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Psychiatry > Eating disorders > Flashcards

Eating disorders Flashcards

1
Q

What is anorexia nervosa?

A

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

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2
Q

What are the risk factors for anorexia nervosa?

A
  • Family history
  • Female
  • Early menarche
  • Sexual abuse
  • Low self-esteem
  • Occupation: ballet dancers, modesl
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3
Q

What are the features of anorexia nervosa?

A

- Fear of weight gain

  • Endocrine abnormalities - causing amenorrhoea (growth hormone, glucose, cortisol, cholesterol raised)
  • BMI <17.5 kg/m2
  • Deliberate weight loss
  • Distorted body image
  • Physical: fatigue, hypothermia, bradycardia, arrhythmias, peripheral oedema, lanugo hair
  • Preoccupation with food: dieting or preparing elaborate meals for others
  • Symptoms of depression
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4
Q

What are the distinguishing features of anorexia nervosa (from bulimia nervosa)?

A
  • Significantly underweight
  • Amenorrhoea
  • No cravings for food
  • Don’t binge eat
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5
Q

How can bulimia nervosa be distinguished from anorexia nervosa?

A
  • Usually normal weight / overweight
  • Less likely to have endocrine abnormalities
  • Strong cravings for food
  • Binge eaters
  • Compensatory weight loss behaviours
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6
Q

What questions for anorexia nervosa?

A

What would be your ideal target weight?

The obvious things people do to lose weight are eat less and exercise more, is this important to you?

When women lose significant weight, their periods stop, has this happened to you?

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7
Q

What investigations should there be for anorexia?

A

Blood tests - FBC (anaemia, thrombocytopenia, leukopenia) U&Es (increased urea and Cr if dehydrated, decreased K, Ph, Mg and Cl), TFTs, LFTs (decreased albumin), lipids (increased cholesterol), increased cortisol, decreased sex hormones, decreased glucose, amylase (pancreatitis is a complication)

VBG - Metabolic alkalosis (vomiting), metabolic acidosis (laxatives)

DEXA scan - rule out osteoporosis

ECG - Arrhythmias e.g. sinus bradycardia and prolonged QT

Questionnaire: eating attitudes test

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8
Q

What are the differentials for anorexia nervosa?

A
  • Bulimia nervosa
  • Depression
  • OCD
  • Schizophrenia with delusions about food
  • Organic: diabetes, hyperthyroidism, malignany
  • Alcohol misuse
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9
Q

What is the biopsychosocial mangement of anorexia nervosa?

A

Bio = treat medical complications e.g. electrolyte disturbances, SSRIs for co-morbid depression or OCD

Psycho = psycho-education, CBT, IP therapy, FT (for 6 months)

Social = self-help groups

RISK ASSESS for suicide and medical complications

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10
Q

What is the first line treatment for children and young people with anorexia nervosa?

A

Family based therapy

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11
Q

What is refeeding syndrome?

A
  • After prolonged starvation, then when increased food there is insulin surge causing hypokalaemia, hypomagnesaemia, hypophosphataemia and abnormal glucose metabolism
  • Phosphate depletion can cause reduction in cardiac muscle activity leading to cardiac failure
  • Refeed slowly and monitor electrolytes
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12
Q

What is bulimia nervosa?

A

Eating disorder characterized by repeated episodes of uncontrolled binge eating followed by compensatory weight loss behaviours

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13
Q

What is the prognosis of patients with anorexia nervosa?

A

Poor - 10% of patients die of the disorder

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14
Q

Is there a genetic component to bulimia?

A

Role of genetics is unclear (unlike AN)

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15
Q

After a binge, what happens in patients with BN?

A

Feel guilty and undergo compensatory behaviours e.g. vomiting, using laxatives, exercising excessively

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16
Q

What are the risk factors for bulima nervosa?

A
  • Female
  • FH of eating disorder
  • Early onset of puberty
  • T1DM
  • Childhood obesity
  • Sexual abuse as child
  • Occupation
  • Co-morbid mental health problems
17
Q

What may BN be comorbid with?

A
  • Depression
  • Anxiety
  • Deliberate self harm
  • Substance misuse
  • Borderline personality disorder
18
Q

How can bulimia nervosa be diagnosed?

A
  • Behaviours to prevent weight gain (vomiting, laxative, diuretics and exercise)
  • Bingeing
  • Fear of fatness
  • Overeating (at least 2 episodes per week over period of 3 months)

(usually normal weight, irregular periods, signs of dehydration - low BP, dry mucous membranes, increased capillary refill time)

19
Q

What is a life threatening complication of excessive vomiting?

A
  • Low potassium resulting in muscle weakess, cardiac arrhythmias and renal damage
  • If mild then eat bananas or supplements
  • If severe then hospitalization and IV K+ replacement
20
Q

What investigations for bulimia nervosa?

A

Bloods: FBC, U&Es, amylase, lipids, glucose, TFTs, magnesium, calcium, phosphate

VBG: may show metabolic alkalosis

ECG: arrhythmias as a consequence of hypokalaemia

21
Q

What are the differentials for bulimia nervosa?

A

Anorexia nervosa

EDNOS - eating disorder not otherwise specified

Depression

OCD

22
Q

What are the physical complications of repeated vomiting?

A
  • Arrhythmias
  • Mitral valve prolapse
  • Mallory-Weiss tear
  • Increased size of parotid gland
  • Dehydration - renal stones / failure
  • Erosion of dental enamel
  • Amenorrhoea, irregular menses
  • Russell’s sign (calluses on back of hands due to abrasions on teeth)
  • Aspiration pneumonitis
  • Cognitive impairment
23
Q

What does the management of bulimia nervosa involve?

A

Bio = fluoxetine is SSRI of choice, treat complications e.g. potassium imbalance

Psycho = CBT / Interpersonal therapy

Social = food diary, techniques to avoid bingeing, small, regular meals

RISK ASSESS (MHA is usually not required as patients have good insight)

Psychiatry (13 decks)

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