Eating Disorders Flashcards
What is the primary shared feature between anorexia nervosa and bulimia nervosa?
Preoccupation with own weight and excessive self-evaluation based on weight / shape
Who is most likely to develop an eating disorder with regards to race, SES, upbringing, and sex? Has the prevalence changed?
Prevalence has been increasing over the past 50 years
Race - White
SES - middle / upper class
Upbringing - Sexually abused or negative feelings about body at puberty
Sex - Female
Who is most likely to develop AN or BN:
Patient A: Family was chaotic, conflicted, and critical.
Patient B: Family was overly controlling, organized, and weight concerned.
A: Bulimia nervosa-> under-controlled and mood-labile patients
B: Anorexia nervosa -> anxious, inhibited, over-controlled, and OCD type patient.
What three psychiatric comorbidities are very common with anorexia nervosa?
- Depression
- OCD - anorexia was once thought to be part of OCD spectrum
- Personality disorders
What personality disorders are associated with anorexia nervosa?
Avoidant & Obsessive-Compulsive Personality Disorder
What personality disorders are associated with bulimia nervosa?
Avoidant & Borderline Personality Disorder
What is a common, severe CNS finding in eating disorders? What drug is contraindicated because of this?
Seizures - bupropion
What is the most common cause of death in eating disorders?
Cardiac arrythmias due to electrolyte imbalance
What are Lanugo and Russell sign?
Lanugo - fine, babylike hair which typically occurs in anorexia
Russell sign - callouses on dorsal hand due to self-induced vomiting (purging-type anorexia, or bulimia)
What is a common bone finding in anorexia?
Osteoporosis - can lead to metatarsal stress fractures
What reproductive / hormonal changes occur in anorexia?
Low LH / FSH / TSH leads to hypothyroid symptoms as well as amenorrhea
What are the oral manifestations of bulimia?
erosion of teeth enamel and decay
What metabolic effects are seen from vomiting in bulimia and purging-type anorexia?
Hypokalemic, hypochloremic alkalosis
- > increased HCl excretion in vomit leads to increased bicarbonate uptake in the kidney to compensate for loss of Cl-
- > less H+ is able to be exchanged for K+, so not as much K+ can be reabsorbed
What are the DSM general criteria for AN?
- Restriction of energy intake leading to low body weight or less than minimally expected for children
- Intense fear of gaining weight
- Disturbed view of own weight / shape
What are the two subtypes of AN?
- Restricting type -> no binging and purging for last 3 months, just calorie restriction
- Binge-eating / Purging type -> engage in binge-eating / purging during last 3 months
People can alternate between these two
How does Binge-eating / purging subtype of AN differ from bulimia?
Bulimia is not associated with a decreased overall weight and an intense fear of weight gain
What types of anorexia nervosa patients have the best prognosis?
Younger patients with prompt treatment
-> neural rewiring has not yet taken place
Close to ideal body weight upon leaving hospital
What is the primary safety concern of anorexia?
High rate of suicide
What is the initial treatment for AN and what should be avoided?
Gradual weight restoration -> try to return to normal weight before discharge
+
Cyroheptadine - antihistamine and anti-5HT to increase apetite
Avoid:
Refeeding syndrome - increased insulin upon introduction of carbohydrates in feeding leads to hypophosphatemia (glucose-6-phosphate formation) and cardiac arrhythmias. GO SLOWLY
SSRIs - until weight is restored
What medications are indicated for maintenance of AN remission?
SSRIs
Cyproheptadine (for appetite)
Atypical antipsychotics
What are the diagnostic criteria for bulimia nervosa?
- Recurrent binge eating with lack of self control
- Recurrent inappropriate compensatory behavior
- > could be vomiting, but often only laxatives, enemas, diuretics, meds, or even excessive exercise - Behavior must average at least 1x per week for 3 months
- Negative self-evaluation on body shape / weight gain
What are the subtypes of BN?
- Purging type -> self-induced vomiting or use of laxatives as compensatory behaviors
- Nonpurging type -> Other inappropriate compensatory behaviors like fasting and excessive exercise are used
How do onset and weight differ between BN and AN?
Onset - Anorexia is earlier
Weight - Anorexia is <85% expected for height, bulimia is normal or near-normal weight
How is management of bulimia nervosa different than anorexia nervosa?
- Most patients can be managed as outpatients rather than inpatients, with same emphasis on therapy and SSRI / antipsychotic use.
- Bulimia patients should NOT be given cyproheptadine since their appetite is normal (vs AN)
