Eating Disorders, Family Issues + Grief Flashcards
Female athlete triad
amenorrhea, ED, OP
Anorexia sx
Restriction of energy intake relative to requirements
Intense fear of gaining weight
Body dysmorphia - preoccupation with >1 perceived defect in physical appearance that is not noticeable to others
Types of AN
Restricting
Binge/ purge
Bulimia sx
Recurrent binge eating and inappropriate compensatory behaviour such as vomiting, laxatives, diuretics, fasting or exercise
Both on average once a week
RF for ED
Hx of dieting in childhood
Preoccupation with body + weight
Sports where leanness is good
Family hx of ED
Psych illness
Screening for ED
SCOFF
Complications of ED
CV = palpitations, CP, SOB, arrhythmia, edemia, MVP
Oral/ dental = lacerations, erosions, cavities
GI = epigastric pain, GERD, haematemesis, hemorrhoids, constipation
Endocrine = amenorrhea, reduced libido, reduced BMD, infertility
Derm = lanugo hair, hair loss, poor healing, brittle nails
General = weak, dizzy, fatigued, syncope, hot flashes
Ix + results for ED
CBC (anemia, leucopenia, thrombocytopenia)
Extended lytes (decreased)
FBG (low glucose)
LFTs (dysfunction)
TSH (low TSH + T4)
B-HCG
ECG (arrhythmia, prolonged QT)
BMD
Refeeding syndrome RF
little to no intake for >10 days, abnormal lytes, pt w/ profound wt loss
Prevention of refeeding syndrome
Inpatient unit
Reefed slowly
Monitor fluids, lytes , vitals + cardiac status
General management of EDs
MDT with doctor, dietician + MH
Nutritional rehab
Weight restoration
Cessation of bingeing + purging
Anorexia management
Nutritional rehab - multivitamin
Controlled wt gain - 30-40 cal/ kg/ day (1lb a week)
CBT, family therapy, MANTRA
Drugs only for comorbidities
Bulimia management
Nutritional counselling
CBT, family therapy
Fluoxetine
Complicated grief sx
Complicated grief: >6mo
Daily distress >6 months
4 of the following:
- difficulty accepting death
- difficulty trusting others
- difficulty moving on with life
- excessive bitterness or anger
- numbness or detachment
- life is meaningless
- lack of hope for future
- agitation
Complications of complex grief
Increased risk of cancer, HTN, CV disease + suicide
Social + occupational dysfunction
Reduced QoL
RF for complicated grief
Close relationship with deceased
Childhood abuse or neglect
Separation anxiety in childhood
Hx of psych problems
Poor social support
Loss of child or fetus
Unexpected or traumatic death
Management of complicated grief
Confronting avoided siutuations
Repeating story of death
CBT, IPT, group therapy
Healthy lifestyle
Join support group
Paroxetine or bupropion
Reasons for admission in anorexia
wt <75% of ideal wt, temp <35.5, hr <45, systolic BP <80, orthostatic changes in HR >20
