia?
- With evidence-based treatment 50% recovery
- With treatment that is not evidence based very little placebo response and very little recovery from BN
- BED has high recovery rates for the psychological symptoms but poor recovery from associated obesity
What is the management for bulimia?
- CBT (including self-help) for normal weight Bulimia Nervosa
- Alternatively IPT, or fluoxetine 60mg daily
- (in fact any antidepressant in high dose)
- Specialised family work (FBT) for anorexia nervosa, particularly for younger patients
What is the management for anorexia?
- CBT
- Olanzapine (increasing gradually to 10mg) safe and helpful in low weight anorexia (Bessada)
- Fluoxetine
What increases the chances of relapse?
- Continuing to be overactive, especially to do solitary overexercise (running, gym)
- Drinking calorie-free fluids, eg diet cola
- Following a restrictive diet eg vegan, ‘clean eating’
- Purging behaviours
- Isolation and secrecy
- Having a baby (50% relapse rate)
- Weight-losing illness eg diabetes
What are the key recommendations from MARSIPAN?
1. Awareness of high risk in adults with AN admitted to medical wards
2.Risk assessment: BMI, Physical examination, muscle power (SUS) bloods, ECG – but remember that such risk assessment is ‘a blunt instrument with a weak evidence base’
3. Refer to SEDU (specialist eating disorders unit)
4. Criteria for medical admission: treament not available on SEDU (eg IV, ECG monitoring) or unavailability of SEDU bed
5. Primary care should monitor patients and refer early
6. Medical teams to be supported by senior ED Psychiatrist
7. Medical inpatient team should contain a physician & dietitian with ED knowledge, preferably within a nutrition team
8. Key tasks are to
- safely re-feed the patient, avoiding under & over feeding
- Manage behavioural problems including those that sabotage renutrition
- When appropriate use Mental Health Act
- Manage family concerns
- Arrange safe transfer to SEDU as soon as the patient can be safely managed there
9. Health Commissioners (Managers) should
- Be aware of - usually inadequate - provision for MARSIPAN patients
- Ensure robust plans are in place, including adequately trained and resourced medical, nursing and dietetic staff on acute wards
