Eating disorders Flashcards
Prevalence of eating disordrs
In populations of young women:
- anorexia nervosa - 0.28%
- bulimia nervosa - 1%
- partial syndromes - up to 10%
In men < 10% of female prevalence
Screening tool for eating disorders
SCOFF Questionaire
- Do you make yourself Sick because you feel uncomfortably full?
- Do you worry you have lost Control over how much you eat?
- Have you recently lost more than One stone (14 pounds or 6.35 kg) in a three month period?
- Do you believe yourself to be Fat when others say you are too thin
- Would you say that Food dominates your life?
2 or more - likely case
How do patients with anorexia nervosa lose weight?
- Restrict intake
- Compulsive compensatory behaviours when food cannot be avoided
- self induced vomiting
- laxative abuse
- excessive exercise
- abuse of appetite suppressants / diuretics
ICD-10 criteria for anorexia nervosa
- Body weight: <15% below expected or BMI <17.5
- Self-induced weight loss
- restiction of eating (+1 of the following)
- self induced vomiting, laxative abuse, excessive exercise, abuse of appetite suppressants/diuretics
- Body image distortion - dread of fatness
- Endocrine dysfunstion (eg amenrrhoea in women, loss of sexual intrest and potency in men)
Causes of anorexia nervosa
Complicated interaction between genetics, neurohormonal and psychological factors:
- Genetic - familiy history of anorexia nervosa
- Neurohormonal - abnormalities in serotonin metabolism
- Psycosocial - adverse life events, perfectionist personalities, high achieving families, media expectations of thinness relating to the ideal female form
Warning signs of anorexia nervosa
- Avoiding meals
- Eating in secret
- Leaving the table after eating
- Daily exercise
- Low calorie foods
- Intolerance of disruption to daily activities
- Reads food lables constantly
Physical complications of anorexia nervosa
- Emaciation, cold extremities, lanugo
- Slow pulse, hypotension
- Anaemia, leukopenia
- Hypothermia
- Osteroporosis
- Electrolyte inbalances, cardiac arrhythmias
- Oedema
- Constipation
- Amenorrhoea, infertility
- Refeeding syndrome
Electrolyte abnormalities resulting from anorexia nervosa
Hypokalaemia, hyponatraemia, hypoglycaemia, hypocalcaemia, hypercholesterolaemia.
What is refeeding syndrome?
Refeeding syndrome is a complication that occurs when a previously malnourished patient receives adequate nutrition.
Reintroduction of nutrition, particularly carbohydrates, causes insulin release and increased cellular uptake of phosphate, potassium and magnesium.
In this context, hypokalaemia and hypophosphataemia can provoke life threatening arrhythmias.
Investigations for anorexia nervosa
- BMI
- Bloods
- FBC (everything low), U&E, LFTs, TFTs, glucose
- calcium levels
- ECG
- Blood pressure (low, postural hypotension), HR (bradycardic), temperature (low)
- Toxicology report if indicated
Anorexia nervosa managment in primary care
- Stabilise weight
- Moniter food intake with a diary
- Education including nutrition
- Assess mood
- Advice to family
- Concentrate on all health aspects
Anorexia nervosa - when to refer for specialist help
- rapid weight loss
- BMI <16
- marked vomiting / laxative abuse
- physical complications eg hypotension
- simple interventions have failed
- when depression is marked
What is the first line medication for anorexia nervosa?
Olanzapine - to get them into recovery, not long term
Psychological treatment used for anorexia nervosa
Family approaches
ICD-10 criteria for bulimia nervosa
- Persistent food craving, pre-ocupation and binge eating
- Compensatory behaviours eg self induced vomiting, laxative abuse, excessive exercise, abuse of appetite suppressants/diuretics (to counteract effects of binge eating) (minimum of 2 times per week for 3 months)
- A morbid fear of fatness
