Eating disorders

Question 1

Anorexia nervosa diagnosis

Answer 1

1. Diagnosis is now based on the DSM 5 criteria.
2. Note that BMI and amenorrhoea are no longer specifically mentioned:
3. 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.
4. Intense fear of gaining weight or becoming fat, even though underweight.
5. 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 denial of the seriousness of the current low body weight.

Question 2

management of anorexia nervosa in adults

Answer 2

1. individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
2. Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
   - specialist supportive clinical management (SSCM).

Question 3

management of anorexia nervosa in children

Answer 3

1. First line treatment ‘anorexia focused family therapy’

2. The second-line treatment is cognitive behavioural therapy.

Question 4

features of anorexia nervosa

Answer 4

reduced body mass index
bradycardia
hypotension
enlarged salivary glands

Question 5

physiogical abnormalities of anorexia nervosa

Answer 5

1. hypokalaemia
2. low FSH, LH, oestrogens and testosterone
3. raised cortisol and growth hormone
4. impaired glucose tolerance
5. hypercholesterolaemia
6. hypercarotinaemia - increased yellow pigmentation of the skin due to excessive consumption of carotene rich food like carrots
7. low T3

Question 6

bulimia nervosa definition

Answer 6

a type of eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising.

Question 7

DM5 diagnostic criterea for bulimia nervosa;

Answer 7

1. Recurrent episodes of binge eating (eating an amount of food that is definitely larger than most people would eat during a similar period of time and circumstances)
2. a sense of lack of control over eating during the episode
3. recurrent inappropriate compensatory behaviour in order to prevent weight gain - such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
4. the binge eating and compensatory behaviours both occur, on average, at least once a week for three months.
5. self-evaluation is unduly influenced by body shape and weight.the disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 8

management of bulimia nervosa

Answer 8

1. referral for specialist care is appropriate in all cases
2. NICE recommend bulimia-nervosa-focused guided self-help for adults
3. If bulimia-nervosa-focused guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks of treatment,
4. NICE recommend that we consider individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
5. children should be offered bulimia-nervosa-focused family therapy (FT-BN)

Question 9

pharmacological drugs for ED?

Answer 9

pharmacological treatments have a limited role - a trial of high-dose fluoxetine is currently licensed for bulimia but long-term data is lacking