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Psychiatry > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

What is the ICD10 criteria for anorexia nervosa?

A 
BMI <17.5 or <85% expected 
Morbid fear of fatness
Deliberate weight loss
Distorted body image 
Amenorrhoea 
Loss of sexual interest/potency in men
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2
Q

Describe sub-clinical anorexia nervosa

A

Not all diagnosis criteria are met and some patients don’t experience amenorrhoea even at low body weight

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3
Q

Name the co-morbidities in anorexia nervosa

A

Anxiety, OCD, depression, alcohol/substance misuse, increasing evidence for autism, diabetes mellitus

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4
Q

How will patients with anorexia nervosa behave?

A

Over-exercising, food restrictions, secrecy, obsession with weight/calories, use of laxatives or diuretics

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5
Q

What are the major red flags in anorexia?

A

Loss of <1kg/week, prolonged QTc, temperature of <34, unable to rise from squat (muscle wasting, BMI <13 and cognitive impairment

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6
Q

State the investigations done in patients with anorexia

A

Haematology
Biochemistry
ECG
DXA - amenorrhoea for >1year

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7
Q

What electrolyte disturbance will be seen in anorexia?

A

Hypokalaemia

Hyponatraemia

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8
Q

What cardiac abnormalities can occur due to anorexia?

A

Low heart rate/BP
Long QTc
Arrhythmias
Arrest

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9
Q

What can happen to your teeth in anorexia?

A

Dental caries due to vomiting acidic/sugary foods

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10
Q

Describe the GI complications of anorexia

A

Discomfort, GORD, oesophageal rupture/tears, constipation, diarrhoea/incontinence with laxative abuse, delayed gastric emptying

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11
Q

Why does oedema occur in anorexia?

A

Rebound retention

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12
Q

What are the neurological complications of anorexia?

A

Peripheral paraesthesia, tentany or seizures, reduced grey matter and enlarged ventricular space

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13
Q

Describe the hepatic complications of anorexia

A

Raised LFTs - GGT/ALT liver breakdown can lead to failure

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14
Q

What endocrine features will be seen in anorexia?

A

Amenorrhoea as ovaries shut down to reduce fertility, hypothalamus is impaired and TFTs may be abnormal

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15
Q

What skin features are complications of anorexia?

A

Dry skin, carotenaemia, lanugo hair, poor circulation, hair loss

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16
Q

Describe the MSK complications of anorexia

A

Muscle wasting, weakness, osteopenia/porosis, russel’s sign

17
Q

What is Russel’s sign?

A

Callous on back of hand from induced vomiting

18
Q

What are the haematological complications of anorexia?

A

Low WBC, reduced ability to fight infection, anaemia (B12 and iron), bone marrow suppression, thrombocytopenia

19
Q

Describe a patients mood in anorexia

A

Anxiety, low mood, irritability/angry outbursts, labile when refeeding, episodes of elation, obsessions and compulsions

20
Q

What happens to patients personality in anorexia?

A

Narrow range of interests, rigid thinking, autism, social withdrawal

21
Q

Describe a patients cognition in anorexia

A

Poor concentration, impaired decision making, drowsiness

22
Q

How can anorexia be treated?

A
  • family based therapy
  • cognitive behaviour therapy
  • interpersonal therapy
  • specialist supportive clinical management
  • medication
  • art/drama therapy
23
Q

What medication can be given in anorexia?

A

Multivitamin supplement - calcium and vit D
Oestrogen patches
Antidepressants

24
Q

What is the ICD 10 criteria for bulimia nervosa?

A

Morbid fear of fatness, craving for food and binge eating with compensatory behaviours, preoccupation with body weight and shape and episodes not exclusively during episodes of anorexia

At least once a week for 3 months and excessive pre-occupation with body shape and weight

25
Q

Define binge

A

Consumption of an unusually large amount of food within a short amount of time associated with loss of control

26
Q

What co-morbidities often present with bulimia?

A

Depression, impulsive behaviours - alcohol, substance misuse, shop lifting

27
Q

How is bulimia treated?

A

Individual (guided self help)
CBT
High dose fluoxetine can reduce cravings

28
Q

What is binge eating disorder?

A

Recurrent bingeing at least once a week for 3 months without compensatory behaviours

29
Q

What needs to be present for a diagnosis of binge eating disorder?

A

3 of

  • rapid eating
  • eating until uncomfortably full
  • eating large amounts when not hungry
  • eating alone due to embarrassment
  • disgusted
  • depressed
  • guilty
30
Q

What is avoidant restrictive food intake disorder?

A

Persistent failure to meet appropriate nutritional needs

  • sensory issues
  • co-existing autism
31
Q

Describe diabulimia

A

Eating disorder in a person with diabetes - deliberate restriction of insulin in order to lose weight. Chronically raised blood sugar and ketoacidosis

32
Q

What condition do body builders often have?

A

Bigorexia/megorexia

33
Q

Describe bigorexia

A

Muscle dymorphia - obsession with building muscle and distorted body image believe themselves to be too small, too thin with insufficient muscle (may use steroids)

34
Q

What is the name given to an unhealthy obsession with healthy food?

A

Orthorexia

35
Q

What is the hallmark sign of refeeding syndrome?

A

Hypophosphataemia

36
Q

What is the main symptoms of re-feeding syndrome?

A

Oedema

Acute gastric dilation is rare - abdominal pain, vomiting and distension

37
Q

How is re-feeding syndrome prevented?

A

Baseline U/Es, vitamin supplements, start slowly

38
Q

What are the complications of re-feeding?

A

Cardiac abnormalities, delirium, respiratory failure, status epileptics, haematological suppression

Psychiatry (18 decks)

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