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PHRM 845 > Eating Disorders - Titus-Lay > Flashcards

Eating Disorders - Titus-Lay Flashcards

1
Q

DSM 5 Diagnostic Criteria for Anorexia

A

Restriction of energy intake leading to a significantly low body weight

Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain, even though at a significantly low weight

Disturbance in the way in which one’s body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

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2
Q

Body weights lowest to highest based on eating disorders (anorexia, binge and purge, binge, bulemia)

A

Anorexia < Bulemia/binge and purge < healthy eating < binge eating < obesity

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3
Q

Anorexia is more prevalent in males or females?

A

Females

0.9% lifetime prevalence in females

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4
Q

Female to male ratio of anorexia prevalence?

A

3:1

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5
Q

Other conditions common in people with anorexia?

A

Depression
OCD
Suicidal ideation

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6
Q

2 types of anorexia

A

Restricting type

Binge-eating/purging type

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7
Q

Restricting type of AN

In last 3 months pt (has/has not) engaged in recurrent episodes of binge eating or purging behavior

A

Has NOT

Weight loss is accomplished through dieting, fasting, and/or excessive exercise

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8
Q

Binge-eating/purging type

In last 3 months pt (has/has not) engaged in recurrent episodes of binge eating or purging behavior

A

Has

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9
Q

What is the main difference between the binge-eating/purging type of AN and bulimia nervosa disorder?

A

binge-eating/purging type of AN typically have a lower body weight

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10
Q

BMI of mild AN

A

> 17

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11
Q

BMI of moderate AN

A

16-16.9

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12
Q

BMI of severe AN

A

15-15.9

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13
Q

BMI of extreme AN

A

<15

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14
Q

What is the lowest normal BMI according to the CDC and WHO?

A

18.5

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15
Q

Health consequences of AN

A

Slow HR and low BP - risk for HF and fatal arrhythmia
Reduced bone density
Muscle loss/weakness
Severe dehydration
Fainting, fatigue, overall weakness
Dry skin, hair loss
Growth of a downy layer of hair all over the body (including the face)

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16
Q

How does the body cope with not having enough energy to perform daily function?

A

It slows down to preserve energy

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17
Q

What results in re-feeding syndrome?

A

A shift from fat metabolism to glucose metabolism

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18
Q

Consequences and main concern of re-feeding syndrome?

A

Electrolyte imbalances (K, Mg, and Phos)
Water retention
Severe edema
Multiple organ failure (main concern!)

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19
Q

Inpatient treatment of AN

A

Electrolyte and fluid correction
Increase calories by 500 kcal/d every 4 days to 3500 kcal/d
Cognitive behavioral therapy
Pharmacotherapy

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20
Q

Outpatient treatment of AN

A

1200-1500 kcal/d
Increase weekly by 500 kcal
Cognitive behavioral therapy
Pharmacotherapy

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21
Q

Pharmacotherapy for AN

A

No drug therapy is FDA approved yet

Fluoxetine and TCAs may be helpful

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22
Q

What drug is contraindicated in AN?

A

Bupropion

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23
Q

DSM 5 Diagnostic Criteria for Binge eating disorder

A

Marked distress regarding binge eating

Occurs, on average, at least once a week for 3 months

NOT associated with recurrent use of inappropriate compensatory behavior

Recurrent episodes of binge eating characterized by BOTH of the following:

  • Eating, in a discrete period of time an amount of food that is larger than what most people would eat in a similar period of time
  • A sense of lack of control over eating during the episode
24
Q

Binge-eating episodes are associated with 3 or more of what 5 criteria?

A

Eating much more rapidly than normal
Eating until feeling uncomfortably full
Eating large amounts of food when not feeling physically hungry
Eating alone because of feeling embarrassed by how much one is eating
Feeling disgusted with oneself, depressed or very guilty afterward

25
Q

Female to male ratio of prevalence of binge eating disorder

A

1:0.7

26
Q

What other conditions are common in people with binge eating disorder?

A

Depression
Anxiety
Borderline personality disorder
Substance use disorders

27
Q

How many calories count as a binge?

A

~3500 kcal

Some people can eat upwards of 6,000-10,000 kcal in one episode

28
Q

How many episodes in mild binge eating disorder?

A

1-3 per week

29
Q

How many episodes in moderate binge eating disorder?

A

4-7 per week

30
Q

How many episodes in severe binge eating disorder?

A

8-13 per week

31
Q

How many episodes in extreme binge eating disorder?

A

14 or more per week

32
Q

Health consequences of binge eating disorder?

A 
High blood pressure
High cholesterol
Heart disease
T2DM
Gallbladder disease
33
Q

Binge eating disorder treatment

A

Cognitive behavioral therapy
Pharmacotherpy
CBT + medication provides best outcomes

34
Q

Pharmacotherapy for binge eating disorder

A

Lisdexamfetamine (FDA approved for moderate-severe)

SSRIs, TCAs, armodafinil, topiramate (not FDA approved)

35
Q

DSM 5 Criteria for Bulimia Nervosa diagnosis

A

Recurrent inappropriate compensatory behaviors in order to prevent weight gain (vomiting, laxatives, diuretics, excessive exercise)

Occur on average at least once weekly for 3 months

Self-evaluation is excessively influenced by body shape and weight

Disturbance does not occur exclusively during episodes of anorexia nervosa

Recurrent episodes of binge eating characterized by both of the following:

  • Eating, in a discrete period of time an amount of food that is larger than what most people would eat in a similar period of time
  • A sense of lack of control over eating during the episode
36
Q

Female to male ratio of prevalence of bulmia nervosa

A

3:1

37
Q

What puts individuals at an increased risk of developing bulimia nervosa

A

Individuals with anxiety as a child
History of sexual or physical abuse
Childhood obesity
Early pubertal maturation

38
Q

What disorders are common in people with bulimia nervosa?

A

Atypical depression
Seasonal affective disorder
Impulsive disorders (borderline personality disorder, substance use disorders, bipolar disorder)

39
Q

How many episodes in mild bulimia?

A

1-3 per week

40
Q

How many episodes in moderate bulimia?

A

4-7 per week

41
Q

How many episodes in severe bulimia?

A

8-13 per week

42
Q

How many episodes in severe bulimia?

A

14 or more per week

43
Q

Methods of purging for bulimia nervosa?

A 
Vomiting
Laxatives
Diuretics
Excessive exercise
"diabulimia"
44
Q

What is diabulimia?

A

When type 1 diabetics do not give themselves insulin to make themselves lose weight

45
Q

Health consequences of bulimia?

A

Electrolyte imbalances
Inflammation, gastric rupture, esophageal rupture from frequent vomiting
Tooth decay and staining from stomach acid released during frequent vomiting
Chronic irregular bowel movements and constipation as a result of laxative abuse
Physical sores from exercising too much
Diabetic ketoacidois from withholding insulin in type 1 DM

46
Q

Treatment of bulimia nervosa

A

CBT
Pharmacotherpay
CBT + medication provides best outcomes

47
Q

Pharmacotherapy for bulimia

A

Fluoxetine (FDA approved - also useful for underlying depression)
TCAs, trazodone, and MAOIs (not FDA approved)

48
Q

FDA approved drug(s) for treatment of binge eating disorder

A

Lisdexamfetamine

49
Q

FDA approved drug(s) for treatment of AN

A

None!

50
Q

FDA approved drug(s) for treatment of bulimia

A

Fluoxetine

51
Q

What eating disorder meets all the criteria for AN except that despite significant weight loss, the individual’s weight is within or above the normal range

A

Atypical anorexia nervosa

52
Q

What eating disorder meets all the criteria for bulimia except the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months

A

Bulimia nervosa of low frequency and/or limited duration

53
Q

What eating disorder meets all the criteria for binge-eating except that the binge eating occurs, on average, less than once a week and’or for less than 3 months

A

Binge-eating disorder of low frequency and/or limited duration

54
Q

What eating disorder is characterized by recurrent purging behavior to influence weight or shape in the absence of binge eating

A

Purging disorder

55
Q

What eating disorder is characterized by recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal?

A

Night eating syndrome

56
Q

During night eating syndrome there (is/is not) awareness and recall of the eating

A

is

57
Q

Night eating syndrome can not be better explained by what 2 things?

A

External influences such as changes in the individual’s sleep-wake cycle or by local social norms
Binge-eating disorder or another mental disorder, including substance use, adn is not attributable to another medical disorder or to an effect of a medication

PHRM 845 (2 decks)

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