Eating Disorders

Question 1

List the good and poor prognostic factors for an eating disorder

Answer 1

Good
- early onset with diagnosis and treatment occurring early
- timely treatment within 3 years
- weight recovery within 2 years
Poor
- late age of onset
- long duration of illness
- history of previous hospitalization
- greater individual and family disturbance

Question 2

Discuss the pathology surrounding developing an eating disorder

Answer 2

• vulnerable you under influence of a stressor youth uses weight as a way of control -> after losing weight have sense of achievement which gives new importance to dieting -> reinforcement of restriction behaviour -> propagation of increased restriction

Question 3

Discuss the secondary affects of starvation on the body

Answer 3

Cardiovascular
- hypotension
- bradycardia
- smaller heart
- QTc prolongation
- heart failure
Metabolic and Hematology
- hypothermia
- anemia
- immune deficiency
- low albumin
- Ca, vit D deficiency
- increased cortisol
Reproduction
- amenorrhea and infertility
Dermatology and teeth
- dry skin and hair
- reduced breast tissue
Gastrointestinal
- constipation
- pancreatic function
- risk of SMA syndrome

Question 4

Discuss the secondary affects of purging on the body

Answer 4

Cardiovascular
- arrhythmia due to hypokalemia
- cardiac arrest
Metabolic and Hematology
- metabolic alkalosis
- hypokalemia
Reproduction
- amenorrhea and infertility
Dermatology and teeth
- Russell's sign (calluses on knuckles from induced gag reflex)
- enlarged parotid
- perioral skin irritation
- erosion of dental enamel
Gastrointestinal
- hematemesis
- GERD
- poor muscle tone in colon due to laxative

Question 5

List the features that increase the risk of death with eating disorders

Answer 5

• very low body weight at admission
• bradycardia
• no medical follow up
• longer duration of illness
• multiple purging methods
• chronic self harm
• substance use

Question 6

List the diagnostic criteria for anorexia nervosa

Answer 6

Restriction of energy intake leading to significantly low body weight
- adult is <85% of baseline prior weight
- female is weight before menstruation stopped
- BMI <17
Intense fear of gaining weight
- Distorted body image or undue influence of weight on self or denial of seriousness of low weight

Question 7

List the specifiers for anorexia nervosa

Answer 7

Restricting type
- weight loss primarily by dieting/fasting/excessive exercise with no binge purging
Binge-eating/purging type
- patient engaged in binging or purging
Severity
- mild BMI >=17, moderate BMI 16-17, and severe BMI 15-16 and extreme is BMI <15

Question 8

List the indications for treatment with anorexia nervosa

Answer 8

Persistent decline in oral intake or rapid weight loss (>1kg/wk) in patients lost >20% of estimated weight
Abnormal vital signs (brady <40, tachy >110, hypothermia)
Metabolic abnormalities
- electrolyte imbalances: hypoNa <125, hypoK <2.5 or hypoMg <0.55
- hypoglycemia
Uncontrolled comorbid diabetes
Pregnancy posing risk to fetus

Question 9

Discuss the treatment of anorexia nervosa

Answer 9

Medical stabilization
- treat electrolyte imbalance or arrhythmia
Nutritional Rehabilitation
- increase 2-3lbs for inpatients and 0.5 for outpatients with oral, NG, NJ, PEG or PEJ, or IV
- start at caloric intake of 30-40kcal/kg/day increasing to 70-100kcal/kg/day
- include phosphate and thiamine to prevent refeeding syndrome
- sudden increase in insulin with food lead to shift of phosphate, potassium, magnessium, glucose and thiamine into cells (refeeding syndrome)
Pscyhotherapy
- CBT and IPT
- family therapy
Pharmacotherapy
- Olanzapine
- Metoclopramide

Question 10

List the diagnostic criteria for bulimia nervosa

Answer 10

Recurrent episode of binge eating
- eating a very large amount of food in discrete time
- sense of lack of control
Recurrent compensatory behaviour to prevent weight gain
Binge eating and inappropriate compensatory behaviour occur for at least once a week for 3 months
Self esteem is unduly influenced by weight
Not anorexia

Question 11

List the severity of bulimia

Answer 11

Mild: 1-3 episodes per week
Moderate: 4-7 episodes per week
Severe: 8-13 episodes per week
Extreme: >14 episodes per wee

Question 12

Discuss the treatment for bulemia nervosa

Answer 12

Medical Stabilization
- high risk of hypokalemia
Psychotherapy
- CBT
Pharmacotherapy
- SSRI: fluoxetine 60mg daily for >1yr (cannot use NDRI)

Question 13

List the diagnostic criteria for binge eating disorder

Answer 13

Recurrent episode of bine eating that occur at least once a week for 3 months
Binge eating associated with >=3
- eating much more rapidly than normal
- eating until feeling uncomfortably full
- eating large amount of food when not feeling physically hungry
- eating alone because feeling embarassed
- feeling disgusted with onself, depressed or guilty afterwards
Distress regarding binge eating
No compensatory behaviour

Question 14

Discuss the treatment for binge eating disorder

Answer 14

Nutrtional Rehabilitation
- weight program with calorie restriction
Psychotherapy
- CBT
Pharmacotherapy
- SSRI