Eating disorders Flashcards
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?
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
- BMI <17.5
- Self-induced weight loss
- A morbid fear of fatness
- Endocrine dysfunstion (eg amenrrhoea)
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
Symptoms of anorexia nervosa
- Excessive weight loss
- Weakness and fatigue
- Cold intolerance
- Cold (blue) peripheries
- Bradycardia, hypotension
- Primary or secondary amenorrhoea
- Thin lanugo hair over face and body
- Inability to perform squat test
- Short stature
- Osteopenia, osteoporosis
Complications of anorexia nervosa
- Death
- Endocrine dysfunction (eg amenorrhoea)
- Metabolic alkalosis - from excessive vomiting
- Metabolic acidosis - from laxative abuse
- Cardiac complications - arrhythmias and QT prolongation that may lead to sudden death
- Refeeding syndrome
- Electrolyte abnormaities
- Anaemia
- Proximal myopathy
Electrolyte abnormalities resulting from anorexia nervosa
Hypokalaemia, hyponatraemia, hypoglycaemia, hypocalcaemia, hypercholesterolaemia.
Refeeding syndrome
Results in hypophosphataemia which can lead to:
- rhabdomyolysis
- arrhythmias
- respiratory failure
- convulsions
- coma
- death
Investigations for anorexia nervosa and bulaemia nervosa
- BMI
- Bloods
- FBC, U&E, LFTs, TFTs, glucose
- calcium levels
- ECG
- Blood pressure
- Toxicology report if indicated
Treatment for anorexia nervosa
- CBT
- Correction of electrolyte imbalance
- Restore healthy weight
- Urgent situations may require refeeding under the mental health act
What is the first line medication for an eating disorder?
Olanzapine
ICD-10 criteria for bulimia nervosa
- Patient engages in binge eating
- Evidence of purgative behaviour (eg vomiting to counteract effects of binge eating) - minimum of 2 times per week for 3 months
- A morbid fear of fatness
Causes of bulaemia nervosa
Similar to anorexia nervosa
- Genetic - family history of bularmia nervosa
- Neurohormonal
- Psychosocial - adverse life events, perfectionist personalities, past dieting behaviour, anorexia nervosa, personality disorders particularly borderline personality disorder, low self esteem and depression
Signs of bulimia nervosa
Signs of induced purging:
- Russell’s sign
- Tooth enamel that is pitted/eroded
- Enlarged parotid glands
- Oesophageal tears
Signs of electrolyte imbalance:
- Cardiac arrhythmias
- Hypokalaemia - associated with vomiting as well as laxative abuse
Treatment for bulimia nervosa
- CBT
- Correction of electrolyte imbalances
- Antidepressants have been shown to decrease purgative behaviour
- Urgent situations are less common than for anorexia nervosa since patients are often of normal weight
