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Y5 Psych > Eating Disorders > Flashcards

Eating Disorders Flashcards

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1
Q

What kind of person is likely to have an eating disorder?

A

Perfectionist, high achieving young women with low self esteem

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2
Q

What age do eating disorders start at?

A

16-22

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3
Q

What are components to the aetiology of ED?

A

Genetic
Personality (perfectionist, low self esteem)
Personal history (obesity, child abuse, traumatic life event)
Family (overprotective, overbearing, poor boundaries)
Societal pressures

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4
Q

What conditions to eating disorders overlap with?

A

Depression
Anxiety
OCD

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5
Q

What are the 4 KEY clinical presentations of anorexia nervosa?

A

BMI <18.5 (or 15%lower than expected)
Deliberate WL
Distorted body image
Endocrine dysfunction

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6
Q

How do AN patients cause deliberate WL?

A

Restricted eating (counting calories, avoid fatty foods)
Purging (vomiting, laxatives)
Increase energy expenditure (excess exercise e.g. 10k runs every day)
Dangerous medications

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7
Q

What kind of dangerous medications could an ED pt take for WL?
What about diabetics?

A 
appetite suppressant 
thyroxine
diuretic
stimulant
Diabetics may SKIP insulin to prevent fat deposit
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8
Q

What kinds of endocrine dysfunction occur in AN?

A

HPA dysfunction > amenorrhoea, erectile dysfunction, loss of libido
No secondary sex characteristics if prepubertal

Low insulin

High cortisol

Altered TFT

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9
Q

What are systems you need to look into for symptoms of AN (starvation)

A 
General 
Neuro 
Cardio 
GI 
Haem 
Endocrine 
MSK
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10
Q

What are general symptoms of starvation

A 
Emanciation 
Dehydration 
Short stature 
Lethargy 
Cold intolerance 
Cold peripheries 
Hypothermia 
Infection (from weak immunity) 
Dry skin, brittle hair and nails 
Lanugo hair
Peripheral oedema (LOW ALBUMIN) 
Hypercholesteraemia 
Hypercarotenaemia (yellow skin)
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11
Q

What are Neuro symptoms of starvation?

A

Peripheral neuropathy
Cognitive defects
Delirium
Coma

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12
Q

What are cardio sx of starvation?

A 
Bradycardia 
hypotension 
mitral valve dysfunction 
cardiafc failure 
syncope 
sudden death
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13
Q

What are GI sx of starvation?

A 
constipation 
abdo pain 
bloating (delayed gastric emptying) 
Reflux 
Malnutrition > deficiency diseases
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14
Q

What are endocrine sx of starvation?

A

delayed/arrested puberty
Amenorrhoea
Erectile dysfunction, loss of morning erections
ow libido
infertility (ovarian, testicular atrophy)
Hypothyroidism

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15
Q

What are haematological sx of starvation?

A

Anaemia
Leukopoenia
Thrombocytopoenia
Pancytopoenia

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16
Q

What are symptoms of purging?

A 
Dehydration 
Russell sign (knuckle calluses/cuts from induced self vomiting)
Dental caries 
Mallory weiss tear 
Gastric rupture
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17
Q

What are differentials for AN?

A

Organic:

  • Endocrine - Hyperthyroidism, T1DM, Addison’s
  • malignancy
  • chronic infection (TB, HIV)
  • GI disease (coeliac, Chron’s)

Affective (depression/BPAD)

Anxiety (GAD, OCD with food avoidance)

Psychosis (persecutory - someone is trying to steal my food)

ASD

Body Dysmorphic Disorder

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18
Q

What are differentials for BED?

A

Depression (atypical, with overeating)

Organic - Kluver Bucy (hyperrhagia, hyper sexuality), Prader WIlli

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19
Q

Investigations for AN

A 
BMI 
SCOFF questionnaire 
SUSS (sit up squat stand) test
Bloods (FBC, U&amp;E, ESR, TFT, LFT, CK, K+. PO43-. Na )
ECG
Dexa, pregnancy test if indicated
20
Q

Why would you check CK=?

A

To see if patient has been exercising

21
Q

Why would you check Na?

A

Because it is low in patients who waterload

They have raised ICP > cerebral oedema >death

22
Q

How do you manage anorexia nervosa?

A

Psychotherapies

  • Motivational interviewing
  • Family therapy
  • Interpersonal therapy
  • CBT

Medical treatment (nutritional stabilisation on medical ward) using MARSIPAN guidelines

Treat other psych conditions

23
Q

What are complications of AN?

A

Refeeding syndrome

24
Q

What is refeeding syndrome?

A

Complication of establishing adequate food intake in patients who are starved

25
Q

Why does refeeding syndrome occur?

A

During starvation, body switches from carb to fatty acid / amino acid metabolism > insulin secretion is suppressed

During refeeding, if there is sudden increase in glucose, insulin secretion resumes

There is a rapid increase in basal metabolic rate

Electrolytes (K, Mg, PO - already low) are rapidly moved from blood to IC stores

This causes severe electrolyte depletion > arrhythmia > death

26
Q

What does refeeding syndrome present as?

A

LOW phosphate, magnesium, potassium
Thiamine deficiency
Salt and water retention

27
Q

How do you know if a patient with AN needs to be admitted?

A

Use MARSIPAN guidelines

  • BMI <13
  • hypotension
  • bradycardia
  • hypothermic
  • low muscle power (SUSS)
  • blood test results (low Na, K)
  • ECG with long QT
28
Q

What is bulimia nervosa?

4 KEY presentations

A

binge eating with compensatory behaviour and overvalued ideas about ideal body shape

  1. BINGE EATING
  2. PURGING
  3. BODY IMAGE DISTORTION
  4. BMI >18.5
29
Q

what is binge eating?

A

Repeated bouts of overeating

Irresistible cravings, lose control (eat large amount with urgency and compulsion)

30
Q

How do you treat BN?

A

Treat medical complications
SSRI (reduces bingeing by enhancing impulse control)
Treat comorbid psych illness

31
Q

What questionnaire can you do for anorexia and bulimia

A

SCOFF questionnaire

32
Q

Explain the SCOFF questionnaire

A

S: Do you make yourself Sick because you feel uncomfortably full

C: Do you ever worry you have lost Control on how much you eat

O: Have you ever lost more than One stone (6kg) in 1 month

F: Do you believe yourself to be Fat when others say you are thin

F: Do you think that Food dominates your life

33
Q

When doing an electolyte/blood test in anorexia, what things are low and what things are high

A

Most things are LOW

HIGH Cs and Gs:

  • Cortisol
  • Cholesterol
  • Carotinaemia
  • GH
  • Glucose
  • Salivary glands
34
Q

How do you manage anorexia nervosa

A
  1. Psycho education: advise on nutrition and health
  2. Treat co-morbid psych illness - depression, OCD, substance misuse
  3. Nutritional management, weight restoration - set realistic weight gain target, set eating plan
35
Q

What kind of anorexia specific psychotherapies are available for AN in adults

A

Offer one of 3:

CBT-ED
MANTRA: Maudsley AN Treatment in Adults
SSCM: Specialist Supportive Clinical Management

36
Q

What is CBT ED

A 
addresses control, low self esteem, perfectionsism 
40 sessions (once weekly)
37
Q

what is MANTRA

A

Maudsley AN Treatment in Adults
Helps patient understand what is causing the anorexiaa and focus on 3hat is important to the patient
20 sessions

38
Q

What is SSCM

A

Specialist Supportive Clinical Management

  • explores the main problems that cause andorexia
  • educate about nutrition and how different eating habits cause symptoms

20 sessions

39
Q

What are therapies for AN in children

A
  1. Family therapy

2. CBT

40
Q

what other general therapies are good to consider for AN

A

motivational interviewing

interpersonal therapy

41
Q

How does family therapy for AN work

A

some sessions alone

other sessions with family

42
Q

In extreme cases, how can you enforce feeding?

A

Mental health act

43
Q

What kind of referrals can you do for AN

A

REFER ALL PTS WITH ED TO SPECIALIST TEAM IMMEDIATELY

Severe: urgent referral to Community Eating Disorder Service
Moderate: routine referral to CEDS
Mild: support for 8 weeks, reccomend BEAT, refer to CEDS if no improvement

44
Q

What charity is good for AN

A

BEAT

45
Q

What kind of self help programme can you give for BN

A

BN focused guided self help programme for adults

46
Q

What is the general plan for BN for adults

A
  1. self help programmee 4 weeks
  2. CBT-ED
  3. Consider trial of high dose fluoxetine for impulse control

Y5 Psych (17 decks)

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