Eating Disorders and Refeeding Syndrome Flashcards

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1
Q

What is an indication for hospitalization in reference to suicide in eating disorders?

A

hospitalize when patients have specific suicide plan or intent

–> high lethality

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2
Q

Does bulimia nervosa or anorexia nervosa have higher suicide rates?

A

bulimia–> 7x higher than general population
—- 25-40% hx attempt

anorexia–> 5x higher than general population
—— 8-27% hx attempt

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3
Q

What should you screen for with a patient with bulimia or anorexia?

A

suicide ideation

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4
Q

Describe anorexia nervosa

A

restriction of energy intake–> low body weight for age, sex, and development

intense fear of gaining weight or becoming fat, despite being underweight

distorted perception of body weight and shape–> decreased self-worth, denial of medical seriousness of low body weight

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5
Q

What are the types of anorexia nervosa?

A

Restricting:
-3 months of no binging or purging via self-induced vomiting or laxatives
~~~excessive exercising, fasting, dieting

Binge eating/purging:
- 3 months of binging and purging behaviors
~~~self-induced vomiting; misuse of laxatives, diuretics and enemas

-how to distinguish from bulimia: AN has low body weight

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6
Q

Describe a person with anorexia nervosa

A

constant viewing in mirror

weight body or body parts constantly

deny starvations sx even when emaciated

weight is form of control–> self esteem centers around it

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7
Q

What worsens as anorexia patients lose weight?

A

fear of weight gain rises as they lose weight–> out of control

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8
Q

Medical complications of anorexia

A

arrhythmias, brady, hypotension, QT dispersion, mitral valve prolapse

amenorrhea and decreased libido (losing weight starts to attract others, out of control loses interest in partners and sex)

osteoporosis, hypothermia, euthyroid, hypoglycemia

gastroparesis and constipation d/t excessive laxative use

dehydration, hypokalemia, low phosphate, low magnesium (huge electrolyte disturbances)

respiratory muscle atrophy and dyspnea

anemia, leukopenia, thrombocytopenia

brain atrophy

skin issues

refeeding syndrome

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9
Q

Describe refeeding syndrome

A

result of fluid and electrolyte shifts during aggressive nutritional rehab of malnourished patients

complications are potentially fatal:
low phosphate and potassium, CHF, peripheral edema, rhabdo, seizures, hemolysis

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10
Q

How to avoid refeeding syndrome?

A

limit amount of calories and fluid in early stages of refeeding

avoid very rapid increases in daily calories

closely monitor labs and patient during first few weeks of refeeding

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11
Q

Comorbidities of anorexia

A
OCD
impulse control disorders
depression
personality disorders
perfectionism, compulsivity, narcissism
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12
Q

Anorexia treatment

A

when in doubt–> hospitalize

interdisciplinary team of mental health, dietician, IM

minimum first line of care: nutrition rehab, psychotherapy

hospitalize d/t SI, resistance to refeeding–> stay until normal weight to reduce re-hospitalization

anorexia and associated psych usually resistant to meds, only use with depression/anxiety that create barriers to care

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13
Q

Range for gaining weight in anorexia patients

A

2-3lb per week for inpatients

0.5-1lb gained per week for outpatients

initial intake of 30-40 calories more, progressively increase to match weight goals and avoid refeeding syndrome

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14
Q

First line therapy for anorexia

A

nutrition rehab AND psychotherapy (CBT, motivational interview, family therapy in adolescents)

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15
Q

Pharm considerations for anorexia

A

consider only in patients who are resistant to other therapies and are willing to take meds

low dose d/t increase side effects a/w low weight, dehydration, etc

AVOID BUPROPION d/t increased seizure risk with binge/purge subtype

AVOID TCA d/t cardiotoxicity

Olanzapine helps weight gain
Lorazepam reduces anxiety around meals
SSRI if severe anxiety/depression
–> second generation antipsychotics if not responsive

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16
Q

Criteria for diagnosing bulimia nervosa

A

recurrent episodes of binge eating (large in discrete period of time, can’t control eating during this time)

inappropriate compensatory behavior to prevent gaining weight (purging)

at least 2 times per week for 3 months

weight is normal, slightly under or over, or obese

17
Q

Do bulimics focus on weight as much as anorexics?

A

anorexia obsessed with staying thin and not gaining weight

bulimics fearful of gaining weight but don’t need to be thin (just don’t want to be fat)
—————> feel like shit after binging

18
Q

Medical complications of bulimia

A

same as anorexia with:

Mallory-Weiss syndrome/esophageal rupture
parotid or submandibular gland hypertrophy
abd pain/bloating/constipation

tooth enamel erosions and caries, Russel’s sign (callus on dorsum of hand from self-purging)

19
Q

Comorbidities of bulimics

A

anxiety, mood, substance use disorders

personality disorders

impulsivity, perfectionism, compulsivity, narcissism

20
Q

Treatment for bulimia

A

nutrition rehab

CBT (treatment of choice)–> stop binge/purge but not reducing weight

pharm (less effective if used alone)

pharm and CBT appropriate if can’t get nutrient rehab

AVOID BUPROPION d/t seizure risk

21
Q

Pharm for bulimia

A

Fluoxetine first line

SSRIs at higher starting doses second line (sertraline or fluvoxamine)

third line: TCA, topiramate, trazadone, MAOIs

22
Q

Criteria for binge eating disorder (BED)

A

episodes of binge eating, lack control
–> large amounts when not hungry, rapid eating, uncomfortable after eating, eating alone, guilt and depression or disgust after episode

once a week for at least 3 months

  • ***** no regular use of inappropriate compensatory behaviors (purging, fasting, excessive exercise)
  • -> how to differentiate between this and bulimia
23
Q

Treatment for binge eating disorder

A

reduce binge eating, excess weight gain, comorbidities, body image concerns

psychotherapy first line treatment (CBT and IPT)

Vyvanse only med to treat

SSRIs with CBT but not more effective than CBT alone

anti-obesity drugs not recommended d/t side effects