Eating Disorders

Question 1

How dangerous is anorexia?

Answer 1

The most fatal mental health disorder. 20% mortality in severe.

Question 2

What is anorexia characterised by and how is this achieved?

Answer 2

Compulsive need to control eating and body shape. Weight loss is over-valued and ideal body shapes are sought out by restriction, over-exercising, induced vomiting and laxative abuse.

Question 3

Give the 3 diagnostic criteria for anorexia.

Answer 3

1) BMI<17.5. 2) Intense fear of gaining weight with persistent behaviour that interferes with this. 3) Feeling fat when thin

Question 4

What is the male:female ratio for anorexia and when is it most common to onset?

Answer 4

4:1 (but probably under-diagnosed in men due to stigma). Mid-adolescence

Question 5

Give a biological risk factor for developing anorexia, 2 psychological risk factors, a developmental, and 2 socio-cultural.

Answer 5

Biological: Genetics (55% in mz twins). Psychological: depression, anxiety, perfectionism, low self-esteem. Developmental: Adverse live events. Socio-cultural: Substance abuse, negative body image due to media, past bullying for being fat

Question 6

Give 6 signs to look for on examination in anorexia

Answer 6

BMI, pulse, resp rate, SpO2, BP, temperature, squat test (basic, but shows general muscle weakness meaning cardiac muscle may be impaired), slow cognition, confusion

Question 7

Give 6 blood tests for anorexia and an investigation to do with rationale.

Answer 7

Thiamine (Wernicke’s), FBC (WCC usually drops early and real risk of infection), U+Es (K+ lost from D+V  arrhythmia, PO4 and Mg2+ refeeding, HCO3-. Note that anorexics have ‘low’ creatinine as normal due to low muscle mass. If Cr is normal or slightly high this may be AKI), LFTs (can be raised, doesn’t necessarily mean liver is failing), glucose (can be up or down), T3/4 (thrown off), calcium and vit D (osteoporosis).
Also ECG (due to long QT 2ary to electrolytes)

Question 8

Give 5 DDx of anorexia

Answer 8

Bulimia, depression, amphetamine use, psychosis, GI cause, OCD

Question 9

Give 5 red flags of anorexia

Answer 9

BMI<13, temp<34.5, BP<80/50, pulse<40, SpO2<92, long QT

Question 10

What is the overall goal of management for anorexia?

Answer 10

Slowly increase weight to normal BMI

Question 11

What signifies severe/moderate and mild anorexia?

Answer 11

Severe: BMI<15 and organ failure. Moderate: BMI 15.5-15 w/ no organ failure. Mild: BMI<17.5

Question 12

How would each severity of anorexia be treated?

Answer 12

Severe: refer urgently to eating disorder unit. Try to refeed. Moderate: Routine referral. Mild: CBT or family therapy

Question 13

Give two specific therapies for children and adults w anorexia. What can be done if these fail?

Answer 13

Children: CBT, family therapy. Adults: MANTRA, SSCM. If these fail can try inpatient unit or ‘day units’ where there are people to get you through eating and structured classes etc

Question 14

Give 5 immediate risks to patients with severe anorexia

Answer 14

Infection, long QT VT/VF, refeeding syndrome, AKI, low BMI (people look well with decent vitals but can die)

Question 15

What is the prognosis of anorexia

Answer 15

1/3 recover completely, 1/3 partially, 1/3 never. Average lifespan is 11 years from diagnosis

Question 16

What is refeeding syndrome?

Answer 16

Potentially fatal consequence from low PO4 after rapid feeding after a period of starvation.

Question 17

Give 4 signs of refeeding syndrome

Answer 17

Rhabdomyolysis, respiratory/cardiac failure, arrhythmia, seizures

Question 18

How is RF managed? Give 4 things to monitor on bloods.

Answer 18

Refer to dietician, use MARSIPAN guidelines, correct electrolyte deficiencies. Monitor PO4 and Mg2+ especially, also glucose and K+

Question 19

What is bulimia defined as?

Answer 19

1) recurrent episodes of binge eating. 2) Preoccupation with control of body weight. 3) Regular use of mechanisms to overcome fattening of binges (starvation, vomiting, laxatives), 4) BMI<17.5

Question 20

What is the male:female ratio for bulimia, and where is it most common?

Answer 20

9:1. most common in developed countries with young women.

Question 21

Give 3 things bulimia is associated with.

Answer 21

Urbanisation, family Hx of anorexia, genetics

Question 22

Give 5 clinical features of bulimia

Answer 22

Fatigue, bloating, constipation, abdo pain, Russell’s sign, metabolic alkalosis, low Cl, K+

Question 23

How is mild bulimia, and moderate/severe bulimia treated?

Answer 23

Mild: support patient, self-help books, food diary. Refer to ED unit if no response. Moderate/severe: ED unit. Antidepressants decrease binges and purging and CBT has been shown to help

Question 24

What is the prognosis of bulimia?

Answer 24

In 10 years 50% recover