Eating Disorders Flashcards
What is included in the ICD-10 criteria for a diagnosis of anorexia nervosa?
- Body weight <85% of predicted OR BMI <17.5
=> (BMI used more for adults than children) - Self-induced weight loss (strict dieting, vomiting, excessive exercise etc)
- Morbid dread/Fear of fatness
- Late onset puberty/Amenorrhoea
- Sexual dysfunction
What would be seen on physical examination of a patient with anorexia nervosa?
Muscle wasting hair loss/Lanugo hair (thin, soft, unpigmented) Cold, blue peripheries Dry skin Hypercarotenaemia Bradycardia, hypotension Bruising
During a psychological assessment of a patient with anorexia nervosa, what other conditions should be checked for?
Depression
OCD
Substance misuse
Diabetes mellitus
What would be considered “High Risk” on a risk assessment of a patient with anorexia nervosa?
BMI < 13.0 Weight loss >1kg/week Prolonged QT HR<40, Systolic BP < 80 Core temp < 34C Unable to rise from squat without using arms for leverage Cognitive impairment
What investigations are usually carried out in suspicion of anorexia nervosa?
Haematology
Biochemistry
ECG
DEXA
What medical complications can occur as a result of anorexia nervosa?
Cardio GI Renal Endocrine MSK Dental Skin and hair Metabolic
What is refeeding syndrome?
- depletion of already inadequate stores of nutrients e.g. Mg, K, PO4
- these are quickly used up as body starts to repair itself
How is refeeding syndrome treated?
- frequent blood monitoring
- slow pace of initial refeeding
What is MARSIPAN and what are its aims?
Management of Really Sick Patients with Anorexia Nervosa
•Combination of RCPsych and RCPhysicians
•Aim to reduce mortality of starved patients admitted to medical wards
What psychological management is often used for patients with eating disorders?
CBT Dietitian = meal planning Art therapy/drama therapy Family therapy Inpatient treatment if high risk
What is the ICD-10 criteria for bulimia?
Persistent preoccupation with eating Irresistible craving for food Binges Attempts to counter the effects of binges (starvation, vomiting, laxatives, drug misuse) Morbid dread of fatness
What can be found on physical examination of a patient with bulimia?
Calluses on knuckles (Russell’s sign)
Parotid hypertrophy
Dental caries
What other conditions should be looked out for in a psychological assessment of a patient with bulimia?
Depression
Self harm
Substance misuse
Impulsive personality
What medical complications can occur as a result of bulimia?
Oesophageal reflux Oesophageal tears/rupture Hypokalaemia Subconjunctival haemorrhage Dehydration Seizures – metabolic abnormalities
How is bulimia usually managed?
Guided self-help
CBT
SSRI
Where are patients referred to if they are EXCEEDINGLY unwell?
GI ward in Ninewells
When is weighing used in treatment of eating disorders?
Used early in treatment to get patient to healthy weight, however used LESS once patient reaches this to stop the need for patient to weigh themself
Patients at a very low BMI can sometimes still function normally. TRUE/FALSE?
TRUE
can still be studying, exercising etc
HOWEVER must be careful as a small thing can cause rapid deterioration
How are patients fed in inpatient care during the extremes of their eating disorder?
NG tube
to help with refeeding syndrome
Patients with anorexia nervosa often experience a loss of interest in food. TRUE/FALSE?
FALSE
if anything these patients are preoccupied by food for much of the day
What is an overvalued idea and give an example of how this may present in a case such as anorexia nervosa?
Between an obsessive thought (like in OCD) and a delusion
- slightly closer to a delusion as patients often have evidence to contrary
e.g. In Anorexia Nervosa, patients have overvalued idea that they are fat, despite evidence of their low weight/BMI
