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Psychiatry > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

What is the lifelong prevalence of anorexia nervosa?

A

0.1-0.9%

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2
Q

Under what age do most cases of anorexia nervosa occur?

A

22

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3
Q

What is the issue with diagnosing anorexia nervosa?

A

Can present in variety of ways (infertility, IBS etc.)

50% of patients you see with AN will go unnoticed

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4
Q

In which gender is AN more common?

A

9x more common in females

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5
Q

What is an eating disorder more common than in adolescence?

A

Type 1 diabetes and IBS

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6
Q

What is diabulimia?

A

Type 1 diabetics stop/reduce insulin intake in order to lose weight

Remember diabetics already at increased risk of eating disorders

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7
Q

Why is diabulimia so dangerous?

A

Can lead to DKA, eye/foot problems

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8
Q

When is the peak onset for eating disorders?

A

Mid-teens to mid-twenties

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9
Q

Most eating disorder patients are…

A

Perfectionist, very driven and intelligent

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10
Q

What screening tool can you use for eating disorders?

A

SCOFF
2+ = eating disorder likely

Do you make yourself sick because you feel uncomfortably full?
Do you worry you have lost control over how much you eat?
Have you recently loss more than 1 stone in three months?
DO you believe yourself to be fat when others call you too thin?
Would you say food dominates your life?

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11
Q

What is the criteria for diagnosis of anorexia nervosa?

A

Restriction of intake to reduce weight
Relies on compulsive compensatory behaviours when food cannot be avoided (e.g. self induced vomiting, laxatives, diuretics, appetite suppressors, excess exercise)
Body weight 15% below ideal body weight/BMI less than 17/5
There is fear of weight gain

Used to take into consideration amenorrhoea but not now

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12
Q

What are possible signs/symptoms of anorexia nervosa?

A 
Cold tolerance
Blue hands/feet
Constipation 
Bloating 
Delayed puberty 
Muscle loss
Amenorrhoea (primary or secondary)
Dry skin 
Fainting 
Hypotension
Lanugo hair
Scalp hair loss
Early satiety 
Weakness, fatigue
Short stature
Osteopenia/osteoporosis (bone breakdown)
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13
Q

What is the important thing to remember about the signs and symptoms of anorexia/bulimia nervosa?

A

THEY ARE REVERSIBLE after a period of time after refeeding

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14
Q

What is the classification for the diagnosis of bulimia nervosa?

A

Episodes of binge eating with sense of loss of control
Binge eating followed by compensatory activity of purging type (self-induced vomiting/laxatives/diuretics) or nonpurging (xs exercise/fasting/diabulimia)
Binges and resulting compensation occurs 2+/wk for three months
There is dissatisfaction with body shape and weight

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15
Q

What are signs and symptoms of bulimia nervosa?

A 
Mouth sores
Pharyngeal trauma
Dental erosion 
Heartburn, chest pain 
Oesophageal rupture
Impulsivity (stealing, alcohol, drugs, smoking) 
Muscle cramps 
Weakness 
Bloody diarrhoea
Irregular periods
Fainting 
Swollen parotid glands
Hypotension
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16
Q

What is really important to be aware of bulimia nervosa?

A

Electrolyte disturbance from vomiting –> low potassium –> arrhythmias/lower seizure threshold

17
Q

What characterises binge eating disorder?

A

Bulimia - purging behaviour

Ongoing/repetitive cycles often include:
Unusually fast eating, usually alone
Unusually large amounts consumed
Uncomfortably full, often buzzed after eating
Embarrassment, shame, guilt, depression
18
Q

How might someone with an eating disorder avoid calorie intake?

A

Diets (veganism)
Not touching food/grease (for fear of absorbing it)
Developing likes/dislikes/allergies
Interpreting all symptoms as allergy/indigestion
Eating v slowly at certain times only
Avoiding parties/social occasions
Spoiling/messing food/bizarre combos
Refusing to finish eating last/eat more than anyone else
Appetite suppressants - gum, cigarettes, internet meds

19
Q

How might someone with an eating disorder get rid of calories?

A 
Self-induced vomiting
Chewing and spitting out 
Over-exercise
Overactivity (e.g. obsessive housework, twitching) 
Cooling - burn energy by shivering
Blood letting
Medication abuse
20
Q

What factors may perpetuate an eating disorder?

A

Body checking - measurements, mirror gazing etc.
Pro-ana websites
Competing with others and self to attain lower targets
Compulsive browsing of magazines etc.
Deliberate self harm if rules broken

21
Q

What are the psychological consequences of eating disorders?

A

Extreme overvaluation of low weight
Willing to sacrifice highly valued things (education, work, relationships)
Obsessive weight losing feels like the solution, not the problem
Reduced central coherence/narrowed focus of interest
Inability to interpret emotion
Anxiety, depression, loss of concentration on anything but food due to malnourished brain

NB - those with an ED less likely to respond to antidepressants

22
Q

What are the social consequences of an eating disorder?

A

People become obstacle to eating disorder - forced to lie, cheat, steal
Withdrawal from friendships
Loss of interest in sex
Isolation

23
Q

What are the physical consequences of an ED?

A 
Physical damage
Poor repair and resistance
Heart damage
Reduce immunity (bone marrow supressed)
Anaemia
Bone loss
Fertility issues

Purging –> neurochemical disruption –> seizures/arrhythmias

Growth restriction (brain and body)

24
Q

What are the hypothetical natural history of anorexia nervosa?

A

High risk individual with obsessionality –> life event (separation, loss, stress) –> anorexia

Resilience and protective factors –> remission but perpetuation and amplifying factors worsen health

25
Q

What are the causes of AN?

A

Precisely unknown
Genetic risk
Perinatal factors
Life events and traumas

26
Q

What is AN associated with genetically?

A

OCD, anxiety disorders, Aspergers

27
Q

What are the precipitating factors of AN?

A 
Puberty - hormonal and physical changes
Dieting/non-deliberate weight loss --> may lead to viscous cycle
Increased exercise (--> compulsive)
Stressful life event )neglect, abuse, transitions, bullying)
28
Q

What are the perpetuating factors of an ED?

A

Starved brain less receptive to changing
Delayed gastric emptying –> sensation of fullness interpreted as eating too much
Narrowing focus (food becomes salient stimulus)
Obsessionality and body checking
Families, school, clinic staff

29
Q

What is the biggest killer of all psychiatric disorders?

A

Anorexia nervosa

20% have premature death

30
Q

What is the management for AN?

A 
Re-feeding
CBT-ED (40 sessions), Mantra, SSCM
IPT
Fluoxetine 60mg
Olanzapine Family therapy for younger patients

Psychiatry (26 decks)

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