Eating Disorders Flashcards
True or False - EDs have the highest mortality rate out of all mental illness
True
what is the gender split for eating disorders
F>M 10:1
When is the peak age for eating disorder presentation
adolescence
Aetiology for eating disorders
hypothalamic dysfunction perfectionism decreased self-esteem early sexual development history of abuse personality disorder parental overprotection
How do you assess a suspected eating disorder
Establish eating behaviour - method of weight loss, daily intake, relationship with body image, binge eating
Medical history - specifically: menstrual history, sexual dysfunction, starvation complications, digestive complications, known physical illness
Personal /social history - past abuse + context, bullying, bereavements, major change at home or school, and the effect of the behaviour on school, home life, relationships, socialising, hobbies and careers
How do you Diagnose anorexia
<15% expected weight OR BMI <17.5
Weight loss is self-induced via avoidance of ‘fattening’ foods, as well as 1 or more of: purging, excessive exercise, use of appetite supplements, diuretics
Body image distortion with an intrusive, overvalued idea of becoming/being fat, resulting in the patient imposing a low weight barrier on themselves
Widespread endocrine disorder involving the hypothalamic-pituitary-gonadal axis resulting in: amenorrhoea in women and sexual impotence in men
if pre pubertal: delayed development
How do you diagnose Bulimia
Persistent occupation with eating and irresistible craving for food resulting in binge eating sessions
Patient attempts to counteract with one or more of self induced vomiting appetite suppressants voluntary starvation in diabetics - insulin neglect
Morbid dread of obesity
Differentials for an eating disorder
Hyperthyroidism Depression OCD Body dysmorphic disorder Psychosis
Prognosis for anorexia
slow
1/3 in 3 years
2/3 in 3-6 years
>15 years of no recovery = far less likely to recover
What is the 10-year mortality for anorexia
10%
Poor Prognosis indicators for anorexia
very low weight bulaemic features family difficulty personality diffiulty longer illness duration
Prognosis for bulimia
70% recover in 10 years
1% mortality
Poor prognostic indicators for bulimia
low weight and depression
What are some common comorbidities for eating disorders
Anxiety
Depression
Self-harm
What are some hair-related consequences of anorexia
brittle-thin hair lanugo hair (fine baby hair) on face/body
What are some psychological consequences of anorexia
Poor concentration
Inflexible thinking
interest centers on food
irritated mood
What are some cardiovascular consequences of anorexia
decreased BP/HR
increased risk of arrythmia
increased risk of Heart failure
What are some bone-related consequences of anorexia
osteoporosis
what are some endocrine/GU related consequences of anorexia
decreased libido
decreased testosterone
amenorrhoea
what are some fat-related consequences of anorexia
cold extremities
broken skin
swollen feet/ankles
What are some miscellaneous consequences of anorexia
hypothermia
increased infection risk
hematological disturbances
metabolic disturbance
what are some CNS consequences of bulimia
Poor concentration
irritability
seizure (electrolyte imbalance)
What are some oropharyngeal consequences of bulimia
Tooth decay
hoarse voice
mouth/throat bleeding
swollen parotid
cardiovascular consequences of bulimia
hypokalaemia leading to arrythmia
abdominal consequences of bulimia
swollen stomach stomach pain constipation delayed gastric emptying oesophageal tears oesophagitis rectal prolapse renal failure UTI
hand consequences of bulimia
Russels’s sign - callosing of the knuckles due to repeated grazing when purging
feet and ankles consequences bulimia
swollen feet/ankles
cold extremities
miscellaneous consequences of bulimia
Dehydration
Electrolyte imbalance
Muscle paralysis
BioPsychoSocial Management of eating disorders
BIO Weight restoration key Dietician necessary to prevent refeeding syndrome regular weight monitoring Regular bloods and ECG DEXA scan
Psycho
Specialist psychotherapy services
Family therapy if <18 years old
<13 BMI = psychological therapy unlikely to work
Social
carer support
inclusion In social plans
what blood monitoring is recommended in underweight patients
BMI >16 FBC, U+E glucose LFT
BMI <15 same as above + phosphate, magnesium, CK, zinc, B12, folate
What are you looking for on an ECG for underweight patients
QTc prolonging
arrythmia
rate <50
heart block
what do derranged bloods indicate for eating disorder patients
general medical ward admission
what is refeeding syndrome
chronic depletion of serum insulin/electrolytes(especially phosphate)/glucose/intracellular phosphate
then food is induced causing an insulin spike as well as increased serum glucose and electrolytes
this insulin spike drives even more phosphate into the cells leading to extremely low serum phosphate (along with many other vitamins and electrolytes) leading to a variety of life threatening pathologies, including multi-organ failure
