Eating Disorders

Question 1

3 major eating disorder types

Answer 1

Anorexia nervosa

Bulimia nervosa

Binge eating disorder

Question 2

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

Answer 2

Suicidality

Question 3

DSM 5 criteria for anorexia nervosa

Answer 3

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

Question 4

2 types of anorexia nervosa

Answer 4

Restricting type

Binge-eating/purging type

Question 5

Define restricting type of anorexia nervosa

Answer 5

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

Question 6

Define bing-eating/purging type of anorexia nervosa

Answer 6

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]

Question 7

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

Answer 7

Worsen

Question 8

Cardiac, gynecologic, and endocrine medical complications of anorexia nervosa

Answer 8

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

Gynecologic: amenorrhea and decreased libido

Endocrine: osteoporosis, hypothermia, EUTHYROID, and hypoglycemia

Question 9

GI complications of anorexia nervosa

Answer 9

Gastroparesis and constipation

Question 10

Electrolyte abnormalities in anorexia nervosa

Answer 10

Dehydration
Hypokalemia
Hypophosphatemia
Hypomagnesemia

Question 11

Pulmonary and hematologic complications of anorexia nervosa

Answer 11

Pulmonary: Respiratory muscle atrophy and dyspnea

Hematologic: anemia, leukopenia, and thrombocytopenia

Question 12

Neurologic and dermatologic complications of anorexia nervosa

Answer 12

Neurlogic: brain atrophy

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

Question 13

What is re-feeding syndrome?

Answer 13

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!!]

Question 14

Mood disorders often comorbid with anorexia nervosa

Answer 14

Depression and dysthymic disorder

Anxiety disorders — OCD

Impulse control disorders

Question 15

Personality d/o’s associated with anorexia nervosa

Answer 15

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

Question 16

Treatment for anorexia nervosa

Answer 16

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

Question 17

How long should anorexia nervosa pts be hospitalized?

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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

Answer 19

2-3 lbs gained per week for inpatients

0.5-1 lb gained per week for outpatients

Question 20

Psychotherapy options for anorexia nervosa

Answer 20

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]

Question 21

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

Answer 21

Buproprion — increased seizure risk with binging and purging

TCAs — cardiotoxicity

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

Question 22

______ 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

Answer 22

Olanzapine; lorazepam

Question 23

DSM 5 criteria for bulimia nervosa (BN)

Answer 23

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

Question 24

Describe the typical weight of a BN pt

Answer 24

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

[compare this to AN pts who are mostly underweight]

Question 25

The DSM divides BN into _____ and ______ categories

Answer 25

Purging; non-purging

Question 26

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

Answer 26

Conceal Dysphoric

Question 27

Electrolyte changes in BN

Answer 27

Dehydration Hypokalemia Hypochloremia Metabolic alkalosis

Question 28

Cardiac complications in BN

Answer 28

``` Hypotension Orthostasis Sinus tachycardia ECG changes Arrhythmias ```

Question 29

GI complications of BN

Answer 29

Mallory-weiss syndrome or esophageal rupture Parotid and submandibular gland hypertrophy Abdominal pain and bloating Constipation

Question 30

Dental and skin complications of BN

Answer 30

Tooth enamel erosion and dental caries Scar and callus on dorsum of hand (Russel’s sign); xerosis

Question 31

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

Answer 31

True

Question 32

Treatment for BN

Answer 32

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

Question 33

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

Answer 33

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

Question 34

What pharmacotherapy must be avoided in BN?

Answer 34

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

Question 35

First, second, and third line pharmacotherapy options for BN

Answer 35

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

Question 36

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

Answer 36

2 hour 3; 1; 3 months

Question 37

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

Answer 37

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

Question 38

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?

Answer 38

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

Question 39

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

Answer 39

Vyvanse (lisdexamfetamine dimesylate)

Question 40

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

Answer 40

Topiramate

Question 41

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?

Answer 41

``` Citalopram Escitalopram Fluoxetine Fluvoxemine Sertraline ```

Question 42

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

Answer 42

False — they have poor efficacy and serious adverse effects