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Eating disorders Flashcards

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1
Q

Define eating disorders

A

Disturbance of eating behaviour/ behaviour to control weight

driven by extreme fear of fatness

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2
Q

Explain the aetiology / risk factors of eating disorders

A

Perfectionism

Low self esteem

commonly comorbid with other mental health disorders, especially depression and substance misuse

GENETICS!!:
11x inc risk with 1st degree relative
Anorexia, heritability is 58%, and the MZ:DZ
twin concordance rates are 65:32

Bulimia - less genetic inheritance

  • hx of obesity
  • 50% previously had anorexia
  • fhx obesity
  • parental weight concern
  • high parental expectation

psychological and sociocultural theories

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3
Q

Summarise the epidemiology of eating disorders

A

affects perfectionist, highachieving

young women with low self-esteem

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4
Q

define anorexia

GET DSM5 Definition

A

anorexia nervosa

involves weight loss methods causing extreme emaciation

subtypes;

  1. restrictive
  2. binge/purge
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5
Q

define bulimia

A

involves binge eating followed by

vomiting or exercising to get the weight off

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6
Q

define binge eating disorder

A

binge eating disorder is bulimia without

the purging.

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7
Q

list the eating disorders in order of prevalence?

A

anorexia nervosa—0.6%
• bulimia nervosa—1.0%
• binge eating disorder—2.8%

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8
Q

which study describes genetic pattern in eating disorders?

A

Wade et al. 2007

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9
Q

outline the theories explaining eating disorders?

A

Psychological theories;
When life feels uncontrollable, Anorexia comforts by providing the ability to control something (weight).

The disorder is a way of avoiding separation from family
or becoming an independent sexual being.

Sociocultural theories;
Social pressures to be thin and the promotion of dieting
are important influences.
High-risk groups: models, athletes, and dancers.

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10
Q

outline the DSM5 criteria for anorexia nervosa diagnosis?

A
  1. BMI <17.5 or weight 15% less than expected
  2. Deliberate weight loss
  3. distorted body image. dread weight gain
  4. endocrine dysfunction; amennorhea, impotence, loss of libido
    -If AN begins before puberty, menarche and
    breast development are delayed or arrested.
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11
Q

what are the physical complications of anorexia?

A
  1. General;
    Lethargy and cold intolerance.

Milder disorders;
anaemia, leucopenia, or thrombocytopenia. Infections
may result from decreased immunity. amennorhea

Severe disorder: Pancytopenia - bone marrow hypoplasia.
growth stunting
death
pregnancy complications - infertility

  1. Cardiovascular
  2. GI
  3. Reproductive
  4. MSK; proximal myopathy, osteoporosis
  5. Neurological

mental health issues post recovery

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12
Q

list cvs complications of anorexia?

A

80% of AN patients experience
cardiac complications; risking sudden death.

bradycardia, hypotension (postural drop),
arrhythmias (usually secondary to hypokalaemia),
mitral valve dysfunction, and cardiac failure.

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13
Q

list GI complications of anorexia?

A

constipation
abdominal pain to ulcers, oesophageal tears, and
gastric rupture due to vomiting.

Delayed gastric emptying makes patients feel bloated after eating
even small amounts.

Nutritional hepatitis in 1/3rd

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14
Q

patient presents. her bloods show;

low serum protein,
with raised bilirubin, lactate dehydrogenase, and
alkaline phosphatase.

diagnosis?

A

nutritional hepatitis due to anorexia

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15
Q

list neurological complications of anorexia?

A

Peripheral neuropathy, delirium, convulsions

or even coma

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16
Q

what are the differentials for anorexia?

A

1.Medical causes of weight loss, e.g. hyperthyroidism,
malignancy, gastrointestinal disease, Addison’s disease,
chronic infection, inflammatory conditions, and AIDS.

  1. Depression: weight loss can be severe in depression,
    but would not be denied. Low mood is common in
    AN, but weight gain would be resisted.
  2. Bulimia nervosa: bingeing and vomiting can occur
    in anorexia nervosa, but BN should be diagnosed if
    this is the predominant behaviour and the patient is
    not underweight.
  3. Eating disorder not otherwise specified (EDNOS):
    the term for atypical presentations.
  4. Body dysmorphic disorder (BDD): BDD is a condition
    characterized by body image distortion (e.g.
    belief that the nose is misshapen). Deliberate weight
    loss in BDD would be unusual.
  5. Psychosis: self-starvation might occur if food is believedto be poisoned.
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17
Q

ivx for anorexia?

A
  1. Height, weight, and BMI.
  2. Squat test: Ask the patient to squat down and rise
    to standing without using their arms (difficult with
    proximal myopathy).
  3. Essential blood tests
    • ESR, TFTs—exclude most organic causes of weight
    loss, e.g. hyperthyroidism. ESR is normal or low in
    anorexia.
    • FBC, U&E, phosphate, albumin, LFT, creatinine
    kinase, glucose—evaluate nutritional state and risk.
  4. ECG: Bradycardia, arrhythmias, and a prolonged
    QT interval.
  5. Other tests as indicated, e.g. DEXA scans (low bone
    density).
18
Q

the following are seen in which condition;

Russell’s sign (calluses or cuts on the knuckles
from self-induced vomiting)
Swollen salivary glands (puffy face)
Oedema

A

Binge/purge/vomit

19
Q

Outline the management for Adult Anorexia according to NICE?

A

Adults;

A. individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)

  • 40 sessions over 40 weeks
  • 2x weekly for frist 2-3wks

B. Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
-20 sessions

C. specialist supportive clinical management (SSCM)
- 20 sessions

20
Q

what does MANTRA involve?

A

nutrition, symptom management, and behaviour change

involve family members or carers
- to help with behaviour change etc

based on the MANTRA workbook

21
Q

waht does individual eating-disorder-focused cognitive behavioural therapy (CBT-ED) involve?

A

encourage healthy eating and reaching a healthy body weight

cover nutrition, mood regulation, social skills, body image concern, self-esteem, and relapse prevention

includes self-monitoring of dietary intake and associated thoughts and feelings

22
Q

what does specialist supportive clinical management (SSCM) involve?

A

provide psychoeducation, and nutritional education and advice

include physical health monitoring

encourage reaching a healthy body weight and healthy eating

23
Q

what is next line management if the 3 first line therapies have not workeed for anorexia?

A

Eating-disorder-focused focal psychodynamic therapy (FPT)

40 sessions over 40 weeks

24
Q

1st line management for Anoxeria in kids and young people? NICE

A

1st line - FFT:
Consider anorexia-nervosa-focused family therapy for children and young people (FT-AN), delivered as single-family therapy or a combination of single- and multi-family therapy

have option to do it without family or with family.
18-20 sessions over 1 year

2nd line - individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)

Adolescent focussed therapy - teens

25
Q

2nd line management for anoxeria in kids and young people? NICE

A

if the family therapy did not work or is contraindicated;

individual CBT-ED or adolescent-focused psychotherapy for anorexia nervosa (AFP-AN).

40 sessions over 40 weeks
up to 12 sessions must be with family

26
Q

when is inpatient admission warranted in eating disorders?

A

(preferably in a specialist eating disorders unit)

  • BMI <13 or extremely rapid weight loss; 1kg+ per week
  • serious physical complications
    • purpuric rash
    • cold peripheries, core BT <34.5
    • hypotension <80/50
    • bradycardia <40 OR prolonged QT
    • hypokalaemia, hyponatraemia, low PO4
    • cant stand from squatting w/o hands

• high suicide risk.

27
Q

what framework should be used to guide refeeding?

A

MARSIPAN

Junior MARSIPAN

28
Q

what is a recognized
cause of mortality in the early stages of treatment?

aetiology?

A

refeeding syndrome

characterized by electrolyte imbalance (principally low
serum phosphate, potassium, and magnesium) caused by
their sudden intracellular movement due to the switch
from fat to carbohydrate metabolism and associated
increased secretion of insulin (Hearing 2004).

29
Q

what is the prognosis for anorexia and bulimia?

list poor prognostic factors

A

Anorexia;
After 10 years, 50% of patients with AN have no eating
disorder and 10% have died (suicide accounts for a
third of deaths). The remaining 40% have ongoing problems and crossover to BN is common.

Poor prognostic indicators:
very low weight, bulimic features,
later onset, or longer illness duration.

Bulimia;
The prognosis for BN is better. 70% have
recovered completely and only 1% have died at 10 years.

poorer prognosis:
severe binging or purging, low body weight, and comorbid depression

30
Q

What are the features of Bulimia?

A
  1. Binge eating
    Repeated bouts of overeating
    irresistible cravings - lose control,
    eating enormous amounts, of ‘forbidden’ (sweet, high
    calorie, high fat)
    Thousands of calories may be consumed and
    there is often a sense of desperate urgency and compulsion. triggered by distress.
    - occurs at least 1x a week for at least 3 weeks -
  2. Purging of binges
    feelings of shame and guilt =
    measures to undo the ‘damage’,
    e.g. vomiting, use of laxatives or diuretics.
    Between binges, there may be episodes of fasting and excessive exercise to control weight.
  3. Body image distortion
    Patients feel fat, are preoccupied
    with their shape and weight, and often hate their body.
    - innapropraite compensatory mechanisms
  4. BMI >17.5 In contrast with AN, patients with BN
    are of normal or slightly increased weight and periods
    are usually present.
    very secretive about their binging or purging
    behaviour.
    physical symptoms are mostly those secondary to vomiting and
    purging, e.g. arrhythmias (hypokalaemia) or convulsions
    (hyponatraemia).
31
Q

ivx for bulimia?

A

attention to electrolytes and ecg

32
Q

management for bulimia in adults?

A
  1. Bulimia-nervosa-focused guided self-help (BNF self help)
    - 9 sessions over 16 weeks

-> If unacceptable, contraindicated, or ineffective after 4 weeks of treatment;

  1. individual eating-disorder-focused cognitive behavioural therapy (CBT-ED).
    - 20 sessions over 20 week
33
Q

management for bulimia in in kids and young adults?

A

1st line - FFT: bulimia-nervosa-focused family therapy (FT-BN)

2nd line - individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
- at least 4 sessions with parents/carers

34
Q

when can medicatoins prove helpful in bulimia?

A

SSRIs - fluoxetine to reduce binging and purging by improving impulse control

treatment of comorbid psych illnesses

35
Q

which are the other eeating disorders

A

pica
rumination disorder
restrictive food intake disorder

36
Q

define purging disoder

A

includes omiission of insulin

37
Q

characterise avoidant restrictive eating disorder

A

no weight/shape concerns

interference with psychosocial function - cant eat in a new place etc

38
Q

what is peak age onset for all eating disorders?

A

15-19

39
Q

what are standardised moratility ratio for anorexia?

A

very high - 5

Die from cardiovascular complicatoins and suicide

40
Q

what are standardised moratility ratio for anorexia?

A

very high - 5

Die from cardiovascular complicatoins and suicide

41
Q

bulimia complications?

A

dental erosion - from purging
growth stunting
mental health issues post recovery
osteoporosis

pregnancy complications - infertility

A- Psych (24 decks)

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