Eating Disorders Flashcards
What is an Eating Disorder?
Umbrella term for a group of mental health disorders (MHDs) characterised by negative beliefs about eating, body shape and weight accompanying behaviours including restricted eating, binge eating, excessive exercise, vomiting and laxative/diuretic use.
Which sex do EDs generally affect?
Females (3:1)
What is a MUST score?
Malnutrition Universal Screening Tool (MUST) used as a rapid nutritional assessment tool screening for nutritional risk and dietetic involvement
What are the categories in a MUST score?
BMI (0-2): >20 / 18.5-20/ 18.5 >
Weight loss (0-2): < 5%/ 5-10%/ > 10%
Acutely unwell (0 or 2): Yes or No
What are the risk categories are there for the MUST assessment?
Low Risk (0)
Medium risk (1)
High Risk (2≤)
What is the definition of weight loss?
Loss of 5% body weight over 6 months
When communicating with Adolescents, what key features do you aim to obtain in a Social History?
Home Education + Employment Eating Activities + hobbies Drugs (Alcohol + Tobacco) Sex Self-harm + self-image Safety
What is Avoidant-Restrictive Food Intake Disorder?
Eating disorder characterised by lack of interest in food, fears of negative consequences of eating and selective eating with 1 Sx ≤ weight loss, nutritional deficiency, supplement dependency and interference with psychosocial functioning.
Give 3 Sx and S of ARFID?
- Selective eating (fussy eating)
- Fear of negative consequences of eating
- Dependence on nutritional supplements
• Weight loss
Give the Tx for ARFID?
• Family-based therapy
±
• Nutrition
What is Anorexia Nervosa?
Eating disorder characterised by caloric intake restriction leading to low body weight, intense fear of gaining weight, body dysmorphia
What is the Sx Triad for Anorexia Nervosa?
Weight + Fear + Body dysmorphia
Give 5 Sx and S of being Anorexic
- Low body weight: ≤ 18.5 kg/m2
- Fear of gaining weight
- Disturbed body image (body dysmorphia)
- Calorie restriction
- Purging (behaviours to counteract food): Psychogenic vomiting; Diet pills; Laxatives; Diuretics)
- Fatigue
- Poor concentration
- Amenorrhoea
- Loss of libido
- Orthostatic hypotension
- Non-specific GI: Constipation/Fullness/Bloating/Cramping gas
- Cardiac Sx: QTc prolongation/1st degree AV heart block; T-wave changes
- Decreased SC fat
- Lanugo
- Cracked nails
- Hair thinning
The presence of hair growth due to nutritional deficiencies in Anorexia nervosa is termed?
Lanugo
How do you diagnose Anorexia?
Clinical Diagnosis –> SCOFF Qs (Sick/Control/One Stone/Fat/Food)
What is the Tx for Anorexia Nervosa?
• Nutritional Rehabilitation: Dietary assessment; Balanced meal plan (1500-1800kCal); Fluid intake; Vitamin + Mineral replenishment (+ monitoring)
±
• Psychotherapy: Counselling/CBT
+ (Medically unstable/outpatient failure)
• Admission: Oral/Enteral/Parenteral nutrition
±
• Fluid intake correction
±
• Potassium Repletion: 40-100mEq PO OD or IV PRN
-> KCl
±
• Magnesium Repletion: 10-20mmol IV OD
-> Mg(SO4)2
±
• Calcium Repletion: 100-1000mg IV every 6 hours
-> Calcium gluconate
±
• Sodium Repletion: Fluid restriction + balanced nutrition/ Hypertonic Saline (if severe Sx – seizures; confusion; coma)
+ (Depression)
• SSRIs: Fluoxetine/Sertraline
+ (OCD)
• CBT
• SSRIs: Fluoxetine/Sertraline
What is Bulimia Nervosa?
Eating disorder typified by recurrent episodic binge eating in conjunction with compensatory purging behaviours (– psychogenic vomiting; fasting; excessive exercise; misuse of laxatives; diuretics; enemas or other medication), lasting at least weekly for 3 months.
Give the Sx + S of Bulimia Nervosa
• Recurrent episodic binge eating: Discrete period time + ≥ Normal intake – speed/amounts/fullness/cephalic/embarrassed/guilty
-> At least 1 week-1 over 3/12
• Purging behaviour: Psychogenic vomiting/Laxatives/ Enemas/ Suppositories
• Compensatory behaviour: Fasting/ Excessive exercise
• Body dysmorphia: Weight/Shape-conscious
• Depression: Persistent low mood + Anergia + Anhedonia
• Menstrual irregularity
• Misuse of insulin
• Self-harm
• GI Sx: GORD/Diarrhoea/Constipation/Abdominal pain
- Dental erosion: Abrasive food/ HCl/ Night-grinding
- Russel Sign: Calluses on dorsum of hand from psychogenic vomiting
- Parotid hypertrophy
- Arrhythmia
Give the Tx for Bulimia Nervosa
• Nutritional Rehabilitation: Dietary assessment; Balanced meal plan (1500-1800kCal); Fluid intake; Vitamin + Mineral replenishment (+ monitoring)
±
• Psychotherapy: CBT -> x9 20 min support sessions over 16/52
+ (Depression)
• SSRI/SNRI: Fluoxetine/ Sertraline/ Venlafaxine
-> Fluoxetine 1st; Sertraline tolerated best; Venlafaxine for rapid onset
What is Binge Eating Disorder?
Eating disorder characterised by regular, episodic binge eating which may be planned and commonly leads to weight gain.
Give the Sx + S of Binge Eating Disorder
- Impulsivity: Buying large quantities/Eating rapidly/Eating when not hungry
- Obsession: Organising life around food/ Eating when not hungry/ Time talking about food
- Asocial behaviour: Eating in isolation
- Irritability
- Mood lability: Mood swings
- Low self-esteem/confidence
- Co-morbid MHDs
- Tiredness
- Fatigue
- Weight gain
- Bloating
- Constipation
- Abdominal pain
