Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry Clerkship > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

DSM-5 Diagnostic Criteria - Anorexia Nervosa

A

A - restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health (significantly low = weight less than minimally normal or less than minimally expected)
B - intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain
C - disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation or persistent lack of recognition of the seriousness of current low body weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

2 types of anorexia nervosa?

A
  1. Restricting type

2. Binge-eating/purging type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Features of anorexia nervosa - restricting type?

A

During the last 3 months, the individual has not engaged in recurrent episodes of binge-eating or purging. Weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Features of anorexia nervosa - binge-eating/purging type?

A

During the last 3 months, the patient engaged in recurrent episodes of binge eating or purging

(Binge eating can be subjective - not actually eating a large amount of food)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Severity classification of anorexia nervosa?

A

Mild: BMI > 17
Moderate: BMI 16-16.99
Severe: BMI 15-15.99
Extreme: BMI <15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is reverse anorexia?

A

Aka muscle dysmorphia
Subset of BDD
Concerned that they will never be muscular enough
Predominantly men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prevalence of anorexia nervosa?

A

Previous estimates ~1%
Broad criteria - 4.2%
Strict criteria - 2.2%
Possible increase in prevalence in recent years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

___% of patients with anorexia nervosa are female.

A

90-95

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Age of onset of anorexia nervosa?

A

Puberty and menarche (13-14 and 17-18)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Discuss anorexia nervosa as it relates to culture.

A

-Occurs cross culturally (not considered culture bound)
-Most prevalent in industrialized societies (food plentiful, thin ideal)
-Classic pt - higher SES and Caucasian
AA - less ED behaviors
Latino - same or more severe behaviors
Asian American - unclear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Genetic findings of anorexia nervosa?

A

Runs in families
Appears to have a shared transmission of OCD/anxiety
Higher concordance for monozygotic compared to dizygotic
Serotonin 2A R (?)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Possible pathophysiology of anorexia nervosa?

A
  • Enlargement of sulci, interhemispheric fissure, and ventriles
  • Cerebral dystrophic changes
  • Deficits in dopamine function
  • Increased 5-HT1A receptors and decreased 2A
  • Hypoperfusion to frontal and parietal
  • Global hypometabolism
  • Different functioning in the cingulate cortex and insula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

High risk populations for anorexia nervosa?

A
  • Participation in activities that require attention on weight appearance (ballet, long distance running, gymnastics, ice skating, modeling)
  • Chronically ill women (CF, DM, spina bifida, mood disorders)
  • High standards of achievement
  • Homosexual men
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DDx - anorexia nervosa

A
  • Medical illness (GI disease, hyperthryoidism, malignancy, AIDS - none of these have fear of gaining weight)
  • MDD
  • Schizophrenia
  • SUDs
  • Social Anxiety
  • OCD
  • BDD
  • Bulimia Nervosa
  • Avoidant/Restrictive Food Intake Disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Symptoms of anorexia?

A 
Amenorrhea, infertility
Depression
Exertional Fatigue
Weakness
Headache
Dizziness
Chest Pain
Faintness
Constipation, Abdominal pain, non-focal abdominal pain, feeling full
Polyuria
Dry Skin
Cold Intolerance
Low back pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Signs of anorexia?

A 
Emaciation
Hypothermia
Hyperactivity
Bradycardia
Hypotension
Hypoactive bowel sounds
Dry skin
Pressure sores
Brittle hair/nails
Hair loss
Carotenemia (orange colored skin)
Lanugo hair (very soft light hair - developed to keep in heat)
Cyanosis
Edema
Heart murmur (MVP)
Muscle wasting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cardiac complications of anorexia?

A
  • Increased sudden death (unclear reason)
  • Decrease in CO and cardiac mass (below 20% IBW)
  • Progressive bradycardia, decreased HR variability
  • EKG often normal
  • MVP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

GI complications of anorexia?

A
  • Gastroparesis
  • GERD
  • Constipation
  • Abdominal pain w/o tenderness
  • Abnormal LFTs
  • Superior mesenteric artery syndrome (so little fat that the SMA collapses onto the intenstines -> increased pain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Gynecologic complications of anorexia?

A

Hypothalamic amenorrhea (should not be treated with OCPs)
Decreased levels of all sex steroids
May occur even before significant amount of weigh lost, may persist after weight regained
Infertility, pre-term birth, smaller head circumference, miscarriages, LBW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Endocrine complications of anorexia?

A

Normal cortisol with decreased clearance
Possible hyeprsecretion of CRH
Decreased IGF-1, increased or normal GH
Euthyroid sick syndrome (low/low normal T3/T4, normal TSH, increased rT3)
Fasting hypoglycemia
Increased cholesterol (due to increased HDL)
Osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Discuss osteoporosis as a complication of anorexia.

A
  • DEXA z-score >-2.5 SD decrement from young bone mass
  • 40% of patients (92% have osteopenia)
  • Primary site - trabecular bone in lumbar spine and hips
  • Most treatments ineffective for patients with anorexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

There is no increased prevalence of anorexia in patients with DM1. However, when these occur together, how does it present?

A

Brittle diabetes, repeat symptomatic hypoglycemia
Patients may omit doses of insulin to cause an osmotic diuresis or increase dose to compensate for a binge
Increased retinopahty, nephropathy, neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Comorbid conditions with anorexia?

A
  • MDD
  • Dysthymia
  • Bipolar disorder
  • Anxiety disorder
  • GAD
  • Panic
  • OCD
  • Alcohol and substance use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Course of anorexia?

A

<50% will have a full recovery
33% will improve
20% will remain chronically ill
33% of recovered with relapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is diagnostic migration and when is the risk highest?
Development of bulimic symptoms after anorexia nervosa resolves; highest in the first 5 years
26
What are some reasons anorexia has the highest mortality rate of any psychiatric disorder?
- High rate of suicide - Direct consequence of starvation or alcohol - Cardiac failure
27
Initial work-up for a patient with a possible eating disorder?
- Complete physical exam - Orthostatics - EKG - CBC - BMP - Ca/Mg/Phos - LFTs - Amylase - BUN/Cr - Glucose - Thyroid - Urinalysis - Stool examination - UDS - Dexa scan if AN > 6 months
28
Rx - anorexia?
- Little evidence for pharmacotherapy - Nutritional rehabilitation (mainstay) - Some psychiatric comorbidities improve with nutritional rehabilitation - Resistance to medications (fear of weight gain)
29
Discuss the pathogenesis of refeeding syndrome.
Chronic malnutrition/prolonged fast -> decreased insulin, increased glucagon and cortisol -> glycogenolysis, gluconeogenesis, protein catabolism -> depletion of electrolytes, proteins, fats, minerals, vitamins Refeeding -> insulin secretion -> increased proteins and glycogen synthesis + increased glucose, phosphorus, magnesium, and potassium uptake + increased thiamine use -> hypophosphatemia, hypokalemia, hypomagnesemia, thiamine deficiency, sodium and water restriction -> convulsions, delirium, ataxia, hypotension, renal failure, arrhythmia, edema, fasciculations, rhabdomyolysis
30
Steps to prevent refeeding syndrome?
1. Identify patients at risk 2. Measure electrolytes and correct before refeeding 3. Electrolytes and phosphorus every other day for 7-10 days, then biweekly 4. Start at 800-1000 kcal/day or 20-25 kcal/kg/day and increase caloric intake by 300-400 kcal every 3-4 days until producing 2-3 lb/week (max 3500 kcal for F, 4000 kcal for M/day) 5. Monitor for tachycardia and edema 6. Begin with low lactose, low fat, no added salt, gradually introduce more dairy and fats
31
Criteria for tube feeding?
- Persistent failure to gain weight with standard dietary procedures - Life-threatening weight loss - Worsening psychological state
32
Medications to AVOID in patients with eating disorders?
- Stimulants - Wellbutrin - Topiramate - Levothyroxine (Can all lead to increased weight loss)
33
Medications to treat anorexia?
- SSRIs - meta-analysis shows no evidence in the acute phase; may be helpful in maintenance (inconsistent results) - Venlafaxine - no data for efficacy - Mirtazapine - avoid due to potential for neutropenia - Antipsychotics - tried due to the potential delusional nature of AN thought processes; concern for QTc prolongation and reduced seizure threshold (typicals), atypicals - weight gain, anxiolytic, anti-obsessional, need more data - Mood stabilizers - no evidence unless comorbid bipolar disorder
34
Psychotherapy Rx for anorexia?
- Family based treatment - very efficacious for adolescents, little data for use in adults - CBT - research minimal - IPT - possible greater maintenance than CBT, efficacy unclear - Self-help/case management - Psychodynamic
35
DSM-5 Criteria for Bulimia Nervosa?
A. Recurrent episodes of binge eating (eating in a discrete period of time any amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances + a sense of lack of control over eating during the episode) B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; excessive exercise C. Binge eating and inappropriate compensatory behaviors both occur, on average, at least 1x/week for 3 months D. Self-evaluation is unduly influenced by body shape and weight E. Disturbance does not occur exclusively during episodes of AN No undue fear of weight gain
36
Compare onset of AN vs. BN.
BN - later onset than AN
37
Prevalence of BN?
DSM-IV criteria - 1.5% for women, 0.5% for men Using DSM-5 criteria - 2% for women
38
Pathogenesis hypothesis of BN?
- Evidence of diminished 5-HT metabolite levels - Altered serotonin A1 and A2 activity - Increased activation in anterior cingulate cortex and insula, decreased activity in other cortical structures - Higher concordance with identical twin
39
Risk of BN with female relative with an eating disorder?
4.4x risk general population
40
Symptoms of BN?
``` Irregular menses Heart palpitations Esophageal burning Non-focal abdominal pain Abdominal bloating Lethargy, fatigue Headache Constipation/diarrhea Edema of hands/feet Frequent sore throat Teeth sensitviity Depression Swollen feet ```
41
Signs of BN?
``` Calluses on back of hand Salivary gland hypertrophy Erosion of dental enamel Periodontal disease Dental caries Facial petechiae Perioral irritation Mouth ulcer Hematemesis Edema Abdominal bloating Cardiac Arrhythmia ```
42
Lab abnormalities seen in BN (vomiting)?
Increased bicarbonate and pH Decreased K and Cl Variable Na
43
Lab abnormalities seen in BN (laxatives)?
Decreased K Increased or decreased Cl, bicarbonate, pH Variable Na Over time, becomes: Increased bicarbonate and pH Decreased K and Cl Decreased or normal Na
44
EKG changes seen in BN?
Low K - T waves flat, U waves, ST segment depression | Low Mg/Ca - prolonged QT, non-specific T wave changes
45
GI complications of BN?
``` Severe reflux Spontaneous vomiting Laryngitis, odynophagia, dysphagia Barrett's esophagus Mallory weiss tear Esophageal rupture Constipation Atonic, distended colon ```
46
Cardiac complications of BN?
Less likely if normal weight If previously AN - higher ventricular arrhythmias No consistent findings on cardiac evaluation, vitals, EKG, or echos Arrhythmias due to electrolyte abnormalities (can be any arrhythmia with reduced K, but Vtach and Vfib most worriseome) More likely with purging than laxative use Ipecac use is a risk for irreversible cardiomyopathy
47
Dental complications of BN?
``` Cheliosis Perimolysis (erosion of enamel) Caries Increased gingivitis Sialadenosis Hyperamylasemia ```
48
Most common sign of BN?
Perimolysis (erosion of enamel)
49
Psychiatric comorbidities of BN?
Mood disorders Anxiety disorders Substance use Borderline personality disorder
50
Course of BN?
Very variable longitudinal course ~50% will achieve remission at 5-12 years 33% will relapse Minority with chronic symptoms
51
Associated with a worse prognosis for BN?
Unsuccessful treatment attempts Comorbid substance use Cluster B traits
52
Diagnostic migration is more common in which direction?
AN -> BN
53
What is the binge restriction cycle?
Overvaluation of shape and weight -> restriction -> binging -> purging
54
Initial work-up for BN?
CMP (very important, more likely to be abnormal in BN) Consider hospitalization for electrolyte abnormalities (especially if K<3) EKG if purging behavior
55
Rx - BN (pharmacotherapy)?
- Fluoxetine (decreased binge/purge, associated psychological symptoms, more data for acute phase) - SSRIs (especially fluvoxamine for maintenance) - TCAs - desipramine - MAOIs - brofaromine
56
Non-antidepressant pharmacotherapy for BN?
- Topiramate (double-edged sword - helps with cravings, can decrease appetite) - Ondansetron - potential use at times of urges - Naltrexone - mixed efficacy - Baclofen - reduce rewarding effects in substance abuse - Memantine - reduced binge eating - Antipsychotics - little to no data, especially in normal weight BN, potential for mood stabilization
57
Psychotherapy for BN?
- CBT - gold standard (acute and maintenance) - IPT - may be as good as CBT (better in the long-term, CBT better in short-term) - targets psychosocial issues which can lead to relapse - DBT - needs more research - Self-help, group, psychodynamic
58
DSM-5 Diagnostic Criteria for Binge Eating Disorder?
A. Recurrent episodes of binge eating B. Binge eating episodes are associated with 3+ of the following: -Eating much more rapidly than usual -Eating until feeling uncomfortably full -Eating large amounts of food when not feeling physically hungry -Eating alone because of feeling embarassed by how much one is eating -Feeling disgusted with oneself, depressed, or very guilty afterward C. Marked distress regarding binge eating D. Occurs, on average, at least 1x per week for 3 months E. Not associated with the recurrent use of inappropriate compensatory behavior as in BN and does not occur exclusively during BN or AN
59
Prevalence of Binge Eating Disorder?
F - 3.5% | M - 2.0%
60
Medical comorbidities of Binge Eating Disorder (chicken or egg)?
- Increase in health complications and health dissatisfaction - Obesity - IBS - Fibromyalgia - DM2 - HTN - OA
61
Psychiatric comorbidities of Binge Eating Disorder?
``` MDD Bipolar disorder Anxiety Disorder BN SUDs Personality Disorders ```
62
Course and outcome of Binge Eating Disorder?
Chronic condition, similar morbidity and mortality to BN Length similar or longer than BN, much longer than AN Treatment - some data suggest less likely to relapse -Little to no diagnostic migration to BN or AN
63
Rx - Binge Eating Disorder (pharmacotherapy)
SSRIs - mixed data Sibutramine - decreased episodes/weight, possibly depression Orlistat Topiramate - reduces frequency of binge episodes and facilitates weight loss, does not help psychological symptoms, poorly tolerated Zonisamide - reduced frequency of binge eating, poorly tolerated Atomoxetine - reduced binge frequency, promotes weight loss, does not help psychological symptoms
64
Nutritional treatment of Binge Eating Disorder?
Traditional weight loss programs - variable, some efficacy supports Structured exercise
65
Psychotherapy for Binge Eating Disorder?
CBT - gold-standard (over medications) | IPT, DBT, self-help, groups
66
DSM-5 Diagnostic Criteria of Rumination Disorder?
A. Repeated regurgitation of food over a period of at least 1 month. May be re-chewed, re-swallowed or spit out B. Repeated regurgitation not attributable to an associated GI or other medical condition C. Does not occur exclusively during AN, BN, BED, or avoidant/restrictive food intake disorder
67
Rumination disorder common in what populations?
Children and adolescents | individuals with intellectual disabilities
68
Rx - Rumination disorder?
Operant conditioning - gold standard G and J tubes may be necessary
69
DSM-5 Diagnostic Criteria for Avoidant/Restrictive Food Intake Disorder?
A. Eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with 1+ of the following: -Significant weight loss -Significant nutritional deficiency -Dependence on enteral feeding or oral nutritional supplements -Marked interference with psychosocial functioning B. Disturbance not better explained by lack of available food or by an associated culturally sanctioned practice C. Does not occur exclusively during the course of AN or BN and there is no evidence of a disturbance in the way in which one's body weight or shape is experienced D. Not attributable to a concurrent medical condition or another mental disorder
70
Atypical AN?
All criteria met except for significant weight loss (weight within or above normal range)
71
Purging disorder?
Recurrent purging behavior to influence weight or shape in the absence of binge eating
72
Night eating syndrome?
Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal Awareness and recall of eating Not better explained by external influences Causes significant distress and impairment Not better accounted for by another disorder/substance

Psychiatry Clerkship (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions