Eating disorders Flashcards
What are the three eating disorders described by the ICD-10?
Anorexia nervosa
Bulimia nervosa
Eating disorder not otherwise specified
What are the defining features of anorexia nervosa according to DSM-V? Which one of these is deemed inappropriate?
BMI <18.5
Core psychopathology present
Amenorrhoea - not always present and doesn’t help with diagnosis of men with AN
How many men and how many women does AN affect?
Men - 1 in 2000
Women - 1 in 250
What are some examples of core beliefs of those with AN?
Fear of fatness
Pursuit of thinness
Body dissatisfaction
Body image distortion - finding fat where there is none
Body-Self perception - they base all feelings of them being a good person around their body shape
What other psychopathologies are included in AN and how does this play into the disease?
Depression Anxiety Suicidal ideation OCD ***it is thought that starvation might cause some of these conditions
What sorts of behaviours might be described by someone with anorexia?
Dieting, Fasting, Calorie counting, excessive exercise
Water loading (filling stomach with water)
Diet pills, water pills, thyroxine, laxatives
Body checking and excessive weight
Culinary behaviours - becoming obsessed with cooking and recipes
Avoidance, isolation, misuse of insulin
What kind of affect does starvation have on the renal, CVS and GI systems?
CVS - hypotension, bradycardia, sudden death
GI - Parotid swelling, delayed gastric emptying, nutritional hepatitis and constipation
RENAL - Oedema, electrolyte abnormalities, renal calculi and renal failure
What kind of affect does starvation have on other systems in the body?
HAEM (anaemia, thrombocytopenia and leukopenia)
ENDO (Amenorrhoea, infertility and hypothyroid)
Seizures, confusion, brittle hair and nails, lanugo
What kind of affects can the binging/purging nature of bulimia nervosa have on the CVS, GI and Renal systems?
CVS - arrhythmias, cardiac failure and sudden death
GI - Parotid swelling, dental or oesophageal erosion and constipation
Renal - Oedema, electrolyte abnormalities, renal calculi and renal failure
What kind of affects can the binging/purging nature of bulimia nervosa have on the other systems in the body?
Oligomenorrhoea
Impaired temperature regulation
Calluses on the dorsal of hands - RUSSEL’S SIGN
There is an imbalance of many hormones and substances in the body in AN, what is a good way of remembering which things are high and which are low?
Most things low apart from Gs and Cs
G - growth hormone, glucose, salivary Glands,
C- cortisol, cholesterol, carotinaemia
What is a good way to SCREEN for eating disorders?
SCOFF questionnaire
S - do you ever make yourself SICK after eating?
C - Do you every worry you have lost CONTROL over how much you eat/
O - Have you every lost more than ONE stone in any three month period?
F - Do you believe yourself to be FAT (when others say you’re thin)?
F - Would you say FOOD dominates your life?
***also always ask about physical symptoms
What investigations should be done in a patient with AN?
Weight them and check BMI
Ask about physical symptoms
ECG (80% deaths in AN from cardiac arrest) - QTc prolongation
What blood changes are you likely to see in someone with eating disorder?
Hypoglycaemia - starvation
Hypokalaemia - Vomiting
Hyponatraemia - Water loading
Laxative misuse - hyperkalaemia and hyponatraemia
Diuretic misuse - hypokalaemia and hyponatraemia
Thyroxine misuse - high T3/T4 low TSH
Proximal myopathy - High CK and High LFTs
Bone Marrow hypoplasia - leucopenia and normocytic anaemia
What is the prognosis for someone with AN?
This is directly linked to their BMI If it is: <17.5 - confirmed AN <15 - moderate risk of death <13 - High risk of death
