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Psychiatry > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

what are the genetic causes of anorexia?

A

signals that convey hunger + fullness

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2
Q

what are the obstetric complications associated with anorexia development?

A

maternal anaemia, dm, preeclampsia, placental infarction, neonatal cardiac abnormalities

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3
Q

what are the GI diseases associated with anorexia development?

A

coeliac, IBS, IBD

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4
Q

what are the factors from pubertal years that are associated with anorexia development?

A

increase in adipose, hormonal changes are risks

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5
Q

what are the psychiatric disorders associated with anorexia development?

A

OCD, depression, anxiety

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6
Q

what are the psychological causes of anorexia?

A

low self-esteem, loneliness, sensitivity to peer pressure, need for approval, overact to stressful situations, perfectionist, need for control, link to abuse

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7
Q

what are the sociological causes of anorexia?

A

peer groups, popular culture, models, dancers, bullying, media

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8
Q

what are the neuroimaging features in anorexia?

A

o alterations in dorsal anterior cingulate cortex (excessive cognitive control)
o somatosensory integration and introspection may relate to abnormal body image
o activations of bottom up limbic region and increased activations in top down cortical regions which may play a role in restrictive eating
o global reduction in grey matter and white matter, increased CSF fluid volumes
o regional decreases in the left hypothalamus, left inferior parietal lobe, right lentiform nucleus and right caudate, increased orbitofrontal cortex, reduced white matter in fornix

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9
Q

what process occurs in the starving state?

A

body uses up body fat, then muscle, then body itself for metabolism (eating liver)

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10
Q

what is the pathophysiology of anorexia?

A

dysregulation of the serotonin pathways
show reduced activation in reward system in response to food
increased binding potential of raclopride in striatum

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11
Q

what are the two types of anorexia?

A

o Restricting – reduce food intake

o Binge/Purge – eat large amounts of food then purge via vomiting/laxatives

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12
Q

how does binge/purge type of anorexia relate to bulima?

A

is bulimia except with low BMI?

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13
Q

what are the characteristic features of anorexia?

A
  • Low BMI
  • Fear of gaining weight
  • Methods of reducing weight – restricting calories, over-exercise, laxatives, vomiting, diuretics
  • Feeling of control
  • Food rituals
  • Obsession and pre-occupation with food and cooking
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14
Q

What are the physical consequences of anorexia?

A

muscle wasting - low Cr, fatigue, breathing problems, hair loss, lanugo hair, cold, blue peripheries, dry/peeling skin, Hypercarotenaemia, bradycardia, hypotension, orthostatic hypotension, Cardiac failure, ankle oedema, low potassium, magnesium and phosphate, low thiamine, amenorrhea, urine low LH and low FSH, falsely low T3 level, bloating, nausea, constipation, Low WBC, RBCs and platelets, Osteoporosis/osteopenia, Halitosis, Brain – atrophy, encephalopathy – ataxia, confusion, death

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15
Q

what is the ICD-10 criteria for anorexia?

A

o BMI 17.5 or less (less than 85% of expected)
o Self-induced weight loss (strict dieting, vomiting, excessive exercise, medication)
o body image disturbance
o fear of fatness
o amenorrhoea

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16
Q

what is the criteria for high risk anorexia?

A 
o	Bmi < 13; wt loss >1kg/week
o	Prolonged qt, hr<40, syst.bp <80
o	Core temp <34c
o	Squat test = unable to rise from squat without using arms for leverage
o	Cognitive impairment
17
Q

what is atypical anorexia?

A

anorexia but normal BMI

18
Q

what is a healthy BMI?

A

18.5-24.9

19
Q

what is the BMI in mild anorexia?

A

17-18.5

20
Q

what is the BMI in moderate anorexia?

A

16-17

21
Q

what is the BMI in severe anorexia?

A

15-16

22
Q

what is the BMI in life-threatening anorexia?

A

<15

23
Q

what is the management of anorexia?

A

structured meal plan
o oral nutrition 1st line
o inpatient admission (oral, enteral or parental nutrition)
o potassium repletion, magnesium repletion, calcium repletion, sodium repletion
CBT, SSRIs

24
Q

what is the pathophysiology of bulimia?

A
  • lower plasma tryptophan levels – decreased levels in brain therefor less synthesis of serotonin – increases bulimic urges
  • abnormal levels of peptides important for regulation of appetite and energy balance
25
Q

what are the genetic causes of bulimia?

A

family history of alcoholism, depression, eating disorder, obesity

26
Q

what are the causes of bulimia related to sex hormones?

A

hyperandrogenism and PCS, association between polymorphisms in oestrogen receptor B gene and bulimia

27
Q

what are the additional causes of bulimia?

A

addictive tendencies, childhood obesity, society portrayal of ideal body shape
Abuse

28
Q

what are the features on physical assessment in those with bulimia?

A

o calluses on knuckles (Russell’s sign) – from sticking fingers down throat
o parotid hypertrophy
o dental caries
o U&Es – low potassium

29
Q

what are the features of psychological assessments in those with bulimia?

A

depression, self-harm, erratic substance misuse, impulsive personality

30
Q

what are the additional clinical features in those with bulimia?

A

o drug seeking behaviour
o misuse of insulin
o GI symptoms – reflux, diarrhoea, constipation, abdominal pain

31
Q

what are the possible complications in those with bulimia?

A 
o	oesophageal reflux
o	oesophageal tears/rupture
o	hypokalaemia
o	subconjunctival haemorrhage
o	dehydration
o	seizures – metabolic abnormalities
32
Q

what is the ICD-10 criteria for bulimia?

A 
o	persistent preoccupation with eating
o	irresistible craving of food
o	binges
o	attempts to counter the effects of binges (starvation, vomiting, laxatives, drug misuse)
o	morbid dread of fatness
33
Q

what is the DSM-5 criteria of bulimia?

A

o Recurrent episodes of binge eating: An episode of binge eating is characterized by both (1) eating, in a discrete period of time (eg, within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances and (2) a sense of lack of control over eating during the episode (eg, a feeling that one cannot stop eating or control what or how much one is eating)
o Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
o The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months
o Self-evaluation is unduly influenced by body shape and weight
o The disturbance does not occur exclusively during episodes of anorexia nervosa

34
Q

what is the management of bulimia?

A
  • guided self-help (manuals, computer programmes)
  • CBT
  • High dose SSRI – reduce cravings to binge
  • nutritional and meal support
35
Q

what is the cause of refeeding syndrome?

A

occurs when eating after a long period of fasting

36
Q

what is the underlying mechanism of refeeding syndrome?

A
  • The result of a change in metabolism, from metabolising fats to metabolising carbohydrates
  • Insulin released after eating causes cellular uptake of electrolytes, leaving low serum levels
37
Q

what electrolytes are low in refeeding syndrome?

A

Low thiamine, low phosphate, hypoglycaemia, low potassium, low glucose

38
Q

what are the clinical features in re-feeding syndrome?

A

confusion, coma. Convulsions, death

39
Q

what is the management of re-feeding syndrome?

A

prevention via thiamine, vit B supplements, biochemistry monitoring

Psychiatry (11 decks)

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