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Psychiatry > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

What is anorexia nervosa?

A

Obsessive fear of fatness/weight gain, resulting in the restriction of intake plus a range of compulsive behaviours when food cannot be avoided, resulting in a body weight 15% below ideal body weight (<17.5)

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2
Q

What is the mortality rate of anorexia nervosa?

A

5-20%

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3
Q

What is the average length of recovery of anorexia nervosa?

A

Estimated at 6-7 years

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4
Q

Give risk factors for anorexia nervosa

A

Genetic predisposition/FH

  • OCD
  • Anxiety disorders
  • Depression

Perinatal factors

Life events and trauma

  • Neglect
  • Abuse
  • Difficult transitions
  • Death and losses
  • Separations and family breakup
  • Bullying

Perpetuating consequences of starvation and avoidance

Puberty

  • Physical effects of hormonal changes on the brain, also psychological response to body changes

Dieting or even non-deliberate weight loss

Increased exercise

Temperament

  • Perfectionism
  • Negative self-evaluation
  • Extreme compliance
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5
Q

Give symptoms and signs of anorexia nervosa

A

Cold intolerance

Blue hands and feet

Constipation: GI tract can’t handle normal meals

Bloating

Delayed puberty

Primary or secondary amenorrhoea

Dry skin

Fainting

Hypotension/orthostatic hypotension: Weak heart muscle

Lanugo hair

Scalp hair loss

Early satiety

Weakness, fatigue: Weak muscles, <rbc></rbc>

<p>Short stature</p>

<p>Osteopenia and osteoporosis </p>

<p>Difficulty breathing: Weak diaphragm</p>

<p>Bradycardia: Weak heart muscle</p>

<p>Damaged immune response</p>

<p>Easy bleeding and bruising: Low platelets</p>

<p>Halitosis: Bad breath from repeated vomiting </p>

</rbc>

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6
Q

What questionnaire is used for anorexia nervosa screening?

A

SCOFF

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7
Q

Give the questions used in the SCOFF questionnaire

A

If patients score 2 or more positive answers, then an eating disorder is likely:

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 in a three month period?

Do you believe yourself to be Fat when others say you’re too thin?

Would you say that Food dominates your life?

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8
Q

What investigations are used in anorexia nervosa monitoring?

A

Decreased Creatinine

  • Low muscle tissue

Electrolytes, re-feeding syndrome

  • Decreased K+
  • Decreased Mg+
  • Decreased Phosphate

FBC, bone marrow shut down

  • Decreased WBC
  • Decreased RBC
  • Decreased Platelets

Endocrine screen

  • Decreased FSH, LH, oestrogen, testosterone
  • Increased GH and cortisol
  • Decreased T3

Decreased Thiamine

BMI

Most low, Gs and Cs high

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9
Q

How can BMI be calculated?

A

Weight/Height^2

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10
Q

How is anorexia nervosa managed?

A

Re-feeding

Psychotherapy

  • CBT

Olanzapine

  • Stimulate appetite

Specialised family work for anorexia nervosa, particularly for younger patients

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11
Q

What behaviours are used to avoid calorie intake?

A

Diets

Not touching food or grease

Developing dislikes, pickiness, even allergies

Interpreting all symptoms as allergy or indigestion

Eating very slowly, or only eating at certain times

Avoiding parties and social occasions

Spoiling or messing of food, bizarre combinations

Refusing to eat more than the person who eats the least, rules about always finishing last etc

Medication abuse - appetite suppressants, including gum, cigarettes, alternative medications, OTC

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12
Q

What behaviours are used to get rid of calories?

A

Self-induced vomiting

Chewing and spitting out

Over-exercise: Often secret

Overactivity: Obsessive housework, fidgeting, twitching, never sitting down, fetching one item at a time, carrying heavy loads

Cooling: Inadequate dress, open windows etc

Blood letting

Medication abuse: Laxatives

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13
Q

What other behaviours can be seen in anorexia nervosa?

A

‘Body checking’: Repeated weighting, mirror gazing, self-measurement, self-photographing, trying on particular tight clothes

Displaying emaciation to elicit reassuringly shocked attention

Cruising ‘pro-ana’ websites/ facebook/ email/ fellow sufferers

Competing with self and others to attain lower and lower targets

Compulsive browsing of gossip magazines and websites - celebrities, ‘thinspirations’

Deliberate self-harm if ‘rules’ are broken

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14
Q

What is re-feeding syndrome?

A

Occurs when patients that have starved begin to eat and metabolize calories

Body shifts from catabolic state (breaking down tissues for nutrients) to an anabolic state (re-building tissues/growth)

This change leads to secretion of hormones which contribute to shifts in salts and fluids in the body

Body is so hungry for nutrients that in an effort to rebuild cells, it moves salts from the blood into growing cells

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15
Q

Give complications of re-feeding syndrome

A

HF

Arrythmia

Respiratory failure

Muscle breakdown

Death

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16
Q

What is bulima nervosa?

A

Episodes of binge eating followed by compensatory behaviour of the purging type (self-induced vomiting , laxative abuse) or non-purging type (excessive exercise, fasting or strict diets), occurring at a minimum of two times per week for three months

17
Q

Give risk factors for bulimia nervosa

A

History of anorexia nervosa

Obesity

Mood disorder

Sexual or physical abuse

Parental obesity

Substance misuse

Low self-esteem

18
Q

Give signs and symptoms of bulimia nervosa

A

Mouth sores: Excessive vomiting

Pharyngeal trauma: Excessive vomiting

Dental caries: Excessive vomiting

Heartburn, chest pain

Oesophageal rupture

Impulsivity: stealing, alcohol abuse, drugs/tobacco

Muscle cramps

Weakness

Bloody diarrhoea

Irregular periods

Fainting

Swollen parotid glands: Excessive vomiting, mouth watering in preparation for vomit

Hypotension

Halitosis: Bad breath from excessive vomiting

Russel’s Sign: Callused knuckles from using hand to induce vomiting

Metabolic alkalosis: As loosing acid in vomit

19
Q

How is bulimia nervosa managed?

A

Evidence-based self help programme

CBT-BN

Antidepressants: SSRI’s

Psycho-education, behavioural management

20
Q

What is binge eating disorder?

A

Similar to bulimia nervosa but absence of purging behaviours, instead they have binging periods followed by periods of guilt and shame

21
Q

What electrolytes are affected in re-feeding syndrome?

A

Decreased Phosphate

Decreased K

Decreased Mg

22
Q

Give complicatons of anorexia nervosa?

A

Refeeding syndrome

Hypothermia

Osteoporosis

Infertility

Immunosuppression

Anaemia

Hypothyroidism

Psychiatry (11 decks)

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