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PSYCHIATRY > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

What is the criteria for Diagnosing Anorexia Nervosa?

A
  • BMI <17.5
  • SELF-INDUCED WGT loss (strict dieting, vomiting, excessive exercise,meds)
  • body image disturbance
  • fear of FATNESS
  • amenorrhoea for MORE than 3 Months
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2
Q

What should be considered when diagnosing a pt with an eating disorder?

A

-a pt may come in WITHOUT falling into the criteria of anorexia nervosa, BUT they may well be EXPERIENCING an eating d.o ( starving themselves, may still be plump)

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3
Q

What is the importance of not dxing a pt with an eating disorder without solely looking at their BMI?

A
  • anorexia nervosa is a SECRETIVE condition

- recognizing that it is an eating disorder allow medical intervention to occur well before the BMI drops really low

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4
Q

WHat makes some individuals more vulnerable to Anorexia Nervosa than others?

A
  • some are genetically inclined

- some have VULNERABLE to environmental triggers

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5
Q

What are the physical features of Anorexia Nervosa?

A
  • muscle wasting
  • lanugo hair , hair loss
  • cold, blue peripheries
  • dry skin
  • hypercarotenaemia
  • bradycardia, hypotension,
  • bruising
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6
Q

What shoudl you search for during psychological assessment of anorexia nervosa?

A
  • Depression
  • OCD
  • SUBSTANCE MISUSE
  • DM
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7
Q

What are the benchmarks for those at HIGH risk?

A
  • BMI< 13
  • wgt loss >1kg/week
  • prolonged QT, HR <40
  • systolic BP <80
  • core temp. <34*C
  • cognitive impairment
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8
Q

What is one test that can be performed for assessing the severity of Anorexia Nervosa?

A
  • ask pt to rise from SQUAT
    (without using arms for leverage)

3: ABLE, no difficulty.
2: ABLE, with some DIFF.
1: able only USING HANDS

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9
Q

What investigations can be performed on an Anoxieria nervosa patient?

A
  • hematology
  • biochem.
  • ECG
  • DXA (bone density)
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10
Q

What lab abnormalities would be seen in anorexia nervosa?

A
    • hypoglycemia
  • Leukopenia
  • elevated liver enzymes
  • EUTHYROID sick syndrome (Low TSH, normal T3 and T4)
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11
Q

What is refeeding syndrome?

A

-the FATAL shifts in FLUIDS and ELECTROLYTES that may occur in MALNOURISHED patients after artificial feeding

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12
Q

How does the refeeding $ develop?

A
  • shift from FAT to carbohydrate metabolism
  • > glucose load will evoke a INSULIN release; triggers incr. CELLULAR uptake of glucose, K, PO-, Mg. ( further depletion of INADEQUATE stores of nutrients)
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13
Q

How to prevent refeeding $?

A
  • by frequent BLOOD monitoring
  • freq. ECG monitoring to avoid fatal arrhythmias
  • slow pace of initial feeding
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14
Q

What are the risks of refeeding syndrome?

A
  • body-fluid imbalances, vit. deficiency, electrolyte disturbances> FATAL CARDIOPULMONARY dysfxn
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15
Q

What specific management is set up for those with Anorexia Nervosa?

A
  • MARSIPAN (managem. of really SICK pts with anorexia nervosa)
  • RCPsych, RCPhysicians
  • AIM: TO REDUCE the mortality of starved pts
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16
Q

What psychological forms of management is available for AN pt??

A
  • CBT
  • dietitian
  • medical monitoring
  • art therapy
  • family therapy
  • InPATIENT rx
17
Q

How is Bulimia Nervosa diff?

A
  • persistent preoccupation with eating
  • IRRESISTIBLE craving for food
  • BINGES
  • attempts to COUNTER effects of binges (staarving, vomiting, laxatives, drug misuse)
  • MORBID DREAD of fatness
  • body dysmorphic $
18
Q

What is seen on physical assessment?

A
  • calluses on knuckles (from forcing fingers down the throat)
  • parotid HYPERTROPHY (excessive salivation post every vomitting sesh)
  • dental caries (ENAMEL erosion)
    • cardiomegaly
  • U &Es
19
Q

What should BN pts be screened for?

A
  • depression
  • self harm
  • substance misuse
  • impulsive personality
20
Q

What are medical complications of BN?

A
  • esophageal reflux/ tears/ ruptures
  • hypokalaemia
  • subconjunctical hemorrhage
  • dehydration
  • seizures (metabolic imbalance)
21
Q

How to manage BN?

A
  • guided self help
  • CBT
  • SSRI
22
Q

What ECG findings are seen with anorexia nervosa and bulimia nervosa?

A
  • LOW voltage
  • Prolonged QT interval
  • Brady cardia
23
Q

What lab abnormalities are seen with BULIMIA NERVOSA?

A
  • hypochloremic
  • hypokalemic
  • metabolic acidosis (from LAXATIVES and DIURETICS)
  • elevated salivary AMYLASE (also seen in the purging subtype of ANOREXIA nervosa)
24
Q

What is seen from medical HX of bulimic pt?

A
  • bloating
  • fullness
  • GERD
  • lethargy
  • abdominal pain
  • sore throat

PSYCHIATRY (32 decks)

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