Eating disorders Flashcards

Question

Which blood tests can come back high in eating disorders?

Answer 1

``` Most things LOW EXCEPT FOR G’s and C’s • Growth hormone • Salivary Glands • Creatine kinase • Cortisol • Cholesterol • Carotenemia (excess beta-carotene, yellow discolourisation of the skin) ```

Answer 2

``` ↓ Phosphate ↓ Magnesium ↓ Calcium ↑ LFTs ↓ K+ ```

Answer 3

asseses physical risk in eating disorders

Answer 4

• Little evidence for drugs, none licensed - food is best medication • Establish good relationship for refeeding o Gradual safe increase working with dietician o Aim for 3000 balance calories a day o Small meals and snacks • Monitor for refeeding syndrome o Risk of sudden death - arrhythmia, confusion, convulsions, cardiac arrest * Treat any associated medical or psychiatric conditions * Feeding against will with NG tube = LAST RESORT

Answer 5

During fasting body switches fuel source from carbs to fatty acids/ketones o When carbs reintroduced insulin levels rapidly rise and carb metabolism resumes which requires phosphates, magnesium and potassium o Those with little intake will have low phosphates, magnesium and potassium o Therefore gets rapidly used up - acutely low electrolyte state o So if very little intake there is high risk of refeeding syndrome

Answer 6

``` • Patient and family education o Carers must be firm but supportive o CBT, CAT, IPT, family therapy  New therapy called MANTRA which is specific for AN has everything Social - family therapy ```

Answer 7

• Other psychiatric disorders o EDNOS, bulimia nervosa, body dysmorphic disorder, depressive disorder, OCD, social phobia, conversion disorder, schizophrenia and personality • Secondary to medical disorders o endocrine disorders such as diabetes mellitus, diabetic ketoacidosis, hyperthyroidism, Graves disease and Addison’s disease; from gastrointestinal disorders such as gastroenteritis, IBD, malabsoption and intestinal obstruction; chronic renal failure, chronic anaemia, chronic infections, neoplasm and pregnancy.

Answer 8

* Prognosis is very variable and a younger age of onset and a short history are important positive prognostic factors. * One fifth of sufferers recover completely but another fifth experience chronic, severe illness. * The remainder make a recovery of sorts but retain abnormal eating habits and sometimes become bulimic. * The long term mortality from suicide and from the complications of starvation is about 15% (higher than any other mental disorder) * Prognosis worse if fast weight loss (>1kg a week)

Answer 9

Bulimia nervosa is a syndrome characterized by repeated bouts of overeating and an excessive preoccupation with the control of body weight, leading the patient to adopt extreme measures so as to mitigate the "fattening" effects of ingested food.

Answer 10

• 10:1 F:M • more common than anorexia nervosa o 1 in 50 females o 1 in 500 males • It is also commoner in models, gymnasts, dancers and male homosexuals. • Typical onset = teens/early 20s • More common in occidental or occidentalised societies that promote individuality and idealise thinness and beauty. • Many bulimia suffers also have a history of anorexia nervosa o Interval between 2 disorders ranges from few months to several years • Premorbid obesity is common o Also history of affective disorders, personality disorders, anxiety, substance misuse and Hx of abuse o Or FH of obesity

Answer 11

1. Recurrent episodes of overeating (at least 2x/week over a period of 3 months) in which large amounts of foods consumed over short periods of time a. Binge can be thousands of calories 2. There is a persistent preoccupation with eating, and an irresistible craving for food 3. The patient attempts to counteract the ‘fattening’ effects of food by one or more of the following a. self-induced vomiting b. purging c. alternating periods of starvation d. use of drugs e.g. appetite suppressants, thyroid preparations or diuretics or other strategies. i. may see drug S/E or OD 1. N.B. diabetic patients may neglect their insulin treatment (diabteitcs particulary at risk with hypoglycaemia) 4. The psychopathology consists of a self-perception of being too fat and a morbid dread of fatness.

Answer 12

loss of control  followed by intense guilt, NB only small amount of food is not a true binge eg 5 grapes more likely restrictive AN

Answer 13

* Fear of fatness * Pursuit of thinness * Body dissatisfaction * Body image distortion * Self-value based on weight and shape

Answer 14

* The onset of bulimia is typically preceded by a period of dietary restriction. * The patient often complains of fatigue, bloating, flatulence, constipation, abdominal pain and menstrual irregularities. * Depressive symptoms are more prominent than in anorexia.

Answer 15

• Education and psychological therapies as for AN o Support the patient and alter disturbed perceptions of the self. o BN: Family therapy is the best for children/ adolescents, CBT for adults * SSRIs have been demonstrated to have a specific antibulimic effect at higher doses, so consider prescribing an SSRI such as fluoxetine 60mg daily. * Monitor and treat assoc physical and mental disorders.

Answer 16

better than in anorexia nervosa, not least because bulimia sufferers are keener to seek and accept help (egodystonic)

Answer 17

* Subthreshold disorders that don’t meet diagnostic criteria for AN/BD * Or, Binge Eating Disorder