Eating Disorders Flashcards
What is anorexia nervosa?
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)
What is the mortality rate of anorexia nervosa?
5-20%
What is the average length of recovery of anorexia nervosa?
Estimated at 6-7 years
Give risk factors for anorexia nervosa
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
Give symptoms and signs of anorexia nervosa
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>
What questionnaire is used for anorexia nervosa screening?
SCOFF
Give the questions used in the SCOFF questionnaire
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?
What investigations are used in anorexia nervosa monitoring?
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
How can BMI be calculated?
Weight/Height^2
How is anorexia nervosa managed?
Re-feeding
Psychotherapy
- CBT
Olanzapine
- Stimulate appetite
Specialised family work for anorexia nervosa, particularly for younger patients
What behaviours are used to avoid calorie intake?
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
What behaviours are used to get rid of calories?
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
What other behaviours can be seen in anorexia nervosa?
‘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
What is re-feeding syndrome?
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
Give complications of re-feeding syndrome
HF
Arrythmia
Respiratory failure
Muscle breakdown
Death
What is bulima nervosa?
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
Give risk factors for bulimia nervosa
History of anorexia nervosa
Obesity
Mood disorder
Sexual or physical abuse
Parental obesity
Substance misuse
Low self-esteem
Give signs and symptoms of bulimia nervosa
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
How is bulimia nervosa managed?
Evidence-based self help programme
CBT-BN
Antidepressants: SSRI’s
Psycho-education, behavioural management
What is binge eating disorder?
Similar to bulimia nervosa but absence of purging behaviours, instead they have binging periods followed by periods of guilt and shame
What electrolytes are affected in re-feeding syndrome?
Decreased Phosphate
Decreased K
Decreased Mg
Give complicatons of anorexia nervosa?
Refeeding syndrome
Hypothermia
Osteoporosis
Infertility
Immunosuppression
Anaemia
Hypothyroidism
