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Year 3 - Mental Health > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

What are the two sub-types of anorexia nervosa?

A

Restrictive

Binge eating/purging type

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2
Q

According to the ICD10 what are the diagnostic criteria of anorexia nervosa?

A

Refusal to maintain or achieve healthy body weight

BMI <17.5

Intense fear of gaining weight

Undue influence of weight/shape on self-evaluation

Amenorrhoea

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3
Q

What different strategies are used by patients with anorexia nervosa in order to lose/avoid gaining weight?

A

Ignore hunger

Eat very little

Develop rules about what they can eat

Compensate for what’s eaten

Diabetics may omit or reduce insulin

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4
Q

What rules may a patient with anorexia nervosa set for themselves?

A

Calorie limits

Foods/food groups to be avoided

Have to eat less than others, or not eat if others aren’t

Have to eat at exact times or not at all

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5
Q

How might a patient with anorexia nervosa compensate for what they eat?

A

Use purging behaviours

Use slimming aids and fat blockers

Take amphetamine like drugs

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6
Q

What are some examples of purging behaviours used in anorexia nervosa?

A

Self-induced vomiting

Taking laxatives

Taking diuretics

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7
Q

When may a person with anorexia nervosa feel the need to induce vomiting?

A

After binges

After small amounts of food

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8
Q

What fuels anorexia nervosa?

A

Distorted body image

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9
Q

What is meant by a distorted body image in the context of anorexia nervosa?

A

Know that they are thin but feel fat

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10
Q

What is meant by ‘feeling fat’ in the context of anorexia nervosa?

A

Many emotions and psychological states

Often due to comparing to others and body checking

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11
Q

What can anorexia nervosa lead to socially?

A

Avoidance of others to avoid comparing

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12
Q

What are the two sub-types of bulimia nervosa?

A

Purging

Non-purging

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13
Q

Define a ‘binge’

A

A subjective loss of control where large amounts of typically calorie laden or ‘forbidden’ foods are eaten

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14
Q

What typically follows binge eating in a patient with bulimia nervosa?

A

Guilt

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15
Q

How is binge eating conducted by patients with bulimia nervosa?

A

In secret with the evidence hidden

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16
Q

What is the diagnostic criteria for bulimia nervosa as described by the ICD 10?

A

Recurrent episodes of overeating

Persistent preoccupation with eating

Strong desire to eat

Patient attempts to counteract fattening affects of binge eating

Self-perception of being too fat

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17
Q

What types of compensatory measures are used by people with bulimia nervosa?

A

Purging

Non-purging

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18
Q

What purging behaviours are used by people with bulimia nervosa to compensate for binge eating?

A

Self-induced vomiting

Laxative abuse

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19
Q

What non-purging behaviours are used by patients with bulimia nervosa to compensate for binge eating?

A

Exercise

Fasting

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20
Q

Do all patients referred to eating disorder clinics have bulimia nervosa or anorexia nervosa?

A

No, 1/3 have more atypical eating disorders

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21
Q

What are some examples of atypical eating disorders?

A

Atypical BN or AN

Binge eating disorders

Other disorders that defy classification

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22
Q

What factors can make people more prone to eating disorders?

A

Genetics

Biological vulnerability

Biological stress

Psychological vulnerability

Psychological stress

Social factors

Cultural factors

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23
Q

Differences in what can lead to differing psychological vulnerability to eating disorders?

A

Certain thinking styles

Interpersonal styles

Emotional processing

Personality traits

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24
Q

What thinking styles can lead to increased psychological vulnerability to eating disorders?

A

Cognitive rigidity

All or nothing thinking

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25
Q

What interpersonal styles can lead to increased psychological vulnerability to eating disorders?

A

Struggling to recognise cues and emotional states of others

Control issues

Managing/avoiding emotions

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26
Q

How can differences in emotional processing lead to increased psychological vulnerability to eating disorders?

A

Some will have difficulty recognising their own emotional state and expressing emotions

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27
Q

What personality traits can lead to increased psychological vulnerability to eating disorders?

A

Perfectionistic

Obsessional

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28
Q

What social factors can lead to increased psychological vulnerability to eating disorders?

A

How relationships are managed

Separation/individualisation

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29
Q

Where is the prevalence of eating disorders currently increasing?

A

Asia and Africa

30
Q

What does the increasing prevalence of eating disorders in developing countries suggest?

A

A link to media images and globalisation

31
Q

What biological effects can starvation have on the body?

A

Increased preoccupation with food

Agitation and restlessness

Tired, distress, and lacking in motivation

Low mood and irritability

Social withdrawal

Focus on body

Worrying about weight gain

Binging

32
Q

What effects can eating disorders have on the endocrine system?

A

Body adjusts its free T4 levels to reduce metabolic requirement

Amenorrhoea

33
Q

What term is given to the adjustment of free T4 levels as a result of eating disorders?

A

Sick euthyroid syndrome

34
Q

What are the effects of sick euthyroid syndrome?

A

Reduced metabolic rate

Reduced body temperature

Bradycardia

35
Q

What effects can eating disorders have on the cardiovascular system?

A

Myocardial thinning

Bradycardia

Hypotension

Arrhythmias

Cardiomyopathy

Mitral prolapse

Heart failure

36
Q

What effects can eating disorders have on the skeletal system?

A

Osteopenia/osteoporosis

Fractures

37
Q

Eating disorders can lead to deficiencies in what?

A

Electrolytes and nutrients

38
Q

What effects can eating disorders have on the blood?

A

Bone marrow suppression

Abnormal WCC, Hb and platelets

39
Q

What effects can eating disorders have on the GI system?

A

Delayed gut motility/delayed gastric emptying

Constipation

Mallory-Weiss tears

Hepatitis

Pancreatitis

40
Q

Do people with anorexia typically appear unwell immediately?

A

No, can look well until their body decompensates

41
Q

What is the most dangerous time for patients with anorexia?

A

Rapid refeeding

42
Q

What effects does starvation have on blood glucose?

A

Decreased blood glucose

43
Q

What effect does decreased blood glucose have on insulin levels?

A

Decreased insulin

44
Q

On refeeding what happens to serum glucose and insulin levels?

A

Increase

45
Q

What does increased insulin levels do to tissues?

A

Causes regeneration

46
Q

What is required for regeneration of tissues?

A

Phosphate for cell division

47
Q

What happens to serum phosphate transport during rapid refeeding?

A

Increased co-transport into cells

48
Q

What effect does rapid refeeding have on serum phosphate?

A

Abrupt decrease

49
Q

Why is there a rapid increase in co-transport of serum phosphate into cells upon refeeding?

A

Starvation causes decreased intracellular phosphate levels due to decreased oral intake

When refeeding occurs, serum phosphate levels rise and phosphate is rapidly taken up from the serum

50
Q

Why do serum phosphate levels not fall during starvation?

A

They are maintained by homeostatic levels

51
Q

Which patients are most at risk of refeeding syndrome?

A

Very low weight, malnourished patients

52
Q

What kind of rapid refeeding carries the biggest risk?

A

Refeeding with food with high carbohydrate content

53
Q

What effect does rapid tissue regeneration occurring as a result of refeeding have on the body?

A

Deficiency in trace elements

54
Q

Deficiencies in which trace elements can occur as a result of rapid tissue regeneration?

A

Phosphate

Potassium

Magnesium

(These are the most dangerous and potentially fatal)

55
Q

What can low serum phosphate result on?

A

Heart failure/multi-organ failure

56
Q

What guidelines can be used to prevent refeeding syndrome?

A

MARSIPAN guidelines

57
Q

What does MARSIPAN stand for?

A

MAnagement of Really SIck Patients with Anorexia Nervosa

58
Q

What suggestions do the MARSIPAN guidelines make?

A

Refeeding requires specialist management

Close blood monitoring is required with daily blood tests

Oral supplements and maybe IV

59
Q

What can make treatment of anorexia difficult?

A

Patients may not want to get better

60
Q

What treatment methods does NICE recommend for anorexia nervosa?

A

CBT

MANTS

SSCM

61
Q

What are the aims of therapy for anorexia?

A

Shift motivational position

Restore healthy weight

Help patients cope with life, and express themselves without resorting to dietary restrictions

Get life back on track

62
Q

How does NICE recommend bulimia should be treated?

A

Guided self-help for milder cases

CBT

Regular eating

Binge analysis

Mood management

Improving self-esteem and resolving interpersonal issues

63
Q

When may a patient with bulimia nervosa be admitted to a specialist unit?

A

Patient wants to change but not progressing with out patient treatment

Patient is in immediate danger

64
Q

What percentage of anorexia nervosa sufferers recover completely?

A

30-75%

65
Q

When is complete recovery most likely in sufferers of anorexia nervosa?

A

Within the first 3 years

66
Q

When does outcome of anorexia nervosa treatment become poor?

A

After 10 years

67
Q

What is the average yearly mortality rate of anorexia nervosa patients?

A

0.5%

68
Q

What percentage of deaths in anorexia nervosa patients are due to suicide?

A

50%

69
Q

What percentage of bulimia nervosa sufferers recover completely?

A

50-70%

70
Q

What kind of course does bulimia nervosa recovery typically follow?

A

Relpasing and remitting

71
Q

What are some predictors of good outcomes of eating disorder treatment?

A

Motivation to change

Short duration of illness

Low level of severity

Onset during adolescence

Good family function

Lack of co-morbid conditions

Year 3 - Mental Health (12 decks)

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