Eating disorders Flashcards
What is the diagnostic criteria for anorexia nervosa, and what are its 2 main types?
DSM5:
Deliberate weight loss, induced and sustained by the patient based on a intense fear of gaining weight or becoming fat, which is an intrusive and overvalued idea, and an excessive preoccuptation with body shape and weight.
Binding and purging: Binge, and then vomit, laxatives, slimming pills.
Restrictive: Severe restriction of food and fluid intake.
What are the physical effects of AN?
Primary Amenorrhoea Stunted growth Enlargement of cerebral ventricles Hirsutism Mitral valve prolapse Liver abnormalities Osteoporosis Collapsed vertebrae Shrunken uterus Marrow suppression
Symptoms of AN?
Abdominal pain Constipation Chronic pain Weakness Fatigue Anxiety Low mood
How do we assess medical risk?
BMI:
<15 moderate risk, <13 high risk
Weight loss/week
>0.5Kg- moderate, >1Kg high risk.
Blood pressure Postural drop Core temperature Blood test- (glucose, electrolytes, FBD, LFT) ECG Squat test
What are some mental health comorbidities?
Depression Anxiety SOcial phobia Personality diorders- Anankastic! DSH
What is bulimia nervosa?
Recurrent episodes of binge eating, where >1000kcal are consumed within 2 hours, producing a sense of lack of control, producing recurrent compensatory behaviour to prevent weight gain. (Self induced vomiting, laxatives, enemas, diuretics, fasting).
This must be present at least twice a week for 3 months. There should also be a preoccupation with body image and weight.
What is BED?
Binge eating disorder. Engaging in uncontrollable episodes of binge eating, but there is no compensatory or purging behaviours- resulting in a high BMI. Eat more because they are embarrassed at the amount they are eating. There is guilt/disgust after eating.
What are the differences in prevalence between genders in the 3 disorders?
BN: 1% young women affected, 90% female.
AN: 0.3% young women, 0.1% men. 80-90% female.
BED: 3.5% of population affected, less difference seen in sexes.
What is the aetiology of EDs?
Genetic- heritability 58-88%
Physical risk: History of obesity
Adverse life events: Sexual abuse, stressful events
Family factors: High concern parenting, over protection
Personality traits: Perfectionism
Societal pressure
How should these disorders be managed?
Patients should be monitored for weight and bloods. Bone scans, ECG and squat tests can also be done.
What medications are possible, in addition to gradual food increaes?
Multi vitamins (thiamine) Mebeverine (abdominal discomfort) Fybogel (constipation) Dioralyte Olanzapine (pre meal anxiety) SSRI
What is refeeding syndrome?
Rapid initiation of refeeding after a period of malnutrition.
Can cause cardiac and respiratory failure, delirium, fits.
Therefore, nutritional repletion should be initiated slowly and tailored to each patient, and intake should be based on blood electrolyte levels.
What happens to AN patients?
40% recover completely, 35% improve, 20% develop chronic ED problems, 5% die due to complication. AN is has the highest mortality rate in adolescents with mental health problems.
A number of AN patients convert to BN/BED.
What are some prognostic factors that predict success of treatment?
Age of onset (younger do better)
Severity of illness (duration, degree of weight loss, motivation)
Comorbidities (abuse, personality, impulse control)
Response to treatment (poor weight gain)
