Eating disorders Flashcards
What is anorexia nervosa?
Eating disorder characterized by deliberate weight loss, fear of fatness, distorted body image and endocrine disturbances
What are the risk factors for anorexia nervosa?
- Family history
- Female
- Early menarche
- Sexual abuse
- Low self-esteem
- Occupation: ballet dancers, modesl
What are the features of anorexia nervosa?
- 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
What are the distinguishing features of anorexia nervosa (from bulimia nervosa)?
- Significantly underweight
- Amenorrhoea
- No cravings for food
- Don’t binge eat
How can bulimia nervosa be distinguished from anorexia nervosa?
- Usually normal weight / overweight
- Less likely to have endocrine abnormalities
- Strong cravings for food
- Binge eaters
- Compensatory weight loss behaviours
What questions for anorexia nervosa?
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?
What investigations should there be for anorexia?
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
What are the differentials for anorexia nervosa?
- Bulimia nervosa
- Depression
- OCD
- Schizophrenia with delusions about food
- Organic: diabetes, hyperthyroidism, malignany
- Alcohol misuse
What is the biopsychosocial mangement of anorexia nervosa?
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
What is the first line treatment for children and young people with anorexia nervosa?
Family based therapy
What is refeeding syndrome?
- 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
What is bulimia nervosa?
Eating disorder characterized by repeated episodes of uncontrolled binge eating followed by compensatory weight loss behaviours
What is the prognosis of patients with anorexia nervosa?
Poor - 10% of patients die of the disorder
Is there a genetic component to bulimia?
Role of genetics is unclear (unlike AN)
After a binge, what happens in patients with BN?
Feel guilty and undergo compensatory behaviours e.g. vomiting, using laxatives, exercising excessively
What are the risk factors for bulima nervosa?
- Female
- FH of eating disorder
- Early onset of puberty
- T1DM
- Childhood obesity
- Sexual abuse as child
- Occupation
- Co-morbid mental health problems
What may BN be comorbid with?
- Depression
- Anxiety
- Deliberate self harm
- Substance misuse
- Borderline personality disorder
How can bulimia nervosa be diagnosed?
- 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)
What is a life threatening complication of excessive vomiting?
- 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
What investigations for bulimia nervosa?
Bloods: FBC, U&Es, amylase, lipids, glucose, TFTs, magnesium, calcium, phosphate
VBG: may show metabolic alkalosis
ECG: arrhythmias as a consequence of hypokalaemia
What are the differentials for bulimia nervosa?
Anorexia nervosa
EDNOS - eating disorder not otherwise specified
Depression
OCD
What are the physical complications of repeated vomiting?
- 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
What does the management of bulimia nervosa involve?
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)
