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PPC2 Exam 1 > Eating Disorders General and Anorexia Nervosa > Flashcards

Eating Disorders General and Anorexia Nervosa Flashcards

1
Q

Overview of eating disorders (7)

A
  1. Complex illness with profound psychosocial and physical consequences
  2. Third most common chronic illness after asthma and obesity
  3. Peak age of onset is 14 to 18 years
    * But can occur at much younger and older ages
  4. Deep dissatisfaction with the patient’s own body and shape—fear of fatness
  5. Increase in prevalence of anorexia
  6. 10% of general population suffers from it but only a minority seek treatment
  7. Increasing recognized in the minority
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2
Q

DSM V Classifications of eating disorders (6)

A
  1. Anorexia nervosa
  2. Bulimia nervosa
  3. Binge eating disorder
  4. Avoidant/restrictive food intake disorder (ARFID)
  5. Rumination disorder
  6. Pica
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3
Q

Eating Disorder Risk Factors (8)

A
  1. : Female gender, particularly adolescent or young adult females.
  2. Certain ethnic groups such as Asians, Native Americans, and African Americans appear less likely to have eating disorders than other ethnic groups.
  3. Weight and Shape: Higher body mass index, concerns about weight, and a history of dieting.
  4. History of psychiatric problems: Depression, anxiety, or substance use
  5. Childhood eating difficulties or sexual abuse.
  6. Genetics
    * Behavioral genetic studies using twin designs → substantial genetic effect for the liability for each of these disorders.
  7. Psychobiology: Serotonin may be abnormal in eating disordered individuals. Seen more commonly in white, middle/ upper class females
  8. Job or profession that demands thinness
    * Models
    * Actors
    * Entertainers
  9. Overeaters
    * Nursing
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4
Q

Predisposing and Precipitating Risk Factors (6)

A
  1. Self-objectification and body dissatisfaction
  2. Depression and negative affect
  3. Impulsivity and distress tolerance
  4. Self-critical perfectionism
  5. Response to internal body signals
  6. Family functions
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5
Q

Characteristics of Patient with Eating Disorders (10)

A
  1. Difficulty resolving conflict
  2. Low self esteem
  3. Ambivalence about growing up
  4. History of sexual abuse
  5. Over involved family
  6. Lack of conflict resolution
  7. Poor communication
  8. Chronic illness
  9. Poor indicators for resolution in AN
    a. Disturbed parent child relationship
    b. Long duration of illness or later onset
    c. Concomitant personality disorder
    d. Presence of vomiting
  10. Poor indicator of resolution of BN
    a. Presence of significant depression
    b. Comorbidity with substance abuse
    c. Coexisting personality disorder
    d. History of sexual abuse
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6
Q

Evaluation of the Patient with a Possible Eating Disorder (4)

A
  1. Screening: Making a diagnosis
  2. Assessing nutritional and psychosocial status
  3. Determine the degree of malnutrition
  4. Evaluating the acute medical complications
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7
Q

Reproductive health history questions with eating disorders (male and female)

A

Male: Ask about libido? Morning erections? Changes?

Females: First period? Regular? Last period and how much did you weigh then

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8
Q

SCOFF Questionnaire (5)

A
  1. Do you make yourself sick because you feel uncomfortably full?
  2. Do you worry you have lost control over how much you eat?
  3. Have you recently lost >1 stone (6.3 kg or 14 lb.) in a 3-mo period?
  4. Do you believe yourself to be fat when others say you are too thin?
  5. Would you say that food dominates your life?
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9
Q

Questionnaire (EDE-Q) - Interview and Questionnaire

A

EDE Interview

  1. Developed in 1987
  2. Gold standard in eating disorder diagnosis
  3. 16th edition
  4. Semi-structured clinical interview that takes 30 to 60 min to complete.

EDE questionnaire

  1. 36-item questionnaire derived from the EDE interview 11th edition
  2. Acceptable internal consistency and test-retest reliability
  3. Validated in the adult population but has not been validated in the adolescent or female athlete population
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10
Q

Female Athlete Screening Tool (FAST) (5)

A
  1. 33-item questionnaire
  2. Developed specifically for female athletes (24).
  3. 15 min to complete
  4. Validated in a collegiate population with subjects from both Division I and Division III National Collegiate Athletic Association schools.
  5. Compared using the EDE-Q, Bulimia Test-Revised (BULIT-R), EDI-2, and FAST. Reliability analysis demonstrated high internal consistency (Cronbach > = 0.87)
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11
Q

Eating Attitudes Test (Eat-26) (5)

A
  1. Widely used standardized self-report measure of symptoms and concerns characteristic of eating disorders
  2. Original EAT-40 that was first published in 1979 and refined
  3. Many different languages
  4. Reliability 0.9 (high)
  5. Validity 0.6 to 0.93
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12
Q

Eating Disorder Inventory-3 (7)

A
  1. Reliability 0.83-0.93
  2. Validity 0.43 to 0.68
  3. Use with females ages 13–53 years.
  4. 91 items divided into twelve subscales rated on a 0-4 point scoring system.
  5. 3 items are specific to eating disorders and 9 are general psychological scales that while not specific are relevant to eating disorders.
  6. Six composites: Eating Disorder Risk, Ineffectiveness, Interpersonal Problems, Affective Problems, Over control, General Psychological Maladjustment.
  7. Self-report questionnaire administered in twenty minutes
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13
Q

ROS with eating disorders (10)

A
  1. Dizziness
  2. Syncope, weakness, fatigue
  3. Pallor, easy bruising or bleeding?
  4. Cold intolerance?
  5. Hair loss, lanugo, dry skin?
  6. Vomiting, diarrhea, constipation?
  7. Fullness, bloating, abdominal pain, epigastric burning?
  8. Muscle cramps, joint paints, palpitations, chest pain?
  9. Menstrual irregularities?
  10. Symptoms of hyperthyroidism, diabetes, malignancy, infection, inflammatory bowel disease?
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14
Q

Orthostatic Hypotension (how it is measured and 3 scenarios in which it is significant)

A

WILL BE ON THE EXAM!

Check the patientʼs blood pressure and pulse in a sitting position (with feet on floor), then have the patient stand for two minutes and retake BP & HR

Significant/positive if

  1. Increase of 20 beats per minute
  2. A decrease of 20 mm HG in systolic BP
  3. A decrease of 10 mm Hg is diastolic BP

*Important to do orthostatic for patients with suspected eating disorders

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15
Q

Eating disorder physical exam findings (8)

A
  1. Scaphoid abdomen
  2. muscle wasting
  3. acrocyanosis
  4. decreased subcutaneous fat
  5. lanugo hair
  6. ecchymosis
  7. diminished reflexes,
  8. dry skin
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16
Q

General PE findings (3)

A
  1. Hypothermia
  2. Cachexia; facial wasting
  3. Russel sign – cuts on top of hands or fingers from sticking fingers down throat
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17
Q

HEENT PE Findings (2)

A
  1. Sialadenitis (parotitis most frequently reported)

2. Angular stomatitis; palatal scratches; oral ulcerations; dental enamel erosion

18
Q

Cardiac PE Findings (3)

A
  1. Sinus bradycardia; other cardiac arrhythmias
  2. Orthostatic changes in pulse (>20 beats per min) or blood pressure (>10 mm Hg)
  3. Cardiac murmur (one-third with mitral valve prolapse)
19
Q

Skin PE Findings (7)

A
  1. Dull, thinning scalp hair
  2. Dry, sallow skin
  3. Lanugo/Bruising/abrasions over the spine related to excessive exercise
  4. Russell sign (callous on knuckles from self-induced emesis)
  5. Cold extremities; acrocyanosis; poor perfusion
  6. Carotenemia (orange discoloration of the skin, particularly palms and soles)
  7. Edema of the extremities
20
Q

Pubertal Changes (2)

A
  1. Delayed or interrupted pubertal development

2. Atrophic breasts; atrophic vaginitis (postpubertal)

21
Q

Psychiatric PE Findings

A

Flat or anxious affect

22
Q

Assessing nutritional and psychosocial status: Lab tests (11)

A
  1. Serum electrolytes with Liver function (comprehensive metabolic profile)
  2. Magnesium
  3. Phosphorus
  4. Blood urine nitrogen and creatinine
  5. Complete blood count
  6. Urinalysis
  7. TSH, Free T4
  8. If amenorrhea, LH, FSH and prolactin
  9. If amenorrhea for more than 6 months, evaluate bone mineral density
  10. If obese, fasting lipid profile, insulin measurement, fasting glucose (Rome, 2016)
  11. Elevated CK with eating disorders
23
Q

ECG Findings (7)

A
  1. Low voltage ECG is common with eating disorders

Obtain if the patient has

  1. Bradycardia (heart rate less than 50)
  2. Abnormal rhythm
  3. Palpitations
  4. Chest pain
  5. Electrolyte imbalance
  6. If athletic heart: Healthy voltage due to the large amount muscle depolarization and repolarization
24
Q

Undernourished heart on ECG

A

Low voltage due to heart muscle loss during starvation

25
Q

Laboratory studies (7)

A
  1. Hematocrit, hemoglobin, transferrin (decreased amounts)
  2. Serum glucose, albumin, electrolytes (decreased)
  3. May have hypernatremia
  4. Liver enzymes (elevated liver function)
  5. Thyroid function (low thyroxin)
  6. Creatinine phosphokinase (elevated)
  7. Electrocardiogram (ECG) (abnormalities)
26
Q

Ideal Body Weight definition

A

Weight believed to be maximally healthful for a person, based chiefly on height but modified by factors such as gender, age, build, and degree of muscular development.

Calculation is adjusted if a patient has a lot of muscle; their ideal body weight would be higher

27
Q

Ideal Body Weight calculation for males

A

50 kg + 2.3 kg (5.06 pounds) for each inch over 5 feet.

*Need to be able to calculate percentage below that a patient is to determine severity of eating disorder

28
Q

Ideal Body Weight calculation for females

A
  1. 5 kg + 2.3 kg for each inch over 5 feet.

* Need to be able to calculate percentage below that a patient is to determine severity of eating disorder

29
Q

Determine the degree of malnutrition via weight and height (4)

A
  1. Calculate the ideal body weight and proportion below ideal body weight (IBW)
  2. A child who is 20% below the IBW is moderate malnutrition
  3. A child who is 25% below the IBW represents severe malnutrition
  4. If the patient is not yet 20% below the IBW, then the child has mild malnutrition
30
Q

Mild, moderate, and severe malnutrition based on %BMI

A

Mild: 80-90% of BMI

Moderate: 70% of BMI

Severe: <70% of BMI

31
Q

Mild, moderate, and severe malnutrition based on BMI z score

A

Mild: -1 to -1.9

Moderate: -2 to -2.9

Severe: -3 or greater

32
Q

Mild, moderate, and severe malnutrition based on weight loss

A

Mild: >10% body mass loss

Moderate: >15% body mass loss

Severe: >20% body mass loss in 1 year or >10% in 6 months

33
Q

DMS 5: Diagnostic Criteria For Anorexia Nervosa (6)

A
  1. Restriction of energy intake relative to requirements
    * Leads to a low body weight in terms of age, sex, and developmental level.
    * BMI below the 10th percentile
  2. Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain
  3. Body image disturbances with an undue influence of weight and shape or persistence lack of recognition of the seriousness of the illness
  4. 1,2,3 must be present then you determine if it is binging/purging
  5. Type is based on whether there is binging/purging or not
  6. The requirement for amenorrhea has been eliminated.
34
Q

Anorexia Nervosa Diagnostic Criteria Specifics

A

Low body weight results from either strict diets and/or excess hyperactivity
*Pursued beyond the bounds of reason and with decreased in age-appropriate activities

35
Q

Anorexia Nervosa Diagnostic Types: Restricting Type

A

Within the last three months, no engagement in recurrent episodes of binge eating or purging behavior
Weight loss is accomplished through dieting, fasting, and/or excessive exercise

36
Q

Anorexia Nervosa Diagnostic Types: Binge-eating/purging type

A

During last three months, there has been engagement in binge eating or purging behavior (self-induced vomiting or misuse of laxative, diuretic or enemas)

37
Q

Anorexia Nervosa Remission Specifics (Partial vs. Full)

A
  1. In partial remission: After full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time
  2. In full remission: After full criteria for bulimia nervosa were previously met, none of the criteria have been met for a sustained period of time
38
Q

Anorexia Nervosa Severity Levels (4)

A
  1. Mild: BMI ≥ 17 kg/m2
  2. Moderate: BMI 16-16.99 kg/m2
  3. Severe: BMI 15 – 15.99 kg/m2
  4. Extreme: BMI ≤ 15
39
Q

Anorexia Nervosa management (15)

A
  1. Seek Information First
  2. Gather in a non-judgmental way
  3. No assumptions
  4. Use a non-confrontational approach
  5. Express compassion
  6. Make appropriate referrals
  7. PNPs must be aware of own biases and feeling towards these patients
  8. Establish trust
  9. Reestablish nutritional intake to restore physical health
  10. Family based treatment models with parents as central role
    * Most effective part of this treatment along with multidisciplinary approach
  11. Nutrition counseling
  12. Medication—antidepressants or anti-anxiety medications
  13. Small amounts more often if the adolescent has fasted for a long period of time
  14. Hospitalization -Has certain criteria
  15. Now a move towards more feeding rather than less feeding
40
Q

Prognosis in Anorexia Nervosa Associated with Physical Hyperactivity (6)

A

Hyperactivity is associated with:

  1. More severe psychopathology
  2. Lower BMI
  3. Higher dissatisfaction with one’s own body
  4. Worse response to treatment
  5. More chronic course
  6. Hyperactivity is actually worse than eating restriction: poor prognosis; means more psychopathology
41
Q

Medical Complications of Anorexia Nervosa (21)

A
  1. Acrocyanosis
  2. Dry skin
  3. Lanugo
  4. Ecchymosis
  5. Fatigue
  6. Muscle wasting
  7. Constipation
  8. Decreased deep tendon reflexes
  9. Orthostatic hypotension
  10. Atrophic breasts
  11. Atrophic vaginal area
  12. Bradycardia
  13. Mitral valve prolapse
  14. Pericardial effusion
  15. ECG abnormalities
  16. Decreased left ventricular mass and contractility
  17. Psychomotor retardation
  18. Growth delay
  19. Amenorrhea
  20. Osteopenia, osteoporosis
  21. Hair without shine

PPC2 Exam 1 (13 decks)

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