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Yr4 - Psych > Eating Disorders > Flashcards

Eating Disorders Flashcards

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1
Q

Define anorexia nervosa

A

Eating disorder characterised by deliberate weight loss, an intense fear of fatness, distorted body image and endocrine disturbances

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2
Q

Predisposing factors for anorexia nervosa

A 
Biological
- genetic
- fhx
- female
- early menarche
Psychological
- sexual abuse
- preoccupation with slimness
- dieting behaviours starting in adolescence
- low self-esteem
- premorbid anxiety or depressive disorder
- perfectionism, obsessional/anankastic personality
Social
- western society - pressure to diet in a society that emphasises being thin
- bullying revolving around weight
- stressful life events
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3
Q

Precipitating factors for anorexia nervosa

A

Biological
- adolescence and puberty
Psychological
- criticism regarding eating, body shape or weight
Social
- occupational or recreational pressure to be slim - ballet, models

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4
Q

Perpetuating factors for anorexia nervosa

A 
Biological
- starvation leads to neuroendocrine changes that perpetuate anorexia
Psychological
- perfectionism
Social
- occupation
- western society
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5
Q

ICD-10 criteria for the diagnosis of anorexia nervosa

A

Fear of weight gain
Endocrine disturbances - amenorrhoea, loss of sexual interest and potency
Emaciated - abnormally low body weight < 17.5
Deliberate weight loss
Distorted body image
Present for at least 3 months and absence of
- recurrent episodes of binge eating
- preoccupation with eating/craving to eat

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6
Q

Differential diagnosis of anorexia nervosa

A 
Bulimia nervosa
Eating disorder not otherwise specified
Depression
OCD
Schizophrenia
Organic causes of low weight - diabetes, hyperthyroidism, malignancy
Alcohol or substance misuse
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7
Q

Complications of anorexia nervosa

A

Metabolic
- hypokalaemia, hypercholesterolaemia, hypoglycaemia, impaired glucose tolerance, deranged LFTs, increased urea and creatinine, low potassium, low phosphate, low magnesium, low albumin, low chloride
Endocrine
- increased cortisol, increased growth hormone, reduced T3/4, reduced LH, FSH, oestrogen and progestogens leading to amenorrhoea, reduced testosterone
GI
- enlarged salivary glands, pancreatitis, constipation, peptic ulcers, hepatitis
CVS
- cardiac failure, ECG abnormalities, arrhythmias, reduced BP, bradycardia, peripheral oedema
Renal
- renal failure, renal stones
Neuro
- seizures, peripheral neuropathy, autonomic dysfunction
Haem
- iron deficiency anaemia, thrombocytopenia, leukopenia
MSK
- proximal myopathy, osteoporosis
Others
- hypothermia, dry skin, brittle nails, lanugo hair, infections, suicide

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8
Q

Features of binge eating disorder

A

Recurrent episodes of binge eating without compensatory behaviour such as vomiting, fasting or excessive exercise

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9
Q

Features of EDNOS or atypical eating disorder

A

Closely resembles other eating disorder but does not meet diagnostic criteria

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10
Q

Management of anorexia nervosa

A 
Aim for 0.5-1kg/ week weight gain for inpatient and 0.5kg/week outpatient
Biological
- treatment of medical complications
- SSRIs - for comorbid depression or OCD
Psychological
- psycho-education about nutrition
- CBT
- cognitive analytic therapy
- interpersonal psychotherapy
- family therapy
Social
- voluntary organisations
- self help groups
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11
Q

Criteria for hospitalisation for anorexia nervosa

A 
Medical
- BMI < 14
- severe electrolyte abnormalities
Psych
- suicidal ideation
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12
Q

Features of refeeding syndrome

A

Potentially life-threatening syndrome that results from food intake after prolonged starvation or malnourishment due to changes in phosphate, magnesium and potassium
- occurs due to insulin surge

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13
Q

Features of refeeding syndrome

A 
Hypokalaemia
Hypomagnesaemia
Hypophosphatemia
Abnormal glucose metabolism
Cardiac failure
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14
Q

Define bulimia nervosa

A

Eating disorder characterised by repeated episodes of uncontrolled binge eating followed by compensatory weight loss behaviours and overvalued ideas regarding body shape/weight

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15
Q

Aetiology of bulimia nervosa

A

Sense of compulsion to eat
Binge eating
Fear of fatness
Compensatory weight loss behaviours

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16
Q

Predisposing factors for bulimia nervosa

A 
Biological
- female sex
- fhx
- early onset of puberty
- type 1 diabetes
- childhood obesity
Psychological
- physical or sexual abuse
- childhood bullying
- parental obesity
- pre-morbid mental health disorder
- preoccupation with slimness
- parents with high expectations
- low self-esteem
Social
- living in a developed country
- profession
- difficulty resolving conflicts
17
Q

Precipitating factors for bulimia nervosa

A 
Biological
- early onset puberty/menarche
Psychological
- perceived pressure to be thing may come from culture
- criticism regarding body weight or shape
Social
- environmental stressors
- family dieting
18
Q

Perpetuating factors for bulimia nervosa

A 
Biological
- co-morbid mental health problems
Psychological
- low self-esteem
- perfectionism
- obsessional personality
Social
- environmental stressors
19
Q

ICD-10 criteria for diagnosis of bulimia nervosa

A

Behaviours to prevent weight gain
- self-induced vomiting, alternating periods of starvation, drugs (laxatives, diuretics, appetite suppressants), excessive exercise
Preoccupation with eating
- sense of compulsion which leads to binging
Fear of fatness
- self-perception of being too fat
Overeating
- at least 2 episodes per week over a period of 3 months

20
Q

Subtypes of bulimia nervosa

A

Purging
- patient uses self-induced vomiting and other ways of expelling food from body
Non-purging
- patients use excessive exercise or fasting after binge

21
Q

Complications of repeated vomiting

A

CVS
- arrhythmias, mitral valve prolapse, peripheral oedema
GI
- mallory-weiss tears, increased salivary glands
Metabolic/Renal
- dehydration, hypokalaemia, renal stones, renal failure
Dental
- permanent erosion of dental enamel secondary to vomiting of gastric acid
Endocrine
- amenorrhea, irregular menses, hypoglycaemia, osteopenia
Derm
- Russel’s sign - calluses on back of hand due to abrasion against teeth
Pulmonary
- aspiration pneumonitis
Neuro
- cognitive impairment, peripheral neuropathy, seizures

22
Q

Management of bulimia nervosa

A 
Biological
- trial of antidepressants - fluoxetine
- medical complications 
Psychological
- psychoeducation about nutrition
- CBT
- interpersonal psychotherapy
Social
- food dietary to monitor patterns
- techniques to avoid binging 
- small, regular meals
- self-help programmes

Yr4 - Psych (13 decks)

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