Eating Disorders Flashcards
Who is anorexia most commonly seen in? What is the female: male ratio?
Young females aged 15-34 / 1: 10
What are some social factors which increase risk of the development of anorexia?
Higher social class, Westernised family, certain occupational groups (dancers/nurses) and in societies where cultural value is placed on thinness
Patients with anorexia often see the condition as what?
A way to escape from the problems of adolescence and regress back to childhood
What are some antecedents of anorexia?
Childhood abuse, dietary problems earlier in life, low self-esteem, perfectionism
How can people with type 1 diabetes also develop anorexia?
By running their blood sugars very low
The onset of anorexia is usually when?
In adolesence
What will be the background of a patient presenting with anorexia?
They will eat very little, but be obsessed with food. There will be excessive exercise and weighing.
What are some physical consequences of anorexia?
Increased sensitivity to the cold, constipation, hypotension and bradycardia
In people with anorexia who binge and vomit, or abuse purgatives, what others features may be present?
Hypokalaemia and alkalosis
What is the body weight definition of anorexia in ICD-10?
A body weight > 15% below the standard weight, or a BMI < 17.5
Apart from the actual definition of weight, what are the other key parts of ICD-10 criteria for anorexia?
Self-induced weight loss, distortion of body image, morbid fear of fatness, amenorrhoea in females
What causes amenorrhoea in anorexia? Is it reversible?
Malnutrition / usually it is reversed by refeeding
What investigations should be done for anorexia?
FBCs, biochemistry, LFTs, ECG, DEXA
What may an FBC of someone with anorexia show?
Low WCC
Why is it important to do a DEXA scan in someone who you suspect has anorexia?
The disease can quickly cause osteopenia which can become osteoporosis which is irreversible
What would LFTs show in someone with anorexia?
Raised liver enzymes since the liver is being broken down and used for energy
Treatment for anorexia can be conducted on an outpatient basis unless there is what?
Severe weight loss accompanied by marked CV signs and/or electrolyte and vitamin disturbances
If a patient with anorexia refuses to go to hospital for treatment what can you do?
Compulsory admission
Explain what happens in compulsory admission for anorexia?
In an emergency, artificial feeding can be started but only for 2-3 days. After this, a 2nd opinion from an independent doctor is required.
In treatment for anorexia, you should aim for a weight gain of what?
0.5-1kg per week
What is the outpatient treatment for anorexia?
CBT and interpersonal therapy / family therapy is best if they still live at home
Drugs which do what should be avoided in the treatment of anorexia?
Prolong the QT interval
How should a patient hospitalised for anorexia be fed?
NG tube
What happens in refeeding syndrome?
Already inadequate stores of nutrients are used up as the body starts to repair itself
What are the outcomes of anorexia?
2/3rds of patients maintain a normal weight, while 1/3rd will remain moderately-severely underweight
More than 1/3rd of anorexia patients have what other psychiatric illness?
An affective disorder
What is the lifetime prevalence of bulimia in women? It can sometimes be associated with what?
3-7% / anorexia
A premorbid history of what is common in people with bulimia?
Dieting
Which of the main eating disorders has a better prognosis?
Bulimia
What happens in bulimia?
Episodes of uncontrolled and excessive eating followed by attempts to lose weight
What are some of the attempts to lose weight which may be seen in bulimia?
Vomiting, starvation, laxatives, drug misuse
What other psychiatric conditions are most commonly seen alongside bulimia?
Depression and substance misuse
What happens to the body weight in bulimia?
It fluctuates within normal limits
What happens to periods in bulimia?
They are irregular (but amenorrhoea is rare)
What are some physical signs of bulimia?
Russell’s sign (calluses on knuckles), parotid hypertrophy, dental caries, hypokalaemia
What assessments do people with suspected bulimia undergo?
Psychological assessment to screen for other psychiatric conditions / screen for medical complications
What are the management options for bulimia?
Guided self-help, CBT (individual or group), high dose SSRIs
What is the most effective treatment for bulimia?
CBT
What SSRI should be used for bulimia?
Fluoxetine
