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BSP Exam II > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

3 major eating disorder types

A

Anorexia nervosa

Bulimia nervosa

Binge eating disorder

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2
Q

Bulimia and anorexia nervosa are often accompanied by ______, with rates 7x higher in pts with bulimia nervosa and 5x higher in pts with anorexia nervosa

A

Suicidality

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3
Q

DSM 5 criteria for anorexia nervosa

A

Restriction of caloric intake relative to requirements, leading to SIGNIFICANTLY LOW BODY WEIGHT for age, sex, and development

Intense fear of gaining weight or becoming fat, despite being underweight, or persistent behavior that interferes with weight gain

Distorted perception of body weight and shape, undue influence of weight and shape on self-worth, or denial of medical seriousness of one’s low body weight

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4
Q

2 types of anorexia nervosa

A

Restricting type

Binge-eating/purging type

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5
Q

Define restricting type of anorexia nervosa

A

3 months of no binging or purging; instead weight loss strategies include excessive exercise, fasting, and dieting

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6
Q

Define bing-eating/purging type of anorexia nervosa

A

3 months of binging and purging behaviors including self-induced vomiting and/or misuse of laxatives, diuretics, enemas

[note: this is different from bulimia bc anorexia pt is UNDERWEIGHT while bulimia is typically normal, or slightly above/below normal weight]

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7
Q

In anorexia nervosa, fear of weight gain and other psychological comorbidities tend to _______ as patients lose more weight

A

Worsen

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8
Q

Cardiac, gynecologic, and endocrine medical complications of anorexia nervosa

A

Cardiac: bradycardia, hypotension, QT dispersion, cardiac atrophy, MVP

Gynecologic: amenorrhea and decreased libido

Endocrine: osteoporosis, hypothermia, EUTHYROID, and hypoglycemia

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9
Q

GI complications of anorexia nervosa

A

Gastroparesis and constipation

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10
Q

Electrolyte abnormalities in anorexia nervosa

A

Dehydration
Hypokalemia
Hypophosphatemia
Hypomagnesemia

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11
Q

Pulmonary and hematologic complications of anorexia nervosa

A

Pulmonary: Respiratory muscle atrophy and dyspnea

Hematologic: anemia, leukopenia, and thrombocytopenia

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12
Q

Neurologic and dermatologic complications of anorexia nervosa

A

Neurlogic: brain atrophy

Dermatologic: xerosis, lanugo (diffuse fine hair growth), carotenoderma, acrocyanosis, seborrheic dermatitis

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13
Q

What is re-feeding syndrome?

A

Often occurs in significantly malnourished pts with sudden increase in calorie intake

Food intake —> increased insulin —> hypophosphatemia, hypokalemia, hypomagnesemia —> cardiac complications, rhabdomyolysis, seizures

[do NOT rehydrate or feed pts beyond current capacity — this is a serious complication of treatment!!]

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14
Q

Mood disorders often comorbid with anorexia nervosa

A

Depression and dysthymic disorder

Anxiety disorders — OCD

Impulse control disorders

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15
Q

Personality d/o’s associated with anorexia nervosa

A

Obsessive-compulsive, avoidant, dependent, narcissistic, paranoid, borderline

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16
Q

Treatment for anorexia nervosa

A

Interdisciplinary, including mental health clinician, registered dietician, and general medicine clinician

Nutritional rehab and psychotherapy are needed at minimum for first line care

Hospitalization necessary due to complications of starvation, resistance to re-feeding, suicidality, or severe psychosocial barriers to care

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17
Q

How long should anorexia nervosa pts be hospitalized?

A

Hospitalization should last until normal weight is achieved to reduce relapse rates and rehospitalization

18
Q

T/F: anorexia nervosa and psychiatric comorbidities are usually resistant to pharmacotherapy

A

True; only consider for cases where meds may help reduce depression or anxiety creating barriers to care

Meds should be started at low doses due to increased risk of AEs associated with low weight, dehydration, excess hydration, or vomiting

19
Q

How much weight gain is recommended for inpatient vs. outpatient anorexia nervosa pts?

A

2-3 lbs gained per week for inpatients

0.5-1 lb gained per week for outpatients

20
Q

Psychotherapy options for anorexia nervosa

A

CBT

Specialist supportive clinical management

Motivational interviewing

Family therapy (good for adolescent pts)

[first line therapy focuses on helping pts confront their disorder and change their eating habits and/or thoughts about weight gain]

21
Q

What 2 pharmacotherapy options should be avoided in anorexia nervosa pts?

A

Buproprion — increased seizure risk with binging and purging

TCAs — cardiotoxicity

[also caution with antipsychotics and antidepressants with risk of QT prolongation]

22
Q

______ is the only adjunctive medication shown to help with weight gain in anorexia nervosa pts, and ______ is a medication that may help reduce anxiety associated with confronting meals

A

Olanzapine; lorazepam

23
Q

DSM 5 criteria for bulimia nervosa (BN)

A

Recurrent episodes of binge eating, defined as eating an unusually large amount of food in a discrete period of time; pts feel they cannot control their eating during the episode

Recurrent inappropriate compensatory behavior to prevent weight gain (e.g., vomiting, laxative-use)

Binge eating and inappropriate compensatory behaviors occur at least 2 TIMES PER WEEK and for 3 MONTHS

The pts self evaluation is unduly influenced by body shape and weight

The disturbance does not occur exclusively during episode of AN

24
Q

Describe the typical weight of a BN pt

A

Pts can vary between normal body weight, slightly underweight, overweight, or obese

[compare this to AN pts who are mostly underweight]

25
Q

The DSM divides BN into _____ and ______ categories

A

Purging; non-purging

26
Q

Despite feeling a lack of control over binge-eating, BN pts try to ______ the activity and may stop if caught by someone unexpectedly

Pts often feel _____ after binging

Pts often excessively fearful of weight gain, and don’t necessarily want to become thin, just don’t want to get fat

A

Conceal

Dysphoric

27
Q

Electrolyte changes in BN

A

Dehydration
Hypokalemia
Hypochloremia
Metabolic alkalosis

28
Q

Cardiac complications in BN

A 
Hypotension
Orthostasis
Sinus tachycardia
ECG changes
Arrhythmias
29
Q

GI complications of BN

A

Mallory-weiss syndrome or esophageal rupture

Parotid and submandibular gland hypertrophy

Abdominal pain and bloating

Constipation

30
Q

Dental and skin complications of BN

A

Tooth enamel erosion and dental caries

Scar and callus on dorsum of hand (Russel’s sign); xerosis

31
Q

T/F: BN comorbidities are similar to comorbidities seen with AN

A

True

32
Q

Treatment for BN

A

Best standard treatment includes combo of nutritional rehab, CBT psychotherapy, and pharmacotherapy

33
Q

If only one therapy can be given for BN, what is the treatment of choice?

A

CBT psycho therapy — shown to help reduce binging and purging

Pts must be medically, cognitively, and emotionall stable while participating in therapy

Effectiveness often improved when combined with pharmacotherapy

Goals include improving self-esteem, decrease emphasis on thinness, eliminate dietary restraint, create pattern of regular eating, eliminate binge and purge habits

34
Q

What pharmacotherapy must be avoided in BN?

A

Buproprion — due to increased seizure risk with binging and purging!

35
Q

First, second, and third line pharmacotherapy options for BN

A

1st: Fluoxetine
2nd: other SSRIs at higher dose than that used to tx MDD; recommend Sertraline or Fluvoxamine
3rd: in order of preference - TCAs > topiramate > trazodone > MAOIs

36
Q

Binge eating disorder includes episodes of binge eating, defined as consuming a large amount of food in a ______ period of time. Pts feel they lack control over eating during the episode.

Binge eating episodes are marked by at least ____ additional criteria, and episodes occur on average ____/week for at least ________.

There is no associated compensatory behaviors (e.g., purging, fasting, excess exercise, etc) as are seen in BN

A

2 hour

3; 1; 3 months

37
Q

Binge eating episodes are marked by at least 3 additional criteria — what are the criteria?

A

Eating large amounts of food when not hungry

Eats rapidly

Feels uncomfortably full after eating

Eating alone due to embarrassment over amount consumed

Feelings of guilt, depression, disgust after binging

38
Q

Treatment for binge eating disorder should focus on helping to reduce pts binge eating, excess weight gain (if present), psychiatric comorbidities, and excess body image concerns.

What is the first line treatment?

A

Psychotherapy! — CBT and interpersonal therapy (IPT) are most effective and of relatively similar efficacy

39
Q

_____ is the first and only medication approved to treat moderate-to-severe binge eating disorder in adults

A

Vyvanse (lisdexamfetamine dimesylate)

40
Q

Binge eating disorder pharmacotherapy in combination with CBT is not significantly more effective than CBT alone; the exception to this may be ______

A

Topiramate

41
Q

SSRIs are usually chosen over topiramate or zonisamide for binge eating disorder due to better patient tolerance. What SSRIs are shown to be effective in binge eating disorder?

A 
Citalopram
Escitalopram
Fluoxetine
Fluvoxemine
Sertraline
42
Q

T/F: Anti-obesity drugs are a good option for binge-eating disorder tx

A

False — they have poor efficacy and serious adverse effects

BSP Exam II (10 decks)

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