Eating Disorders Flashcards
What is an Anorexia Nervosa?
An eating disorder characterized by deliberate weight loss, an intense fear of fatness, distorted body image and endocrine disturbances
What is the aetiology of Anorexia Nervosa?
- Aetiology is multifactorial
- Affects female to male in 10:1. Typical age of onset is mid-adolescence
- Most common cause of admission to child and adolescent psychiatry. Prevalence of between 1:100 and 1:200
What is the ICD-10 criteria for Anorexia Nervosa?
Features must be present for at least 3 months and there must be the ABSENCE of (1) recurrent episode of binge eating; (2) preoccupation with eating/craving to eat
- Fear of weight gain
- Endocrine disturbances result in amenorrhoea in females and loss of sexual interest and potency in males
- Emaciated (abnormally low body weight: >15% below expected weight or BMI <17.5 kg/m2)
- Deliberate weight loss with ↓ food intake or ↑ exercise
- Distorted body image
What are other clinical features of Anorexia Nervosa?
- Physical: Fatigue, Hypothermia, Bradycardia, Arrhythmias, Peripheral oedema, headache, Lanugo hair, Hypotension, Reduced BMI, Enlarged salivary gland
- Preoccupation with food: dieting, preparing elaborate meals for others
- Socially isolation, Sexuality feared
- Symptoms of depression and obsessions
What is the investigations for Anorexia Nervosa?
- Blood Tests: FBC (anaemia, thrombocytopenia, leukopenia), U&Es (hypokalaemia, hypophosphatemia, hypomagnesaemia, hypochloraemia, ↑urea and creatinine if dehydrated), LFTs (↓albumin), Lipids (Hypercholesterolaemia), Raised cortisol and GH, Sex hormone (Low FSH, LH, oestrogens and testosterone), Impaired glucose tolerance, Hypercarotenaemia, Low T3, Amylase
- Venous Blood Gas (VBG): metabolic alkalosis (vomiting), metabolic acidosis (laxatives)
- DEXA scan: rule out osteoporosis
- ECG: arrhythmias such as sinus bradycardia and prolonged QT associated with AN patients
- Questionnaires: e.g., eating attitude test (EAT)
What are differentials for Anorexia Nervosa?
- Bulimia nervosa
- Depression
- OCD
- Schizophrenia
- Organic causes of low eight
- Alcohol or substance misuse
- EDNOS
What is the management for psychological management of Anorexia Nervosa?
Psychological
- Needs at least 6 months duration for psychological treatment
- Risk assessment for suicide and medical complications vital.
- For adults with anorexia nervosa
- Individual eating-disorder-focused cognitive behavioural therapy (CBT-E)
- Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
- Specialist supportive clinical management (SSCM).
- In children and young people, NICE recommend
- ‘Anorexia focused family therapy’ as the first-line treatment.
- Second-line treatment is cognitive behavioural therapy.
General management
- Hospitalization is necessary for medical and psychiatric reasons. In cases where insight is clouded, use of MHA or Children act for lifesaving treatment
- Patient at risk of refeeding syndrome which causes metabolic disturbance and other complications.
What is the biological managment of Anorexia Nervosa?
- Treatment of complications.
- SSRI for co-morbid depression or OCD
Aim of treatment as an inpatient is for weight gain of 0.5-1kg/week and as outpatient 0.5kg/week.
What are complications of Anorexia Nervosa?
- Metabolic: hypokalemia, hypercholesterolaemia, hypoglycaemia, impaired hlucose tolerance, deranged LFTs, ↑ urea and creatinine, ↓phosphate, ↓magnesium, ↓albumin and ↓chloride
- Endocrine: ↑cortisol, ↑growth hormone, ↓thyroid hormones, ↓ LH, FSH, oestrogens and progestogens leading to amenorrhoea, ↓Testosterone in men
- Gastrointestinal: Enlarged Salivary Glands, Pancreatitis, Constipation, Peptic Ulcers, Hepatitis
- Cardiovascular: Cardiac failure, ECG abnormalities, Arrhythmias, Low BP, Bradycadia, Peripheral Oedema
- Renal: Renal Failure, Renal Stones
- Neurolgical: Seizures, Peripheral Neuropathy, Autonomic Dysfucntion
- Haematological: Iron Deficiency Anaemia, Thrombocytopenia, Leucopenia
- Musculoskeletal: Proximal Myopathy, Osteoporosis
- Others: Hypothermia, Dry Skin, Brittle Nails, Lanugo Hair, Infections, Suicide
How is Anorexia Nervosa compared to Bulimia Nervosa?
Anorexia Nervosa
- Are significantly underweight
- More likely to have to have endocrine abnormalities such as amenorrhoea
- Do not have strong cravings for food
- Do not binge eat
- May have compensatory weight loss behaviours
- Irrational fear of fatness
- Abnormal hair growth
- Restriction of food intake
- Xerostomia
Bulimia Nervosa
- Usually normal weight/overweihgt
- Less likely to have endocrine abnormlities
- Strong cravings for food
- Recurrent episode of binge eating
- Compensatory weight loss behaviours are present
- Mood disturbances
- Low potassium
- Irregular periods
What is the definition of Bulimia Nervosa?
Type of eating disorder characterised by repeated episodes of uncontrolled binge eating followed by compensatory weight loss behaviours and overvalued ideas regarding ideal body shape/weight.
What are types of Bulimia Nervosa?
2 subtypes
- Purging Type: self-induced vomiting and other ways of expelling food from body
- Non-Purging type: exercise use
Describe the cycle that present in Bulimia Nervosa?
What are risk factors for Bulimia Nervosa?
- Typically occurs in young women.
- BN has equal socioeconomic class distribution
- Common co-exists with following psychiatric disorder hence important to screen for the: depression, anxiety, deliberate self-harm, substance misuse, emotionally unstable personality disorder
What are ICD-10 for diagnosis of Bulimia Nervosa?
- Behaviours to prevent weight gain (compensatory). This includes self-induced vomiting, alternating periods of starvation, drugs (laxative, diuretics, appetite suppressants, amphetamines and thyroxine) and excessive exercise
- Preoccupation with eating: A sense of compulsion to eat which leads to bingeing. Typically regret or shame after episode
- Fear of fatness: self-perception of being too fat
- Overeating: at least 2 episodes per week over period of 3 months
What are the other clinical features of Bulimia Nervosa?
- Normal weight
- Depression and low self esteem
- Irregular period
- Signs of dehydration: ↓blood pressure, dry mucous membrane, ↓skin turgor, sunken eyes, ↑capillary refill time
- Consequence of repeated voting and hypokalaemia
What are investigations for Bulimia nervosa?
- Blood Tests: FBC, U&Es, Amylase, Lipids, Glucose, TFTs, Magnesium, Calcium, Phosphate
- Venous blood gas: may show metabolic alkalosis
- ECG: Arrhythmias as consequence of hypokalaemia, classic ECG changes (prolongation of PR interval, Flattened or Inverted T waves, Prominent U waves after T waves)
What is the biological management of Bulimia Nervosa?
- Pharmacological treatments have a limited role - a trial of high-dose fluoxetine is currently licensed for bulimia.
- Treat complications of the disease. Electrolytes monitored carefully for any potential disturbances and should be replaced accordingly where appropriate
What are the psycholigical treatment measure for Bulimia Nervosa?
Adults
- Recommend bulimia-nervosa-focused guided self-help for adults
- If bulimia-nervosa-focused guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks of treatment, individual eating-disorder-focused cognitive behavioural therapy (CBT-ED) is recommended. Interpersonal psychotherapy also used alternatively
Children
- Children should be offered bulimia-nervosa-focused family therapy (FT-BN)
- Food diary to monitor eating/purging patterns, techniques to avoid bingeing, small and regular meals, self-help programmes
- Risk assessment for suicide. Co-morbid depression and substance misuse common. Mental health act not usually required
What are the social factors in the management of Bulimia nervosa?
- Referral for specialist care is appropriate in all cases
- Inpatient treatment required for cases of suicide risk or severe electrolytes imbalances. Mental health act not usually needed
