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M2 Neuro/Psych > Eating Disorders & Obesity - Russeth > Flashcards

Eating Disorders & Obesity - Russeth Flashcards

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1
Q

What differentiates anorexia from avoidant / restrictive food intake disorder?

A
  • Both feature weight loss and restricted food intake
  • Anorexia also has disordered body image
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2
Q

What differentiates binge-eating disorder from bulimia?

A
  • Both feature binging / overeating.
  • Bulimia also features purging behavior (vomiting, excessive laxative use, etc.)
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3
Q

Describe some of the general features of anorexia nervosa.

A
  • Intense pursuit of weight-loss & self-induced starvation
    • fear of becoming obese
    • dieting & excessive exercise
    • paradoxically focused on food
  • Disturbance in body image
    • Believe they are fat even though they are thin
  • Medical signs & symptoms of starvation
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4
Q

What are the DSM IV criteria for anorexia nervosa?

(Bonus: What changed from DSM IV to DSM V?)

A
  • Weight loss to <85% of ideal body weight or failure to make expected weight gains in children & adolescents
    • Changed to just “significantly low weight” in DSM V
  • Intense fear of gaining weight or behaviors that interfere with weight gain
  • Disturbance in how one perceives thier body
  • Amenorrhea for 3 months in post-menarcheal females
    • This criteria was removed in DSM V
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5
Q

What subtypes of anorexia nervosa exist?

A
  • Restricting Type (most common)
  • Binge-eating / purging type
    • Differentiate from bulimia on basis of the patient’s weight and other classical symptoms of anorexia (e.g. amenorrhea)
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6
Q

What BMI corresponds to a cetegorization of anorexia nervosa as:

  1. Mild?
  2. Moderate?
  3. Severe?
  4. Extreme?
A
  1. Mild: >17
  2. Moderate: 16-16.99
  3. Severe: 15-15.99
  4. Extreme: <15
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7
Q

What is binging/purging?

A
  • Eating a large amount in a short period
  • Compensatory behavior ot get rid of the food/weight
  • Feelings of loss of control during episode
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8
Q

What physiological signs of starvation would be noted when measuring a patient’s vitals?

A
  • Hypotension
  • Bradycardia
  • Hypothermia
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9
Q

What physiological signs of starvation can be noted in the following organ systems? (1 of 2)

  • Cardiac
  • Skeletal
  • Endocrine
A
  • Cardiac
    • Bradycardia
    • Hypotension
    • Syncope
    • EKG changes
    • Arrhytmias
    • Sudden Death
  • Skeletal
    • Osteopenia
    • Osteoporosis
  • Endocrine
    • Decreased LH, FSH, & estradiol, abnormal TSH
    • Cold intolerance, hypothermia
    • Decreased libido, amenorrhea
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10
Q

What physiological signs of starvation can be noted in the following organ systems? (2 of 2)

  • Dermatologic
  • Hematologic
  • Gastrointestinal
  • Neurologic
A
  • Dermatologic
    • Dry skin
    • Alopecia
    • Lanugo (fine baby-like hair over the body)
  • Hematologic
    • Pancytopenia
  • Gastrointestinal
    • Delayed gastric emptying
    • Constipation
  • Neurologic
    • Fatigue, weakness
    • Reduction in brain mass/volume
    • Cognitive deterioration
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11
Q

Describe the demographics of anorexia nervosa.

What is the #1 risk factor for the disease?

A
  • Females > Males, 10:1
  • Onset typically in mid-teens. Increasing in preadolescents!
  • 1% of the population
    • 5% of population shows subclinical signs
  • #1 Risk Factor: Dieting!
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12
Q

Are there believed to be genetic factors that contribute to developing anorexia nervosa?

A

Yes.

Higher rates in monozygotic twins.

Strong family history for mood disorders.

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13
Q

What type of psychological factors/features are often seen in anorexia nervosa patients?

A
  • Perfectionist, harm-avoidant, high-achieving
  • Feel helpless, not able to establish autonomy, demands to increase independence
  • Focus on food vs. “normal” activities
  • Maturation fears: fear of becoming an adult, being shapely or sexual
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14
Q

What other conditions should be ruled out (aka on your differential) before making a diagnosis of anorexia nervosa?

A
  • Brain tumor or cancer
  • Other psychiatric disorder:
    • Depression
    • Somatization
    • Schizophrenia
    • Bulimia
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15
Q

What is the **most lethal **psychiatric disorder?

A

Anorexia nervosa! 7-18% mortality rate.

(75% have good to moderate prognosis)

May require impatient medical stabilization

Key point: Don’t ignore weight loss in teenage patients!

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16
Q

Describe the treatment of anorexia nervosa.

A
  • Food is the best treatment!
  • Hospitilization if needed
    • Correct dehydration, electrolyte abnormalities
    • Reinstate nutrition, correct metabolic abnormalities
  • Treatment team is key
    • PCP, psychiatrist, dietician, psychotherapist
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17
Q

What is refeeding syndrome?

A
  • Dangerous shift in fluid and electrolytes during nutritional rehabilitation
  • Risk related to:
    • Amount of weight lost
    • Rapidity of weight restoration
  • Can be life-threatening
    • Hypophosphatemia
    • Delirium
    • Arrhythmias & Cardiac Arrest
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18
Q

What kinds of psychotherapy are used to treat anorexia nervosa? Name three specific methods.

A
  • Family, individual, and group therapy
    • Maudsley Family Based Treatment:
      • Parents play active role in restoring weight, gradually hand over control back to patient
    • Cognitive behavioral therapy (CBT):
      • Address cognitive distortions
    • Dielectical behavioral therapy (DBT):
      • Address behaviors that interfere with treatment
19
Q

What kinds of medications are used to treat anorexia nervosa?

A
  • No medication has consistently shown benefit for the core symptoms of anorexia nervosa. None are indicated.
  • Medications are used to treat psychic comorbidities
    • Depression, social phobia, OCD, etc.
20
Q

What are the DSM IV criteria for bulimia nervosa?

(Bonus: How did they change in DSM V?)

A
  • Recurrent episodes of binge eating followed by inappropriate compensatory behavior in order to prevent weight gain
  • Episodes occur at least twice a week for three months
    • ​DSM V seperates binge eating and compensatory behaviors into two criteria and requires episodes of each occur at least once per week for 3 months
  • Self evaluation is unduly influenced by body shape and weight
  • The disturbance does not occur exclusively during anorexia nervosa
21
Q

What are the DSM IV subtypes of bulimia nervosa?

A
  • Purging type
  • Nonpurging type
  • These were removed in DSM V
22
Q

How is the “severity” of bulimia nervosa ranked? What falls under each category?

  • Mild
  • Moderate
  • Severe
  • Extreme
A
  • Based on # of compensatory behavior episodes per week
  • Mild: 1-3
  • Moderate: 4-7
  • Severe: 8-13
  • Extreme: 14+
23
Q

What types of compensatory behaviors exist in bulimia nervosa? Name 5.

A
  • Purging
    • Vomiting
    • Misuse of laxatives, diuretics, enemas
  • Other
    • Excessive exercise
    • Restrictive dieting
    • Skipping meals
24
Q

What physical exam findings of bulimia can be noted by observation alone?

A
  • Swollen cheecks
    • Parotid gland hypertrophy or infection
  • Metacarpal-phalangeal calluses (Russel’s signs)
    • Abrasions on knuckles from scraping against teeth
  • Dental erosions and caries from gastric acid in the mouth
    • Front teeth that are chipped or ragged and “moth-eaten”
25
Q

What are the findings in the following systems in bulimia nervosa?

  • GI
  • CV
  • Endo
  • Neuro
A
  • GI
    • GERD, esophageal varices/rupture
    • melanoisis coli
      • ​From laxative overuse - discoloration of colon wall noted on colonoscopy. Benign with no sequelae in of itself.
  • CV
    • Arrhythmias & myopathies
  • Endo
    • Menstrual abnormalities
  • Neuro
    • Neuropathy, fatigue, cognitive slowing, seizures
26
Q

What lab findings are noted in bulimia nervosa?

Which are specifically associated with vomiting and diuretic use?

With laxative abuse?

A
  • From vomiting and diuretic use:
    • Metabolic alkalosis: low K+, low Na+, high bicarb
    • Also low Cl-
  • From laxative abuse:
    • Hyperchloremic metabolic acidosis: low K+, high Cl-, low bicarb
  • ​Other:
    • Low Mg2+
    • Elevated serum amylase
    • Generally normal lipase
27
Q

At what point is an inpatient evaluation indicated for bulimia nervosa?

A
  • If purging more than 3x/day
    • Excessive potassium loss can cause potentially lethal arrhythmias
28
Q

Describe the epidemiology of bulimia nervosa.

A
  • More common than anorexia nervosa: ~1-3% of population
  • Generally later onset than AN: Late adolescence/early adulthood
  • Up to 20-40% of college women report binging and purging
  • Genetics: 1st degree relatives with BN or depression
  • Endorphin release during purging reinforces vomiting
29
Q

What type of psychological factors/features are often seen in individuals who develop bulimia nervosa?

A
  • Overachiever, competitive
  • Secretive, ego dystonic, self-critical
  • Outgoing, angry, impulsive
  • Associated with many psych disorders:
    • Depression
    • Sustance use disorders (incl. EtOH)
    • Impulse control disorders
    • Personality disorders
    • Emotional lability
    • Anxiety
    • History of abuse
    • Dissociative disorders
30
Q

What other psych disorders should be ruled out before a diagnosis of bulimia nervosa is made?

A
  • Seizures
  • tumors
  • Kluver-Bucy
  • Klein-Levin
  • Other psych diagnoses may be comorbid
31
Q

What psych therapies are effective for treating bulimia nervosa?

A
  • Cognitive behavioral therapy
  • Dialectical behavioral therapy
  • Family therapy
  • Group therapy
    • (esp. for inpatients, though most cases do not require hospitalization)
32
Q

What medication is effective in treating bulimia nervosa?

What medication is contraindicated and why?

A

SSRIs - Fluoxetine is only FDA approved agents

Buproprion is contraindicated - increased seizure risk

33
Q

How does the prognosis of BN compare to that of AN?

A
  • Higher potential for full recovery than AN
  • If untreated, remains chronic
  • Poor prognosis if complicated by substance abuse issues
34
Q

What are some other more atypical eating disorders?

A
  • Specified:
    • Atypical AN (normal weight)
    • Low frequency/Limited duration BN or binge-eating disorder
    • Purging disorder
    • Night eating syndrome
  • Unspecified - if it causes clinically significant distress or impairment, it can probably be called an eating disorder
35
Q

What is the definition of obesity?

What is the definition of being overweight?

Is obesity an eating disorder?

A

Obese: >20% ideal body weight (IBW) or BMI > 30

Overweight: BMI 25-29.9

NO.

36
Q

How common is obesity in the US?

Being overweight?

List numbers for both adults and children.

A

>1/3 US adults are obsese. >2/3 are overweight or obese.

25% of preschool and 35% of school-age children are overweight or obese.

Child obesity rates are leveling off recently after many years of increasing rates.

37
Q

What percentage of Americans don’t meet activity level requirements?

What percentage are completely sedentary?

A

78%

25%

38
Q

What general types of therapy are useful in treating obesity?

What’s the gold standard?

A
  • Gold standard: Sensible diet and exercise
    • Caloric intake < Calories burned
    • N.B. Commercial dieting & weight loss programs: regain weight in 5yrs
  • Bariatric surgery
    • For the extremely obese
    • Initially effective, but questions regarding long-term efficacy
  • Pharmacologic agents
    • Variable efficacy & safety
39
Q

Name three prescribed drugs useful in treating obesity.

A
  • Orlistat
    • Pancreatic lipase inhibitor
  • Phentermine
    • Sympathomimetic amine, decreases appetite
  • Lorcaserin HCl
    • 5-HT2C agonist, increases satiety
  • Previously: Sibutramine HCl
    • Blocks monoamine reuptake, increases satiety
    • Off market due to risk of MI and stroke
40
Q

What is considered a reasonable rate of weight loss in adults?

A
  • 5-10% of initial body weight over 6 months or 1-2lbs per week
    • Cut back 500-1000 calories/day
  • Focus on keeping the initial 10% off for the whole 6 months and then evaluate if further weight loss is needed
41
Q

What is considered a reasonable rate of weight loss in children?

A
  • Losing weight at this age is dangerous, so weight loss is typically not recommended unless child is very obese
    • If so, focus on maintaining weight for 3mo and then slow weight loss, from 1lb/mo
  • Focus on maintaining weight or slowing weight gain by healthy eating & exercise
42
Q

What is most successful when it comes to making reasonable dietary changes in obese patients?

A

Behavioral modification

  • Recognize external cues
  • Keep food diary
  • Eat slowly, chew food well, stay seated while eating
  • Rewards/reinforcements

Also: do not skip meals. Limit portion sizes and limit calorie-dense foods/additives

43
Q
A

M2 Neuro/Psych (45 decks)

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