Eating Disorders Flashcards
1
Q
ICD-10 criteria for Bulimia Nervosa
A
- Recurrent episodes of overeating (twice a week for three months)
- Self perception of being too fat and intrusive dread of fatness
- Persistent preoccupation with food
- Attempts to counteract the “fattening” aspects of food by one of the following; self induced vomiting, purgative abuse, alternating periods of starvation, or use of drugs
2
Q
Management of Bulimia Nervosa for adults
A
- Consider bulimia nervosa focused guided self help for adults
- Bulimia nervosa focused guided self help programmes should use CBT self help materials for eating disorders and supplement the self help programme with brief supportive sessions
- If self help is unacceptable, contraindicated or ineffective after 4 weeks, consider individual eating disorder focused CBT (CBT-ED) which should consist of up to 20 sessions over 20 weeks and consider twice weekly sessions in the first phase which focuses on engagement and education, establishing regular eating and providing encouragement, advice and support followed by addressing psychopathology
3
Q
Management of Bulimia Nervosa for children and young people
A
- Offer bulimia nervosa focused family therapy - typically 18-20 sessions over 6 months, support and encourage the family to help the person recover, include information about regulating body weight, dieting, adverse effects of attempting to control weight via vomiting or other compensatory behaviours, support developing a level of independence and relapse prevention.
- If FT-BN is unacceptable, contraindicated or ineffective consider CBT-ED.
4
Q
ICD-10 criteria for Binge Eating Disorders
A
- Increasingly recognised as an accepted diagnosis characterised by regular binge eating
- Binge eating = 3/5 of the following;
- Eating much more quickly than usual
- Eating until uncomfortably full
- Eating a lot when not hungry
- Eating alone because of embarrassment
- Feeling very bad or guilty after eating
5
Q
Management of Binge Eating Disorder
A
- Offer binge eating disorder focused self help;
- Using CBT self help materials
- Focus on adherence to the self help programme
- Supplement the self help programme with brief supportive sessions
- If guided self help is unacceptable, contraindicated or ineffective after 4 weeks, offer group eating disorder focused CBT-ED
6
Q
ICD-10 criteria for Anorexia Nervosa
A
- Weight loss (or in children lack of weight gain), leading to a body weight at least 15% below the normal or expected weight for age and height
- Weight loss is self induced by avoidance of fattening foods
- Self perception of being too fat, which leads to a self imposed low weight threshold
- Widespread endocrine disorder involving the hypothalamic-pituitary-gonadal axis is manifest as amenorrhea or in men, loss of sexual interest and potency
- Other facts to note:
- M:F is 1:10
- 50% recover with treatment
- 5% mortality rate
7
Q
Atypical Eating Disorders
A
- Atypical eating disorders, also known as Eating Disorder Not Otherwise Specified (EDNOS), affect approximately half of all people with an eating disorder.
- An eating disorder is called atypical if they do not fit exactly into the diagnostic categories. For example a person may have most of the symptoms of anorexia or bulimia but not all; or they may have symptoms of both conditions; or they may move from one condition to another.
8
Q
Managment of an Atypical Eating Disorder
A
- In the absence of evidence to guide the management of atypical eating disorders (eating disorders not otherwise specified) other than binge eating disorder, it is recommended that the clinician considers following the guidance on the treatment of the eating problem that most closely resembles the individual patient’s eating disorder.
9
Q
Physical complications of Anorexia Nervosa
A
10
Q
Management of Anorexia Nervosa in adults
A
- For adults consider one of CBT-ED, Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), SSCM
- If CBT-ED, MANTRA or SSCM is unacceptable, try one of the others or eating disorder focused focal psychodynamic therapy
- Individual CBT-ED should:
- Consist of up to 40 sessions over 40 weeks with twice weekly sessions in the first 2-3 weeks
- Aim to reduce the risk to physical health and any other symptoms of eating disorder
- Encourage healthy eating and reach a healthy body weight
- Consider nutrition, cognitive restructuring, mood regulation, social skills, body image concern, self esteem and relapse prevention, create a personalised treatment plan, explain risks of malnutrition, enhance self efficacy, self monitoring of intake and thoughts and feelings, homework
11
Q
Management of Anorexia Nervosa in children and young people
A
- Consider anorexia nervosa focused family therapy for children and young people (FT-AN): give children and young people the option to have single and family sessions
- Typically 18-20 sessions
- Emphasise the role of family in helping them recover
- Psychoeducation about nutrition and malnutrition
- Establish a good therapeutic alliance with the person
- Latterly support the person to establish a level of independence
- Relapse prevention
- IF FT-AN is unacceptable, contraindicated or ineffective consider CBT-ED or adolescent focused psychotherapy
12
Q
Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN)
A
- Concerns that a number of patients with severe anorexia nervosa were being admitted to general medical units and sometimes deteriorating and dying
- Focus on patients with BMI<15
- Contains guidance for clinicians looking after MARSIPAN patients on acute medical wards and psychiatric wards, but also includes service recommendations e.g. most MARSIPAN patients should be admitted to a SEDU, treated by local expert physician with interest in nutrition/nutrition team
13
Q
Physical risk assessment and management in eating disorders
A
- BMI and rate of weight loss
- Cardiovascular risk (BP, pulse, ECG)
- Glucose level/albumin level
- Electrolyte abnormalities (low sodium, low potassium, altered eGFR)
- Liver function abnormalities
- Bone marrow abnormalities – low WCC, Hb, Platelets
- Low potassium in Eating Disorders signifies low total body K and hypokalaemia can recur soon after discharge from inpatient care with sometimes fatal results
14
Q
Criteria for patients at high risk of refeeding syndrome
A
- Criteria for determining high risk include:
- BMI less than 16kg/m2
- Weight loss greater than 15% within the last 3-6 months
- Little or no nutritional intake for more than 10 days
- Low levels of potassium, phosphate or magnesium prior to feeding
- History of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics
- The presence of purging behaviours, such as vomiting and /or laxative misuse
15
Q
Pathophysiology of refeeding syndrome
A
- In starvation the secretion of insulin is decreased in response to a reduced intake of carbohydrates.
- Instead fat and protein stores are catabolised to produce energy. This results in an intracellular loss of electrolytes, in particular phosphate.
- Malnourished patients’ intracellular phosphate stores can be depleted despite normal serum phosphate concentrations.
- When they start to feed a sudden shift from fat to carbohydrate metabolism occurs and secretion of insulin increases. This stimulates cellular uptake of phosphate, which can lead to profound hypophosphataemia.
- Can also lead to losses of potassium and magnesium.
- Causes fatigue, weakness, confusion, inability to breath, HTN, seizures, heart arrhythmias, coma and death.
