Eating Disorders

Question 1

What is included in the ICD-10 criteria for a diagnosis of anorexia nervosa?

Answer 1

• 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

Question 2

What would be seen on physical examination of a patient with anorexia nervosa?

Answer 2

Muscle wasting
hair loss/Lanugo hair (thin, soft, unpigmented)
Cold, blue peripheries 
Dry skin 
Hypercarotenaemia 
Bradycardia, hypotension 
Bruising

Question 3

During a psychological assessment of a patient with anorexia nervosa, what other conditions should be checked for?

Answer 3

Depression
OCD
Substance misuse
Diabetes mellitus

Question 4

What would be considered “High Risk” on a risk assessment of a patient with anorexia nervosa?

Answer 4

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

Question 5

What investigations are usually carried out in suspicion of anorexia nervosa?

Answer 5

Haematology
Biochemistry
ECG
DEXA

Question 6

What medical complications can occur as a result of anorexia nervosa?

Answer 6

Cardio
GI
Renal 
Endocrine 
MSK
Dental 
Skin and hair 
Metabolic

Question 7

What is refeeding syndrome?

Answer 7

• depletion of already inadequate stores of nutrients e.g. Mg, K, PO4
• these are quickly used up as body starts to repair itself

Question 8

How is refeeding syndrome treated?

Answer 8

• frequent blood monitoring

- slow pace of initial refeeding

Question 9

What is MARSIPAN and what are its aims?

Answer 9

Management of Really Sick Patients with Anorexia Nervosa
•Combination of RCPsych and RCPhysicians
•Aim to reduce mortality of starved patients admitted to medical wards

Question 10

What psychological management is often used for patients with eating disorders?

Answer 10

CBT
Dietitian = meal planning
Art therapy/drama therapy
Family therapy
Inpatient treatment if high risk

Question 11

What is the ICD-10 criteria for bulimia?

Answer 11

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

Question 12

What can be found on physical examination of a patient with bulimia?

Answer 12

Calluses on knuckles (Russell’s sign)
Parotid hypertrophy
Dental caries

Question 13

What other conditions should be looked out for in a psychological assessment of a patient with bulimia?

Answer 13

Depression
Self harm
Substance misuse
Impulsive personality

Question 14

What medical complications can occur as a result of bulimia?

Answer 14

Oesophageal reflux 
Oesophageal tears/rupture 
Hypokalaemia 
Subconjunctival haemorrhage 
Dehydration 
Seizures – metabolic abnormalities

Question 15

How is bulimia usually managed?

Answer 15

Guided self-help
CBT
SSRI

Question 16

Where are patients referred to if they are EXCEEDINGLY unwell?

Answer 16

GI ward in Ninewells

Question 17

When is weighing used in treatment of eating disorders?

Answer 17

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

Question 18

Patients at a very low BMI can sometimes still function normally. TRUE/FALSE?

Answer 18

TRUE
can still be studying, exercising etc
HOWEVER must be careful as a small thing can cause rapid deterioration

Question 19

How are patients fed in inpatient care during the extremes of their eating disorder?

Answer 19

NG tube

to help with refeeding syndrome

Question 20

Patients with anorexia nervosa often experience a loss of interest in food. TRUE/FALSE?

Answer 20

FALSE

if anything these patients are preoccupied by food for much of the day

Question 21

What is an overvalued idea and give an example of how this may present in a case such as anorexia nervosa?

Answer 21

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