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Phase II - Psychiatry > Eating disorders > Flashcards

Eating disorders Flashcards

Anorexia nervosa, bulimia nervosa.

1
Q

What is anorexia nervosa?

A

Eating disorder characterised by deliberate weight loss, intense fear of fatness, distorted body image, endocrine disturbances.

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2
Q

What are the predisposing factors to anorexia nervosa? (Biopsychosocial).

A

Bio - genetics, family history, female, early menarche.
Psycho - sexual abuse, preoccupation with slimness, dieting behaviour early on, low self-esteem, premorbid anxiety or depression, perfectionism, obsessional/anankastic personality.
Social - Western society, bullying at school about weight, stressful life events.

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3
Q

What are the precipitating factors for anorexia nervosa? (Biopsychosocial).

A

Bio - adolescence and puberty.
Psycho - criticism about eating, body shape, weight.
Social - occupational or recreational pressure to be slim from media etc.

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4
Q

What are the perpetuating factors of anorexia nervosa? (Biopsychosocial).

A

Bio - starvation leads to neuroendocrine changes which perpetuate anorexia.
Psycho - perfectionism, obsessional/anankastic personality.
Social - occupation, Western society.

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5
Q

What are the physical features of anorexia nervosa?

A

Fatigue, bradycardia, arrhythmias, peripheral oedema (hypoalbuminaemia), headaches, lanugo hair.

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6
Q

What are the non-physical features of anorexia nervosa?

A

Preoccupation with food. Socially isolated, sexually feared. Depression and obsessions.

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7
Q

What are the ICD-10 criteria for diagnosing anorexia nervosa?

A

Fear of weight gain, endocrine disturbance (amenorrhoea, loss of sexual interest), emaciated BMI <17.5kg/m^2, deliberate weight loss, distorted body image, 3mo + absence of recurrent episodes of binge eating + absence of preoccupation with eating/craving to eat.

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8
Q

What are the metabolic complications of anorexia nervosa?

A

Hypokalaemia, hypercholesterolaemia, hypoglycaemia, impaired glucose tolerance, deranged LFTs, increased urea and creatinine, low potassium, low phosphate, low magnesium, low albumin, low chloride.

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9
Q

What are the endocrine complications of anorexia nervosa?

A

High cortisol, high growth hormones, low T3 and T4, low LH, FSH, oestrogens, progesterogens –> amonorrhoea, low testostosterone.

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10
Q

What are the GI complications of anorexia nervosa?

A

Enlarged salivary glands, pancreatitis, constipation, peptic ulcers, hepatitis.

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11
Q

What are the CVS complications of anorexia nervosa?

A

Cardiac failure, ECG abnormalities, arrhythmias, hypotension, bradycardia, peripheral oedema.

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12
Q

What are the renal complications of anorexia nervosa?

A

Renal failure, stones.

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13
Q

What are the neurological complications of anorexia nervosa?

A

Seizures, peripheral neuropathy, autonomic dysfunction.

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14
Q

What are the haematological complications of anorexia nervosa?

A

Iron deficiency anaemia, thrombocytopenia, leucopenia.

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15
Q

What are the MSK complications of anorexia nervosa?

A

Osteoporosis, proximal myopathy.

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16
Q

What are the general complications of anorexia nervosa?

A

Hypothermia, dry skin, brittle nails, lanugo hair, infections, suicide.

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17
Q

Which points should be covered in a history about anorexia nervosa?

A

Fear of weight gain, overvalued ideas about weight, deliberate weight loss, amenorrhoea, physical symptoms.

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18
Q

What would the MSE findings be of anorexia nervosa?

A

Appearance - thin, weak, slow, makeup to disguise emaciation, dry skin, lanugo hair.
Behaviour - anxious.
Speech - slow, slurred, or normal.
Mood - low or euthymic.
Thought - preoccupation with food, overvalued ideas about weight and appereance.
Perception - normal.
Cognition - normal or poor if physically unwell.
Insight - poor.

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19
Q

What are the investigations for anorexia nervosa?

A

Bloods - FBC for anaemia, thombocytopenia, leukopenia; U+Es for high urea and creatinine; low K, Mg, Cl; TFTs; LFTs for low albumin; lipids - high cholesterol; high cortisol; sex hormones for low LH, FSH, oestrogens and progestogens; low glucose; amylase for pancreatitis is complication.
VBG: metabolic alkalosis from vomiting, metabolic acidosis from laxatives.
DEXA scan for osteoporosis.
ECG for arrhythmias, bradycardia, prolonged QT.
Questionnaires.

20
Q

What are the differentials for anorexia nervosa?

A

Bulimia nervosa but no binge eating; eating disorder not otherwise specified - doesn’t meet ICD-10 criteria; depression; OCD; schizophrenia with delusions about food; organic cause - diabetes, hyperthyroidism, malignancy; alcohol or substance misuse.

21
Q

How is anorexia nervosa managed?

A

Risk assessment for suicide and medical complications.
Inpatient goal of 0.5-1kg gain/week, outpatient 0.5kg/week. Hospitalisation if BMI <14. SSRIs, treat medical complications. Psychoeducation, CBT, cognitive analytic therapy, interpersonal psychotherapy, family therapy. Voluntary organisations, self-help groups.

22
Q

What is refeeding syndrome?

A

Prolonged starvation means when food is eaten, there’s a huge insulin surge -> hypokalaemia, hypomagnasaemia, hypophosphataemia, abnormal glucose metabolism.

23
Q

How is refeeding syndrome managed?

A

Measure serum electrolytes and monitor refeeding bloods daily.

24
Q

What is bulimia nervosa?

A

Eating disorder with repeated episodes of uncontrolled binge eating followed by compensatory weight loss behaviours and overvalued ideas about ideal body shape/weight.

25
Q

What is the cycle in bulimia?

A

Sense of compulsion to eat -> binge eating -> fear of fatness -> compensatory weight loss behaviours -> sense of compulsion to eat etc.

26
Q

What are some compensatory behaviours in bulimia?

A

Vomiting, laxatives, exercising excessively.

27
Q

What is the demographic affected by bulimia mostly?

A

Young women, 15-40 years, 1-2% prevalence in women.

28
Q

What are the biological predisposing factors for bulimia?

A

Female, family history, early onset puberty, type 1 diabetes, childhood obesity.

29
Q

What are the psychological predisposing factors for bulimia?

A

Abuse, childhood bullying, parental obesity, mental health disorder, preoccupation with slimness, parents with high expectations, low self-esteem. Co-morbid depression, anxiety, deliberate self-harm, EUPD.

30
Q

What are the precipitating factors for bulimia? (Biopsychosocial).

A

Bio - early onset puberty/menarche
Psycho - perceived pressure to be thin, criticism about body weight or shape.
Social - environmental stressors, family dieting.

31
Q

What are the perpetuating factors for bulimia? (Biopsychosocial).

A

Bio - co-morbid mental health problems.
Psycho - low self-esteem, perfectionism, obsessional personality.
Social - environmental stressors.

32
Q

What are the clinical features of bulimia?

A

Normal weight, depression and low self-esteem, irregular periods, signs of dehydration, hypokalaemia.

33
Q

What is the key electrolyte disturbance in bulimia?

A

Hypokalaemia due to repeated vomiting.

34
Q

What are the signs of hypokalaemia?

A

Muscle weakness, cardiac arrhythmias, renal damage.

35
Q

How is hypokalaemia managed?

A

Mild - oral replacement and/or supplements.

Severe - hospitalisation and IV K+ replacement.

36
Q

What are the ICD-10 criteria for bulimia nervosa?

A

Compensatory behaviours (vomiting, starvation, drugs, excessive exercise), preoccupation with eating (compulsion leads to binges), fear of fatness, overeating (2/week for 3mo +).

37
Q

What are the two subtypes of bulimia nervosa?

A

Purging - self-induced vomiting and other ways of expelling food from the body.
Non-purging - less common, use excessive exercise or fasting after binge.

38
Q

What are the CVS complications of bulimia?

A

Arrhythmias, mitral valve prolapse, peripheral oedema.

39
Q

What are the GI complications of bulimia?

A

Mallory-Weiss tear, increased size of salivary glands.

40
Q

What are the metabolic complications of bulimia?

A

Dehydration, hypokalaemia, renal stones, renal failure.

41
Q

What are the dental complications of bulimia?

A

Permanent erosion of enamel.

42
Q

What are the endocrine complications of bulimia?

A

Amenorrhoea, irregular menses, hypoglycaemia, osteopenia.

43
Q

What are the dermatological complications of bulimia?

A

Russell’s signs (calluses on back of hands due to abrasion against teeth).

44
Q

What are the pulmonary complications of bulimia?

A

Aspiration pneumonitis.

45
Q

What are the neurological complications of bulimia?

A

Cognitive impairment, peripheral neuropathy, seizures.

46
Q

GOT TO DIAGNOSIS AND INVESTIGATIONS

A

Page 48

Phase II - Psychiatry (14 decks)

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