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Psychiatry > Eating disorders > Flashcards

Eating disorders Flashcards

1
Q

ICD-10 diagnostic criteria for anorexia nervosa

A
  1. Low weight: BMI<17.5 (weight loss or lack of weight gain in children, <5thcentile)
  2. Weight loss is self-induced by avoidance of “fattening foods”
  3. Self-perception of being “too fat” leading to low weight threshold, even when thin
  4. Irrational fear of fatness
  5. Amennorhoea
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2
Q

Definition of atypical anorexia nervosa

A

Fulfills some but not all features of AN (e.g. may have weight loss behaviours in absence of endocrine changes/dread of being fat)

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3
Q

ICD-10 criteria for bulimia nervosa

A
  1. Recurrent episodes of overeating: 1000-4000 kcal, loss of control
  2. Compensatory behaviours e.g. purging, starvation, exercise, drugs
  3. Preoccupation with eating
  4. Perception of being too fat/dread of fatness
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4
Q

Time criterion for bulimia nervosa

A

>=2 episodes of overeating per week, for 3 months

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5
Q

Criteria for binge-eating disorder (DSM-V)

A
  1. Recurrent episodes of binge-eating: characterised by lack of control
  2. Distress: regarding binge-eating (depression frequently co-morbid)
  3. No compensatory behaviour: BMI >25
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6
Q

Time criteria for binge-eating disorder

A

>=1 per week for 3 months

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7
Q

Features of binge eating episodes in binge-eating disorder

A

>=3 of:

  1. Eating until uncomfortably full
  2. Eating when not physically hungry
  3. Eating alone due to shame/embarrasment
  4. Eating more rapidly than normal
  5. Feelings of disgust, guilt, depression afterwards
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8
Q

Biological predisposing factors for eating disorder

A
  1. Female
  2. Genetics (56% AN, up to 80% BN)
  3. Early menarche (BN)
  4. Obesity (BN)
  5. +ve FHx (?biological)
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9
Q

Psychological predisposing factors for ED

A
  1. Perfectionism (AN)
  2. Low self-esteem
  3. Sexual abuse (less common in ED, little evidence)
  4. Anxiety
  5. Impulsivity (BN)
  6. FHx of obesity (BN)
  7. PPH of eating disorder (AN –> BN)
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10
Q

Social predisposing factors for ED

A
  1. Adverse parenting (arguments, expectations, contact)
  2. Western society
  3. Specific groups (e.g. models)
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11
Q

Biological precipitating factors for ED

A
  1. Dieting/lent
  2. Illness/infection
  3. Puberty
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12
Q

Psychological precipitating factors for ED

A
  1. Emotional stress
  2. Bullying/critical comments
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13
Q

Social precipitating factors for ED

A
  1. Family dieting
  2. Peer group/lifecycle transition
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14
Q

Biological perpetuating factors for ED

A

Neuroendocrine dysregulation

e.g. 5-HT disturbance makes psychopathology worse

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15
Q

Psychological perpetuating factors for ED

A
  1. Over-valued intrusive ideas re: weight
  2. Abnormal weight perception
  3. Co-morbid mood disorder (esp depression)
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16
Q

Social perpetuating factors for ED

A

+ve reinforcement from friends/family

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17
Q

Average age of onset for EDs

A

AN: 15-16 years old

BN:20

BED: 23

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18
Q

F:M prevalence ratio for eating disorders

A

6:1 in community, 10:1 in clinical samples

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19
Q

Prevalence of ED

A

AN: 1%

BN: 1%

BED: 1-2%

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20
Q

Physical symptoms in anorexia nervosa

A
  1. Sensitivity to cold
  2. Amennorhoea/delayed onset of puberty
  3. Reduced sex drive
  4. Dizziness, fatigue
  5. Poor concentration
  6. Poor sleep
  7. GI symptoms: constipation, bloating
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21
Q

Physical signs of anorexia nervosa

A
  1. Cold extremities
  2. Sarcopenia
  3. Bradycardia, postural hypotension, arrhythmia
  4. Dry skin, sometimes orange (hypercarotinaemia)
  5. Brittle hair/nails
  6. Lanugo on back, forearms, cheeks
  7. Peripheral oedema
  8. Proximal myopathy
  9. Osteoporosis/osteopaenia
  10. Poorly developed 2ry sexual characteristics
22
Q

Endocrine abnormalities in anorexia nervosa

A

Low: LH, FSH, T3, estradiol

High: Cortisol, GH

23
Q

Metabolic abnormalities in anorexia nervosa

A

Hypoglycaemia

Hypercholesterolaemia

24
Q

Electrolyte abnormalities in anorexia nervosa

A

Hyponatraemia, hypokalaemia, metabolic alkalosis

​MAY PRESENT AS ASYMPTOMATIC HYPOGLYCAEMIA DUE TO RESERVE

25
Q

ECG abnormality in anorexia nervosa

A

Prolonged Q-T interval, arrhythmias, bradycardia

26
Q

Physical signs in bulmia nervosa

A
  1. Pitted teeth
  2. Calluses on knuckles (Russell’s sign)
  3. Enlarged salivary glands
  4. Hoarse voice
27
Q

Blood abnormalities in bulimia nervosa

A

Renal dysfunction, electrolyte abnormalities from diuretics

Metabolic alkalosis from vomiting

Colonic hypomotolity from laxatives

28
Q

Psychiatric differential for anorexia

A
  1. Depressive disorder
  2. OCD
  3. Body-dysmorphic disorder
  4. Substance misuse
29
Q

Physical differential for anorexia

A
  1. IBD, IBS
  2. Diabetes insipidus/mellitus
  3. Hypopituitarism
  4. Pituitary brain tumour (headache + non-induced vomiting)
  5. Cancer
  6. Malabsorption syndromes
  7. Amphetamine use
30
Q

Differential for bulimia

A
  1. Binge-eating disorder
  2. Atypical depression (psychogenic overeating)
  3. Anorexia nervosa
  4. Medical causes of vomiting
31
Q

Short-term management of anorexia nervosa

A
  1. Physical + psychosocial assessment –> assess immediate risk to consider admission to hospital
  2. If moderate anorexia –> secondary care referral
  3. Slowly begin refeeding –> monitor electrolytes prior to refeeding and regularly to avoid refeeding syndrome
    1. Use Pabrinex, multivitamin supplements
  4. Agree on goals/need for treatment to work towards
    1. aim for 0.5-1kg weight gain per week
  5. Psychoeducation + self-help resources
32
Q

Long-term management of eating disorders

A

CBT

Family therapy (esp in adolescents)

Regular physical monitoring (electrolytes, height, weight, dental review)

Use of nutritional supplements (e.g. multivitamins)

Monitor drugs (esp for prolonged Q-T)

Weight gain 0.5-1kg per week) –> improves psychopathology

Consider SSRI (for BN/BED, or comorbidity)

33
Q

Risk factors for refeeding syndrome

A

Low initial electrolytes

BMI <13

Significant comorbidity (intercurrent infection, alcoholism, uncontrolled diabetes, cardiac failure)

34
Q

Criteria for considering admission to hospital for AN

A
  1. Risk of suicide/severe self-harm
  2. Home environment impedes recovery
  3. Rapid weight loss, BMI <15
  4. Bradycardia, hypoglycaemia, severe intercurrent infeciton, pronounced oedema, electrolyte abnormalities
35
Q

Components of hospital management of severe eating disorder

A
  1. Medical: life-saving treatment, refeeding + avoid refeeding syndrome, manage complications
  2. Psychological: intensive individual, family, and group therapy
36
Q

Treatment of bulimia nervosa

A
  1. Self-help programmes
  2. CBT: Break vicious cycle between bingeing, purging + preoccupation with weight + shape
  3. interpersonal therapy (emphasises the role of relationships, takes longer)
  4. Trial of fluoxetine (high doses needed, 60mg)
37
Q

Success rate of CBT in bulimia

A

60-70% disease-free at 5 years

38
Q

Prognosis for BN

A

30% residual symptoms at 10y

Evidence unclear

39
Q

Poor prognostic factors for bulimia

A

Low self-esteem

premorbid hildhood obesity

Co-morbid personality disturbance

long duration prior to prersentation

40
Q

Poor prognostic factors in anorexia

A

Long duration prior to presentation

Adult onset (20-29)

Severe weight loss (ost prognostic)

Vomiting/purging subtype

41
Q

10-year mortality of anorexia nervosa

A

10-20%

60% due to starvation (mainly cardiac failure due to dilation/thin walls, reversible with weight gain)

27% due to suicide

42
Q

Anorexia red flags that raise risk

A
  1. BMI <13
  2. ECG: Long Q-T or flattened T-waves
  3. Skin: purpura
  4. Vascular: BP <80/50, pulse <40, Sats <92%
  5. Temperature <34.5
  6. Wt loss >1kg/week
  7. Electrolyte abnormalities
  8. Proximal myopathy (not using arms for leverage unable to get up
43
Q

Signs of refeeding syndrome

A
  1. Falling PO4, K+, Mg2+
  2. Falling BP
  3. Rhabdomyolysis
  4. Cardiac/respiratory failure
  5. Arrhythmias
  6. Seizures
44
Q

Prognosis for anorexia nervosa

A

1/3 complete recovery

1/3 partial recovery

1/3 chronic illness

0.5% mortality per year

45
Q

Psychosocial assessment in suspected eating disorder

A
  1. Motivation to change eating habits
  2. Causes of eating habits
  3. Views on consequences of eating habits
  4. Suicide risk
  5. Psychiatric comorbidities: Depression, OCD, anxiety
46
Q

Physical assessment in suspected eating disorder

A
  1. Height + weight
  2. Core body temperature
  3. Cardiovascular incl. postural drop
  4. Muscle power
  5. Skin signs
47
Q

Questions to ask about weight control behaviours

A
  1. Typical day’s dietary intake
  2. Exercise: type and frequency
  3. Induced vomiting
  4. Laxatives, diuretics (incl. coffee), amphetamines
  5. Binges: loss of control + feelings afterwards
48
Q

Questions to ask about attitude to weight + shape

A
  1. Current weight + frequency of weighing behaviour
  2. How do you feel about your body shape/weight?
  3. How would you feel if you were a size bigger?
  4. Do you think you’re fat?
  5. Have other people said you’re thin? Do you believe them
49
Q

Screening questions for eating disorder

A

SCOFF (>2=further assessment)

  • Do make yourself SICK?
  • Do you feel like you’ve lost CONTROL of your eating?
  • Have you lost more than ONE stone (6-7kg) in the last 3 months?
  • Do you think you’re FAT even when others tell you you’re thin?
  • Do you often think about FOOD?
50
Q

Anorexia nervosa subtype with worse mortality

A

Binge-purging

51
Q

Co-morbidity in AN

A

40-60% depression

Also anxiety, OCD, PD

Psychiatry (20 decks)

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