Eating disorders Flashcards

1
Q

What questionnaire can be used?

A

Deps R

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2
Q

How do we pick up eating disorders?

A

SCOFF questionnaire

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3
Q

Features of Scoff questionnaire

A

If patients score 2 or more positive answers, then an eating disorder is likely:
Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone (14 pounds or 6.35 kg) in a three month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?

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4
Q

Description of anorexia nervosa?

A

obsessive fear of fatness…
with avoidance of food & other sources of calories..
..& a range of compulsive ‘compensatory’ behaviours when food cannot be avoided
-

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5
Q

Features of Anorexia Nervosa

A
  • Restriction of intake to reduce weight
  • Relies on compulsive compensatory behaviours when food cannot be avoided, Self induced vomiting, laxative abuse, excessive exercise, abuse of appetite suppressants / diuretics
  • Fear of weight gain
  • amenorrhoea, absence of menstrual cycle
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6
Q

When is someone considered anorexic?

A

15% below ideal body weight/BMI 17.5 or <

ideal is 20-25

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7
Q

Anorexia - what happens when someone restricts calorie intake

A
  • loss of fat, glycogen from liver

- break down skeletal/cardiac muscle

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8
Q

Symptoms of anorexia?

A
Cold intolerance
Blue hands and feet
Constipation
Bloating
Delayed puberty
Primary or secondary amenorrhea
Dry skin
Fainting
Hypotension
hair loss
weakness/fatigue
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9
Q

Bulimia Nervosa features

A

Episodes of binge eating with a sense of loss of control
Binge eating is followed by compensatory behaviour of the purging type (self-induced vomiting, laxative abuse, diuretic abuse) or nonpurging type (excessive exercise, fasting, or strict diets).

  • dissatisfaction with body shape and weight
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10
Q

anorexia nervosa binge purge sub type is diagnosed when

A

BMI <17.5

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11
Q

Bulimia Nervosa features?

A
Mouth sores
Pharyngeal trauma
Dental caries
Heartburn, chest pain
Esophageal rupture
Muscle cramps
Weakness
Bloody diarrhoea
Irregular periods
Fainting
*Swollen parotid glands*
hypotension
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12
Q

Binge eating disorder has the absence of?

A

absence of purging

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13
Q

Binge Eating Disorder features?

A
  • Ongoing and/or repetitive cycles often include
    unusually fast eating, usually alone.
    unusually large amounts consumed.
    uncomfortably full; often “buzzed” after eating.
    embarrassment, shame, guilt, depression.
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14
Q

Binge eating disorders often get better with?

A

CBT

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15
Q

Avoidance of calorie intake?

A
diets – becoming vegetarian, vegan
not touching food or grease
pickiness
eating slowly
avoiding social occasions
spoiling foods
medication abuse
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16
Q

Getting rid of calories?

A
Self-induced vomiting 
Chewing & spitting out
Overexercise – often secret
Overactivity
Cooling
blood letting
medication abuse
17
Q

what is Diabulimia?

A

combination of diabetes and bulimia

- take less insulin in than needed after meals - eg carbohydrate diet but omits insulin in purging behaviour

18
Q

OTHER EATING DISORDER BEHAVIOURS?

A

‘Body-checking’ - repeated weighing, mirror , hands around wrist, taking photos

  • pro- ana websites
  • competing with self and others
  • self hard
19
Q

Psychological consequences (4)

A
  • extreme overvaluation of low weight
  • obsessive weight losing feels like a solution not a problem
  • reduced central coherence, narrowed focus of interest - don’t see the bigger picture
  • unable to interpret emotions
  • anxiety eating in company
  • fail to find other ways to cope
20
Q

malnourished brains experience?

A

experience depression, anxiety, obsessionality and loss of concentration on anything but food.
- depression at a low weight rarely responds to medication

21
Q

Social consequences of eating disorders?

A

are forced to lie and cheat, even to steal about eating disorder concerns. Sufferers withdraw from friendships and lose interest in sexual relationships/ family relationships

22
Q

Physical consequences

A

Starvation causes physical damage, poor repair and resistance, heart damage, reduced immunity to infections, anaemia, bone loss, fertility problems
- impaired white cell count

  • re-nutrition is more urgent the younger the patient due to growth and pubertal development
23
Q

purging behaviours causes?

A

neuro-chemical disruption with special damage to brain (seizures) and heart (arrhythmias). Potassium is only one crude measure of the problem

24
Q

if purging goes on for many years?

A

oesophageal function doesn’t fully recover

25
Q

Predisposing factors

A

social pressure to be thin

  • life events
  • conflicts
  • losses
  • stresses

Genetic predisposition – OCD, anxiety disorders, perfectionism
Perinatal factors
Life events – and traumas
Perpetuating consequences of starvation and of avoidance

26
Q

% of eating disorders in monozygotic twins?

A

65%

27
Q

Precipitating factors of eating disorders?

A

Puberty
Dieting or even non-deliberate weight loss
Increased exercise
Stressful life events

28
Q

What does overexercise cause ?

A

endorphin release and may result in a picture which resembles both addictive and obsessive-compulsive psychopathology. Starved animals and humans may become paradoxically hyperactive, aggitated and aggrerssive

29
Q

Perpetuating factors- starvation syndrome consequences (4 main)

A

Delayed gastric emptying - sensations of fullness interpreted as fatness,

narrowing focus with avoidance of interpersonal interest, change of values so that food becomes the most salient stimulus.

Obsessionality. Phobia of ‘fat’ increases as avoidance increases. ‘Body checking’ amplifies body image concern

Families, School, Clinic staff
High EE in family(and other carers) may delay recovery (Butzlaff & Hooley, 1998)

30
Q

highest mortality rate of any psychiatric disorder?

A

anorexia

31
Q

average recovery time for anorexia?

A

6 – 7 years

32
Q

Treatment for ED?

A

Re-feeding
- CBT 40 sessions
Mantra - 20 sessions
SSCM - 20 sessions

  • specialised family work
33
Q

Medication for ED?

A

INTERPERSONAL psychotherapy , or

fluoxetine 60mg daily - purging

  • olanzapine - antipsychotic - shuts out thoughts
34
Q

Some of the human rights acts?

A

The Human Rights Act (1998)

Scottish Mental Health Act