Eating disorders Flashcards
What are the three eating disorders described by the ICD-10?
Anorexia nervosa
Bulimia nervosa
Eating disorder not otherwise specified
What are the defining features of anorexia nervosa vs bullimia nervosa according to DSM-V?
ANOREXIA NERVOSA
BMI<18.5
Core psychopathology
BULLIMIA NERVOSA
BMI>18.5
Core psychopathology
Regular binge/purge 1x/week
How many men and how many women does anorexia nervosa affect?
Men - 1 in 2000
Women - 1 in 250
What are some examples of core beliefs of those with anorexia nervosa ? (5)
Fear of fatness
Pursuit of thinness
Body dissatisfaction
Body image distortion - finding fat where there is none
Self evaluation based on weight and shape
What other psychopathologies are included in anorexia nervosa and how does this play into the disease?
Depression Anxiety Suicidal ideation OCD ***it is thought that starvation might cause some of these conditions
What questions would you ask to determine behaviours related to anorexia nervosa?
EATING HABITS
- Tell me what you eat on day to day
- Avoid certain foods?
- Drink a lot of water?
- Who do you eat with?
- How does eating make you feel?
THROUGHOUT THE DAY
- Are you aware of calories?
- Do you weigh yourself (ideal weight/ thoughts of current weight/how do you feel when you put weight on)
AFTER EATING
-Do you do anything to compensate for eating? (exercise/vomit)
-Do you take any laxatives after you eat?
-Do you take any medication to help you lose weight/manage hunger?
ARE YOU AWARE THAT THIS IS BAD FOR YOU
What kind of affect does starvation have on the CVS system?
starvation can cause hypotension, bradycardia, sudden death
What kind of affect does starvation have on Heam system?
Starvation can cause anaemia, thrombocytopenia and leukopenia
What kind of affects can the binging/purging nature of bulimia nervosa have on the CVS system?
binging/purging can cause arrhythmias, cardiac failure and sudden death
What kind of affects can the binging/purging nature of bulimia nervosa have on the other systems in the body?
Oligomenorrhoea
Impaired temperature regulation
Calluses on the dorsal of hands - RUSSEL’S SIGN
There is an imbalance of many hormones and substances in the body in anorexia nervosa , what is a good way of remembering which things are high and which are low?
Most things low
• Hypokalaemia
• Hypochloraemic alkalosis (both due to vomiting and/or diuretic/laxative abuse)
• Low WCC
•The erythrocyte sedimentation rate (ESR) is normal or reduced.
•Libido may decline in males due to hypogonadotrophic hypogonadism.
•low FSH, LH, oestrogens and testosterone
•low T3
apart from Gs and Cs
G - growth hormone, glucose, salivary Glands,
C- cortisol, cholesterol, carotinaemia
What is a good way to SCREEN for eating disorders?
SCOFF questionnaire
S - do you ever make yourself SICK after eating?
C - Do you every worry you have lost CONTROL over how much you eat/
O - Have you every lost more than ONE stone in any three month period?
F - Do you believe yourself to be FAT (when others say you’re thin)?
F - Would you say FOOD dominates your life?
***also always ask about physical symptoms
What investigations should be done in a patient with anorexia nervosa ? (3)
- Weight them and check BMI
- Ask about physical symptoms
- ECG (80% deaths in AN from cardiac arrest) - QTc prolongation
- Bloods
What blood test would you want to check for eating disorders?
FBC Us Es LFTs TFT Phosphate, Magnesium, Calcium, zinc glucose creatinine kinase
What is the prognosis for someone with anorexia nervosa ?
This is directly linked to their BMI If it is: <18.5 - confirmed AN <15 - moderate risk of death <13 - High risk of death
What are the principles of treatment for anorexia nervosa? (2)
Nutritional rehabilitation and psychological treatment
Fluoxetine has been shown to be useful in some cases of bulimia nervosa
What psychological therapies have been found to be useful for treating eating disorders?
- Guided self-help CBT model (keep a food diary, do structured eating and challenge ideas)
- Motivational enhancement sessions - usually 4-6 of them using the stages of change model to increase determination to change
What are the principles of re-feeding and dietetic management?
Always encourage them to see a dietician
- Make sure someone has adequate nutrition
- Replace what has been lost
-While waiting for dietician recommend
Carbohydrates with every meal
Fats - advise dairy 2-3X a day for fats, calcium and Vit D
Protein - for 2-3 meals a day for growth and repair and immune system repair
6-8 glasses of fluid per day for good hydration
-Re-feeding can occur under MHA if necessary but usually can happen as outpatient
Renal effects of binging/purging and starvation?
binging/purging AND starvation can cause Oedema, electrolyte abnormalities, renal calculi and renal failure
Effects of starving on GI system? (4)
starvation can cause:
- parotid swelling
- delayed gastric emptying
- nutritional hepatitis
- constipation
Effects of binging/purging on GI system? (3)
binging/purging can cause:
- parotid swelling
- dental or oesophageal erosion
- constipation
Endocrine effects of starvation?
Starvation can cause:
- Amenorrhoea
- infertility
- hypothyroid
What are the nuerological effects of starving and binging/purging?
binging/purging AND starvation can cause generalised seizures and confusional states
How does binging/purging and starvation affect skeletal system? (3)
Osteoporosis
Pathological fractures
Starvation specifically can cause short stature
Derm effects of BN and AN?
BULIMIA
-russels sign on nuckles
ANOREXIA
-luango hair and brittle nails
Endocrine effects of binging/purging?
binging/purging can cause irregular periods
metabolic effects of both binging/purging and starvation?
binging/purging AND starvation can cause;
- Impaired temperature regulation
- Hypoglycaemia (dizzyness/fainging)
What might you note on an ECG of a person with eating disorder?
○ T WAVE CHANGES due to hypokalaemia
○ BRADYCARDIA
○ QTc changes (prolongation)
What blood result would indicate vomiting?
Hypokalaemia (alkalosis)
What blood result would indicate water loading?
Hyponatraemia
What blood result would indicate Laxative misuse
hypokalaemia and hyponatraemia
What blood result would indicate diuretic misuse
hypokalaemia and hyponatraemia
What blood result would indicatethyroxine misuse
high T3/T4 low TSH
What blood results would you see in proximal myopathy?
High CK and High LFTs
What blood results would you see in bone marrow hypoplasia caused by eating disorders?
leukopenia and normocytic anaemia
What is first line treatment for children/young people with anorexia?
- anorexia focused family therapyis first-line treatment
- second-line treatment is cognitive behavioural therapy.
What are the NICE guidelines for managing ED?
NICE:
Anorexia 1st line: MANTRA
others: ED-CBT/ SSCM
Bulimia 1st line: CBT
other: IPT/fluoxetine 60mg/self help more useful in BN
