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Psychiatry > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

What is the epidemiology of anorexia nervosa?

A

Incidence is 1%
10 times more common in women
Usually begin in teens

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2
Q

What are the symptoms of anorexia nervosa?

A 
Refusal to maintain body weight (BMI <=17.5)
Intense fear of weight gain
Disturbance of body image 
Denial of seriousness of low weight
Amenorrhoea
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3
Q

What is subclincal anorexia nervosa?

A

Not all diagnostic criteria met = more prevalent, may be precursor to complete syndrome

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4
Q

What is the mortality of anorexia nervosa?

A

Highest mortality of any psychiatric condition = 5% per decade

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5
Q

What are some common co-morbidities of anorexia nervosa?

A

Anxiety, depression, OCD, alcohol misuse

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6
Q

What are some of the behaviours seen in anorexia nervosa?

A

Food restriction, over-exercising, obsession with self-weighing, misuse of laxatives or diet pills, lying about eating, calorie counting

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7
Q

What is the genetic influence in anorexia nervosa?

A

10 times higher risk if first degree relative affected

Heritability may be up to 70%

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8
Q

What are some general complications of anorexia nervosa?

A

Hypokalaemia, hyponatraemia, dehydration and rebound water retention, oedema, enlarged parotid glands, indigestion, bloating, constipation, delayed gastric emptying

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9
Q

What are some CV and CNS complications of anorexia nervosa?

A 
CV = low heart rate and BP, prolonged QTc interval, arrhythmia, cardiac arrest
CNS = peripheral paraesthesiae, tetany, seizures, reduced grey matter, enlarged ventricular spaces
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10
Q

What are some of the MSK complications of anorexia nervosa?

A

Muscle wasting, weakness, osteopenia, dry skin, lanugo hair, poor peripheral circulation, hair loss

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11
Q

What are some haematological complications of anorexia nervosa?

A

Raised LFTs, low WBC, anaemia, bone marrow suppression, thrombocytopenia

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12
Q

How does anorexia nervosa affect people psychologically?

A

Low mood, anxiety, irritability, narrowed range of interests, rigid thinking, social withdrawl, poor concentration, impaired decision making, drowsiness

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13
Q

What are the treatment options for anorexia nervosa?

A

Family based therapy, cognitive behaviour therapy, interpersonal therapy, specialist supportive clinical management, medication

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14
Q

How is family based therapy used to treat anorexia nervosa?

A

1st line in children and teens = parents guided to appropriately feed child calmly but persistently

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15
Q

How is cognitive behaviour therapy used to treat anorexia nervosa?

A

Focuses on recognising unhelpful thoughts about eating then challenging them and learning healthier ways of thinking

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16
Q

What is the focus of interpersonal therapy?

A

Various roles that different relationships have in someone’s life and how they can be used in a more supportive way

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17
Q

What is specialist supportive clinical management of anorexia nervosa?

A

Combines clinical management with supportive therapeutic style = aims to get patients to make a link between their symptoms and their eating behaviour

18
Q

What medications are used in anorexia nervosa treatment?

A

Calcium and vitamin D supplement for bone thinning
Oestrogen patches for amenorrhoea
Antidepressants for low mood

19
Q

What are the symptoms of bulimia nervosa?

A

Recurrent binges associated with compensatory behaviours = vomiting, excessive exercise, fasting
Pre-occupation with body shape and weight

20
Q

What is a binge?

A

Consumption of unusually large amounts of food within a short interval associated with loss of control

21
Q

How often do binges need to occur to diagnose bulimia nervosa?

A

At least once a week for three months

22
Q

What is Russel’s sign?

A

Calluses on back of hand from self inducing vomiting = seen in bulimia nervosa and sometimes anorexia nervosa

23
Q

What are associated conditions of bulimia nervosa?

A

Usually have co-morbid depression an dental caries

Risk of oesophageal or gastric rupture = can be fatal

24
Q

What are the treatment options for bulimia nervosa?

A

Individual and group cognitive behaviour therapy

High dose fluoxetine may reduce food cravings

25
Q

What is binge eating disorder?

A

Recurrent binging at least once a week for 3 months without the use of compensatory behaviours

26
Q

What is the criteria for diagnosing binge eating disorder?

A

At least 3 of = eating more rapidly than normal, eating until uncomfortably full, eating large amounts when not hungry, eating alone because of embarrassment over how much they eat, feeling disgusted/depressed/guilty over eating

27
Q

What is avoidant restrictive food intake disorder (ARFID)?

A

Restrictive eating pattern with persistent failure to meet appropriate nutritional needs

28
Q

What are some features of avoidant restrictive food intake disorder (ARFID)?

A

Patient may or not be underweight
May have co-existing autism
May be related to sensory issues rather than body image concerns

29
Q

What is diabulimia?

A

Patient with diabetes, typically type 1, restricts insulin to lose weight = chronically very raised blood sugar, may have repeated episodes of ketoacidosis

30
Q

What is bigarexia/megarexia?

A

Muscle dysmorphia in male body builders = obsession with building muscle, see themselves as too small, may abuse anabolic steroids

31
Q

What is orthorexia?

A

Unhealthy obsession with eating healthy food = doesn’t necessary lead to malnutrition, focus on eating pure unadulterated food

32
Q

What causes refeeding syndrome?

A

Hormonal and metabolic changes caused by rapid refeeding

33
Q

What mechanisms underlie refeeding syndrome?

A

Increase in blood glucose increases insulin secretion
Insulin stimulates fat, protein and glycogen secretion = this lowers already depleted serum magnesium, phosphate and potassium

34
Q

What are the symptoms of refeeding syndrome?

A

Oedema, acute gastric dilation, cardiac abnormalities, delerium, respiratory failure, status epilepticus, suppression of haematological system

35
Q

What are some features of the oedema that occurs in refeeding syndrome?

A

May lead to weight gain of up to 1kg per day
May be due prolonged period of diuretic abuse
Resolves spontaneously but may take several weeks

36
Q

What is acute gastric dilation?

A

Rare but potentially life threatening = vomiting with abdominal pain and distension, responds to NG aspiration and IV feeding if recognised early

37
Q

How often should electrolytes be monitored to prevent refeeding syndrome?

A

Once daily for one week and at least three times daily the following week

38
Q

Should electrolyte supplements be given to prevent refeeding syndrome?

A

Yes = unless blood levels high before refeeding

39
Q

What vitamin supplementation should be started before refeeding commences?

A

Thiamine = 200-300mg daily orally
Vitamin B = 1-2 high potency tablets
Multivitamin once daily

40
Q

How should refeeding be carried out in a patient at high risk of refeeding syndrome?

A

Start slowly and increase over 4-7 days

Psychiatry (36 decks)

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