Eating Disorders Flashcards
3 major eating disorder types
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
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
Suicidality
DSM 5 criteria for anorexia nervosa
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
2 types of anorexia nervosa
Restricting type
Binge-eating/purging type
Define restricting type of anorexia nervosa
3 months of no binging or purging; instead weight loss strategies include excessive exercise, fasting, and dieting
Define bing-eating/purging type of anorexia nervosa
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]
In anorexia nervosa, fear of weight gain and other psychological comorbidities tend to _______ as patients lose more weight
Worsen
Cardiac, gynecologic, and endocrine medical complications of anorexia nervosa
Cardiac: bradycardia, hypotension, QT dispersion, cardiac atrophy, MVP
Gynecologic: amenorrhea and decreased libido
Endocrine: osteoporosis, hypothermia, EUTHYROID, and hypoglycemia
GI complications of anorexia nervosa
Gastroparesis and constipation
Electrolyte abnormalities in anorexia nervosa
Dehydration
Hypokalemia
Hypophosphatemia
Hypomagnesemia
Pulmonary and hematologic complications of anorexia nervosa
Pulmonary: Respiratory muscle atrophy and dyspnea
Hematologic: anemia, leukopenia, and thrombocytopenia
Neurologic and dermatologic complications of anorexia nervosa
Neurlogic: brain atrophy
Dermatologic: xerosis, lanugo (diffuse fine hair growth), carotenoderma, acrocyanosis, seborrheic dermatitis
What is re-feeding syndrome?
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!!]
Mood disorders often comorbid with anorexia nervosa
Depression and dysthymic disorder
Anxiety disorders — OCD
Impulse control disorders
Personality d/o’s associated with anorexia nervosa
Obsessive-compulsive, avoidant, dependent, narcissistic, paranoid, borderline
Treatment for anorexia nervosa
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
How long should anorexia nervosa pts be hospitalized?
Hospitalization should last until normal weight is achieved to reduce relapse rates and rehospitalization
T/F: anorexia nervosa and psychiatric comorbidities are usually resistant to pharmacotherapy
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
How much weight gain is recommended for inpatient vs. outpatient anorexia nervosa pts?
2-3 lbs gained per week for inpatients
0.5-1 lb gained per week for outpatients
Psychotherapy options for anorexia nervosa
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]
What 2 pharmacotherapy options should be avoided in anorexia nervosa pts?
Buproprion — increased seizure risk with binging and purging
TCAs — cardiotoxicity
[also caution with antipsychotics and antidepressants with risk of QT prolongation]
______ 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
Olanzapine; lorazepam
DSM 5 criteria for bulimia nervosa (BN)
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
Describe the typical weight of a BN pt
Pts can vary between normal body weight, slightly underweight, overweight, or obese
[compare this to AN pts who are mostly underweight]
The DSM divides BN into _____ and ______ categories
Purging; non-purging
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
Conceal
Dysphoric
Electrolyte changes in BN
Dehydration
Hypokalemia
Hypochloremia
Metabolic alkalosis
Cardiac complications in BN
Hypotension Orthostasis Sinus tachycardia ECG changes Arrhythmias
GI complications of BN
Mallory-weiss syndrome or esophageal rupture
Parotid and submandibular gland hypertrophy
Abdominal pain and bloating
Constipation
Dental and skin complications of BN
Tooth enamel erosion and dental caries
Scar and callus on dorsum of hand (Russel’s sign); xerosis
T/F: BN comorbidities are similar to comorbidities seen with AN
True
Treatment for BN
Best standard treatment includes combo of nutritional rehab, CBT psychotherapy, and pharmacotherapy
If only one therapy can be given for BN, what is the treatment of choice?
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
What pharmacotherapy must be avoided in BN?
Buproprion — due to increased seizure risk with binging and purging!
First, second, and third line pharmacotherapy options for BN
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
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
2 hour
3; 1; 3 months
Binge eating episodes are marked by at least 3 additional criteria — what are the criteria?
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
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?
Psychotherapy! — CBT and interpersonal therapy (IPT) are most effective and of relatively similar efficacy
_____ is the first and only medication approved to treat moderate-to-severe binge eating disorder in adults
Vyvanse (lisdexamfetamine dimesylate)
Binge eating disorder pharmacotherapy in combination with CBT is not significantly more effective than CBT alone; the exception to this may be ______
Topiramate
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?
Citalopram Escitalopram Fluoxetine Fluvoxemine Sertraline
T/F: Anti-obesity drugs are a good option for binge-eating disorder tx
False — they have poor efficacy and serious adverse effects
