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Psychiatry > Eating disorders > Flashcards

Eating disorders Flashcards

1
Q

Anorexia is the most common eating disorder - True or False?

A

False

Obesity is the most common eating disorder

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2
Q

What are the ICD-10 diagnostic criteria for Anorexia Nervosa?

A
  1. BMI <17.5
  2. Morbid fear of Fatness
  3. Distortion of body image
  4. Self induced weight loss (purging, laxative, excessive excercise, avoid eating)
  5. Amenorrhea (due to weight loss)
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3
Q

What are the physical consequences of anorexia nervosa?

A
  1. Sensitivity to cold
  2. Constipation
  3. Hypotension and bradycardia
  4. Amenorrhea
  5. Hypokalaemia and Alkalosis
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4
Q

Epidemiology of anorexia nervosa

A

Age: usually begins in adolescence

Gender: 10F:1M

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5
Q

Aetiology of Anorexia Nervosa

A

Genetic

Hormonal - reduced sex hormones secondary to malnutrition can be reversed by re-feeding.

Psychological - history of faddish diets, low self-esteem, family problems

Social media

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6
Q

Physical assessment in an Anorexic patient

A 
Muscle wasting, hair loss 
Lanugo hair
Cold, blue peripheries
Dry skin
Hypercarotenaemia 
Bradycardia, hypotension
Bruising
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7
Q

Co-morbidities with Anorexia

A 
Anxiety
Depression
OCD
Substance misuse
DM
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8
Q

Risk assessment of Anorexia Nervosa

A

BMI <13, weight loss >1kg/week

Prolonged QT, HR <40, systolic BP <80

Core temp < 34

Unable to rise from squat without using arms for leverage

Cognitive impairment

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9
Q

Investigations in Anorexia Nervosa

A

Heamatology
Biochemistry
ECG
DXA

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10
Q

Complications of anorexia

A

Dental: caries, enlarged parotid glands

GI: abdo discomfort, indigestion and bloating, oesophageal and gastric tears (secondary to vomiting)

oedema and dehydration

Neuro: peripheral paraesthesia, tetany or seizures (secondary to nutritional deficiencies)

Renal: renal damage secondary to chronic hypokalaemia

Hepatic: Raised LFT and liver failure

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11
Q

Treatment of Anorexia Nervosa

A

Conduction on outpatient basis except in presence of complications

Family Based Treatment: first line in adolescents

CBT

Interpersonal Therapy

Restoring weight to ideal level - refeeding

Multivitamin supplements

Oestrogen patches

Re-feeding -aimed at gaining 0.5-1kg/week

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12
Q

What is re-feeding syndrome?

A

Potentially fatal shifts in fluid and electrolytes in malnourished patients undergoing rapid re-feeding

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13
Q

Risk factors for re-feeding syndrome

A 
Very low BMI
Little/no nutritional intake for several days
Alcohol and substance misuse
Diabetes
Elderly
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14
Q

Hallmark of re-feeding syndrome

A

Hypophosphataemia

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15
Q

Features of re-feeding syndrome

A 
hypophosphataemia
hypokalaemia
hypomagnesemia 
Abnormal fluid and sodium balance 
Changes in fat, glucose and protein
Thiamine deficiency
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16
Q

Symptoms of re-feeding syndrome

A

Oedema - gain upto 1kg/day

cute gastric dilation- vomiting and abdominal pain and distention

17
Q

How to prevent refeeding syndrome? (NICE)

A

Thorough nutritional assessment before re-feeding is started

Plasma glucose, magnesium, phosphate, potassium and sodium should be monitored at baseline

Electrolytes should be monitored once daily for one week, and at least three times the following week

Oral, enteral or parenteral supplements should be given before refeeding (unless blood levels are high)

Vitamin supplementation should be started immediately before re-feeding and continued for the first 10 days

18
Q

What is bulimia nervosa?

A

Episodes of binge eating accompanied by means of losing weight (self induced vomiting, misuse of drugs)

19
Q

Clinical features of bulimia nervosa

A

Complications of vomiting:

  • cardiac arrythmias
  • renal impairement
  • Muscular pralysis
  • tetany - from hypokalaemic alkalosis
  • Swollen salivary glands
  • eroded dental enamel
  • fluctuation of body weight within normal limits
  • irregular periods (amenorrhea rare)
20
Q

Diagnostic criteria of bulimia nervosa (ICD10)

A 
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
21
Q

Physical assessment of Bulimia Nervosa

A

Calluses on knuckles (Russell’s sign)

Parotid hypertrophy

Dental caries

U & Es

22
Q

Co-morbid psychiatric disorders of bulimia

A

Depression
Self harm
Substance misuse
Impulsive personality

23
Q

Medical complications of Bulimia nervosa

A 
Oesophageal reflux
Oesophageal tears/rupture
Hypokalaemia
Subconjunctival haemorrhage
Dehydration
Seizures – metabolic abnormalities
24
Q

Management of Bulimia Nervosa

A

Guided self-help
CBT
SSRI (fluoxetine, high doses)

Psychiatry (15 decks)

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