Eating Disorders

Question 1

What is the diagnostic criteria for anorexia nervosa?

Answer 1

• body weight > 15% below the standard weight or BMI < 17.5
• self induced weight loss: avoidance of fattening foods, purging, exercise or appetite suppressants
• distortion of body image ie patients regard themselves as fat when they are thin
• morbid fear of fatness
• amenorrhoea in women

Question 2

Is anorexia nervosa more common in women or men?

Answer 2

women (10:1 ratio)

Question 3

Anorexia nervosa has the ______ mortality of all psychiatric illnesses

Answer 3

highest

Question 4

When does anorexia nervosa usually start?

Answer 4

usually starts in adolescent but can arise in older or younger age groups

Question 5

Describe co-morbidity with other psychiatric conditions in anorexia nervosa?

Answer 5

it is common particularly anxiety, depression and OCD, also increasing evidence that many patients with anorexia meet the criteria for ASD

Question 6

List some physical signs and features of anorexia nervosa?

Answer 6

sensitivity to cold
constipation
hypotension and bradycardia
if laxatives and vomiting > electrolyte abnormalities
dental problems if vomiting
vitamin, mineral or potassium deficiencies can cause peripheral paraesthesia, tetany or seizures
renal and hepatic damage due to starvation
loss of fat causes amenorrhoea, reduced body temperature and abnormal thyroid function
dry skin, carotenaemia, lanugo hair, hair loss, poor peripheral circulation
muscle wasting, weakness, osteopenia/ osteoporosis
low WBC, iron, B12, bone marrow suppression, thrmobocytopaenia

Question 7

Give an overview of management of anorexia nervosa?

Answer 7

outpatient management (unless severe)
family based therapy 1st choice for children and adolescents
CBT
interpersonal therapy 
medications

Question 8

Describe medications for anorexia nervosa ?

Answer 8

there is no specific drug treatment for anorexia nervosa; multivitamin supplements recommended; calcium and vitamin D supplements in bone thinning; oestrogen patches may be indicated in adolescent females with amenorrhoea; antidepressants for low mood; olanzapine/quetiapine/aripiprazole used in severe cases off licence to manage anxiety/ rigid thinking/ obsessions around re-feeding.

Question 9

When does someone with anorexia nervosa need treated as an inpatient?

Answer 9

if they have severe weight loss with marked cardiovascular signs and/ or electrolyte and vitamin disturbances

Question 10

Diagnostic criteria for bulimia nervosa?

Answer 10

• persistent preoccupation with eating
• irresistible craving for food
• binges
• attempts to counter the effects of binges e.g. starvation, vomiting, laxatives, drug misuse
• morbid dread of fatness

Question 11

Clinical features of bulimia?

Answer 11

dental caries are common
may be normal weight
Russell sign (calluses on backs of hands due to self induced vomiting)
parotid hypertrophy
U and Es abnormal (hypokalaemia, alkalosis)
irregular periods (amenorrhoea is rare)
Risk of fatal oesophageal or gastric rupture

Question 12

In bulimia weight may be ____

Answer 12

normal !

Question 13

Co-morbid psychiatric problems with bulimia?

Answer 13

commonly co morbid depression
alcohol and substance misuse
impulsive behaviour e.g. shop lifting

Question 14

Russels sign?

Answer 14

calluses on backs of hands due to self induced vomiting

a sign of bulimia nervosa

Question 15

Is there amenorrhoea in bulimia?

Answer 15

no that is rare

periods are often irregular though

Question 16

Management of bulimia nervosa?

Answer 16

individual or group CBT

high dose fluoxetine has been shown to reduce cravings for food