Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PC Ado > Eating DOs > Flashcards

Eating DOs Flashcards

1
Q

What eating disorders did we discuss in class?

A
  • Anorexia nervosa
  • Bulimia nervosa
  • Avoidant/Restrictive food intake disorder (used to be ED NOS)
  • Disordered eating
  • Binge eating disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the typical age of onset for eating disorders?

A

bimodal 14 and 18yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the gender ratio for eating disorders?

A

Female to male ratio 3:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lifetime prevalence of anorexia nervosa

A

0.9% females

03% males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the lifetime prevalence of bulimia nervosa?

A
  1. 5% females
  2. 5% males
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the lifetime prevalence of ED-NOS?

A

~5% all adolescents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the lifetime prevalence of binge eating disorder?

A

3.5% females

2% males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Is there a familial pattern to eating disorders?

A

Yes. More common in sisters and mothers of those with disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Mortality rate of eating disorders

A

5-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 most common chronic illnesses in adolescent girls?

A
  1. Obesity
  2. Asthma
  3. Eating Disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Childhood risk factors for eating disorders

A

History of food refusal

Weight and body image concerns develop prior to puberty

may be a strong genetic component (hard to tease out)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some history “red flags” for an eating disorder?

A
  • unexplained weight loss / failure to gain expected weight
  • Change in eating pattern: progressive changefrom high caloric density foods to lower; vegetarianism/veganism, desier to “eat healthier”, frank restriction; focus on food or rituals
  • Change in activity pattern, exercise (meltdown if can’t do)
  • Lack of concern by teen/child about emaciation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is an “atypical” presentation of anorexia / eating disorder?

A
  • often in males
  • often in context of stressful family or life event
  • often a co-morbid psych dx (anxiety, ocd, depression)
  • Less likely to have body image disturbance- believe they’re thin
  • Weight loss is unexpected - “eating healthy”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why is an “atypical” presentation of eating disorder often delayed and why is this dangerous?

A
  • Seem to be eating healthy / are not worried about their body
  • Seen as a “passing phase”
  • Dangerous because:
    • interruption of normal pubertal processes may lead to shorter stature
    • Changes in brain volumes (MRI)
    • bone accretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some physical symptom red flags of an eating DO?

A
  • symptoms of malnutrition
    • wt loss / inability to maintain normal wt
    • amenorrhea - virtually 100%
    • constipation
    • abdominal pain, bloating (may even perceive feeling of food as pain)
    • fatigue
    • cold intolerance
    • light-headedness
    • signs of cognitive blunting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some presenting physical signs of AN?

A
  • Weight loss (any significant or unexpected weight loss in an adolescent is cause for concern)
  • amenorrhea (loss of menses for >3 months in a postmenarcheal female), pubertal delay
  • lack of growth or poor growth
  • changes in body hair (lanugo hair, hair loss or thinning)
  • skin changes (dry skin, hyperkeratotic areas, yellow or orange discoloration, pitting or ridging of the nails)
  • recurrent fractures
  • hypothermia (temperature as low as 35°C)
  • bradycardia
  • hypotension
  • acrocyanosis
  • peripheral edema
  • systolic murmur sometimes associated with mitral valve prolapse.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Differential Diagnoses for an ED

A
  • Medical Conditions
    • GI - Inflammatory bowel disease, malabsorption
    • Endocrine
      • DM, Addison’s, thyroid disease (st have vomiting, wt loss – no one believes it’s not on purpose)
    • Malignancies
    • CNS lesions
      • tumors, intracranial infections, increased ICP,
    • Miscellaneous - early pregnancy, sarcoidosis, cystic fibrosis
    • Chronic infections (TB, HIV – see fair number of young ppl either acquired at birth or sexual activity)
  • Psychiatric Disorders
    • Mood disorders, OCD, Body dysmorphic disorder (focus on one part of body – sth wrong with it), Substance use disorders, Psychosis

Esp anxiety and depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the cardinal features of anorexia nervosa?

A
  • Self-induced weight loss
  • Psychological disturbance
    • Distorted body image
    • Fear of obesity
  • Secondary physiological abnormalities
    • Result of malnutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which features of anorexia were removed in the transition from DSM IV to DSM V

A

requirement to be above 85th percentile

amenorrhea (absence of menstruation for at least 3 consecutive cycles)

  • important because this allows to catch more at risk ados!*
  • Also - amenorrhea not apply to male / prepuscent / contraception*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

AN: Subtype restricting vs binge/purge according to DSM-V

A
  • Restricting: During the last 3 months, the individual has not engaged in recurrent episodes of binge-eating or purging behavior
  • Binge/Purge: During the last 3 months, the individual has engaged in recurrent episodes of binge-eating or purging behavior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

DSM-V criteria for bulimia nervosa

A
  • Recurrent episodes of binge eating
  • Recurrent inappropriate compensatory behaviors to prevent wt gain
  • The binge eating and compensatory behaviors both occur, on avg, at least once per week for 3 mths (was twice)
  • self eval is unduly influenced by body shape and wt
  • This disturbance does not occur exclusively during episodes of AN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Subtypes of BN (DSMV)

A

used to be purging and non-purging, but removed for DSM V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the “compensatory behaviors” associated w/BN, according to DSM-V?

A

self-induced vomiting; misuse of laxatives, diuretics, or other medications, fasting; or excessive exercise

24
Q

What is constitutes binge eating d/o, according to DSM-V?

A

A

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

  1. Eating, in a discrete period of time (e.g. any 2 hr period), an amount of food that is definitely larger than most people would eat in the same situation
  2. A sense of lack of control over eating during the episode

B

The binge-eating episodes are associated with 3+ of the following:

  1. Eating much more rapidly than usual
  2. Eating until feeling uncomfortably full
  3. Eating large amounts of food when not physically hungry
  4. Eating alone because of being embarrassed by how much one is eating
  5. Feeling disgusted with oneself, depressed, or very guilty after overeating

C

Marked distress regarding binge-eating is present

D

The binge-eating occurs, on average, at least 1x/week for 3 months

E

The binge is not associated with the regular use of compensatory behaviors and does not occur exclusively during the course of AN or BN

25
Q

What constitutes ARFID, according to DSM V?

A

A

Inadequate intake; restricted range of food or calories → weight loss; sensory.

B

Reduced food intake due to emotional disturbance related to eating without concern for body image. Major meal conflicts.

C

Fear of eating related to an actual adverse event (choking, gagging, vomiting)

26
Q

What labs would you order for a suspected eating disorder?

A
  • CBC and platelets, ESR, BUN, CR, electrolytes, LFTs, Ca, phosphate, Mg, albumin, T4, TSH, ECG
    • Consider bone mineral density if amenorrheic for > 6 months

Hyperchloremic acidosis – are they purging?

27
Q

What nutritional assessment would you order for a suspected eating d/o?

A
  • 24 hour recall,
  • %IBW – utilize BMI 50%ile for age (~BMI <16) divide where they are by what 50th should be
  • Recent losses or gains
    • Can determine degree of malnutrition
28
Q

What are some complications of AN?

A
  • Fluid and electrolytes: Dehydration, hypokalemia, hyponatremia, hypophosphatemia, hypomagnesemia, hypoglycemia
  • Cardiovascular: Sinus bradycardia (sinus arrhythmia), orthostatic hypotension, ventricular dysrhythmias, reduced myocardial contractility, sudden death secondary to arrhythmias, cardiomyopathy secondary to ipecac use, mitral valve prolapse, ECG abnormalities (including low voltage, prolonged QT interval, and prominent U waves), pericardial effusion, congestive heart failure
  • Renal: Increased BUN, decreased glomerular filtration rate, renal calculi, edema, renal concentrating defect
  • GI: Delayed gastric emptying, constipation, elevated liver enzymes, superior mesenteric artery syndrome, rectal prolapse, gallstones
  • Hematologic: Anemia, leukopenia, thrombocytopenia
  • Endocrine or metabolic: Primary or secondary amenorrhea, pubertal delay, thrombocytopenia euthyroid sick syndrome (low-T3 syndrome), hypercortisolism, decreased serum testosterone level, partial diabetes insipidus, elevated cholesterol level
  • Low bone mass: Females with anorexia nervosa have reduced bone mass and increased fracture risk
  • Neuromuscular: Generalized muscle weakness, seizures secondary to metabolic abnormalities, peripheral neuropathies, syncope in absence of orthostatic hypotension, movement disorders, structural brain changes (MRI studies have demonstrated enlargement of the lateral ventricles and sulci and significant deficits in both gray- and white-matter volumes in the low-weight stages. Increases in sulcal volume and decreases in gray-matter volume may not be fully reversible with weight recovery.)
29
Q

What hematologic lab results are associated w/AN?

A

Leukopenia, anemia, thrombocytopenia, decreased serum complement C3 levels, decreased erythrocyte sedimentation rate (ESR <4 mm/hr).

30
Q

What chemistry results are associated with AN?

A

Increased blood urea nitrogen (BUN) concentration, mildly increased serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase levels, hypophosphatemia, depressed serum magnesium and calcium concentrations, increased cholesterol, increased serum carotene level, decreased vitamin A level, decreased serum zinc and copper levels.

31
Q

What endocrine changes are associated with AN?

A

The hormonal changes in AN reflect an adaptive response to malnutrition.

  • Thyroid: Normal thyrotropin (TSH), normal or slightly low thyroxine (T4), often low 3,5,3′-triiodothyronine (T3).
  • Growth hormone (GH): Decreased IGF-1 levels, normal or elevated GH levels.
  • Prolactin: Normal.
  • Gonadotropins: Low basal levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH); prepubertal 24-hour LH secretory pattern, blunted response to gonadotropin-releasing hormone.
  • Sex steroids: Low estradiol in females (<30 pg/mL), low testosterone in males.
  • Cortisol: Normal secretion on stimulation. Basal levels are within the reference range or occasionally slightly high.
32
Q

What cardiac findings associated with AN?

A

Electrocardiographic (ECG) changes including bradycardia, low-voltage changes, prolonged QTc interval, T-wave inversions, and occasional ST-segment depression; echocardiographic changes including decreased cardiac size, left ventricular wall thickness; increased prevalence of mitral valve prolapse, and pericardial effusion.

33
Q

What are some GI findings associated with AN?

A

Usually normal findings on upper GI tract series, with occasional decreased gastric motility; normal findings on barium enema.

34
Q

What are some renal / metabolic changes associated with AN?

A

Decreased glomerular filtration rate, elevated BUN concentration, decreased maximum concentration ability (nephrogenic diabetes insipidus), metabolic alkalosis, and alkaline urine.

35
Q

What are some bone changes associated with AN?

A

Low bone mineral density (BMD).

36
Q

Role of parents in AN

A

(a) Be patient, recovery often takes 5 to 6 years.
(b) Avoid blaming.
(c) Avoid comments (regarding adolescent’s weight and appearance).
(d) Promote a positive body image and healthy attitude toward eating and activity.
(e) Encourage family meals as often as reasonably possible.
(f) Avoid making food the struggle.
(g) Work with your health care team.

37
Q

Signs of bulimia nervosa

A
  • (a) body weight is usually normal or above normal;
  • (b) calluses on the dorsum of the hand secondary to abrasions from the central incisors when the fingers are used to induce vomiting (Russell sign);
  • (c) painless enlargement of the salivary glands, particularly the parotids; (d) dental enamel erosion (perimolysis);
  • (e) weight fluctuations;
  • (f) edema (fluid retention).
38
Q

What are some symptoms of AN?

A

Cold intolerance, postural dizziness, fainting; early satiety, abdominal bloating, discomfort and pain; fatigue, muscle weakness, muscle cramps; poor concentration.

39
Q

What are some symptoms of BN?

A
  • (a) weakness and fatigue;
  • (b) headaches;
  • (c) abdominal fullness and bloating;
  • (d) nausea;
  • (e) irregular menses;
  • (f) muscle cramps;
  • (g) chest pain and heartburn;
  • (h) easy bruising (from hypokalemia/platelet dysfunction);
  • (i) bloody diarrhea (laxative abusers)
40
Q

What would you do for an evaluation of BN?

A

complete history, physical examination, and laboratory screening including CBC, BUN and creatinine, electrolytes, glucose, calcium, phosphorus, serum amylase, ECG with rhythm strip, urinalysis (specific gravity).

hyperchloremic acidosis - purging?

41
Q

What are some complications associated with BN?

A
  • Fluid and electrolytes: dehydration, hypokalemia (the most frequently seen electrolyte abnormality), hyponatremia, hypophosphatemia.
  • Cardiovascular: cardiac arrhythmias, ipecac cardiomyopathy.
  • Gastrointestinal: parotid gland enlargement and increased serum amylase, esophagitis, Mallory-Weiss tears, rupture of the esophagus or stomach, acute pancreatitis, paralytic ileus secondary to laxative abuse, cathartic colon, Barrett esophagus.
  • Pulmonary: aspiration pneumonia secondary to vomiting, pneumomediastinum secondary to vomiting.
  • Dental: erosion of dental enamel, dental caries.
42
Q

How should treatment of AN and BN be approached?

A
  • Interdisciplinary team approach.
43
Q

What are some medical and nutrition interventions recommended for BN?

A
  • careful medical monitoring, the correction of any medical complications (electrolyte abnormalities), and a structured meal plan to include eating three normal meals a day.
44
Q

What are some psych interventions recommended for BN?

A
  • Psychological intervention: In adults, cognitive-behavioral therapy (CBT) reduces binge eating and purging activity in approximately 30% to 50% of patients.
45
Q

What are some pharm interventions recommended for BN?

A
  • Pharmacologic treatment: Fluoxetine is the only medication approved by the FDA for the treatment of BN and is most effective at a dose of 60 mg daily. A combination of antidepressant medication and CBT appears to be superior to either modality alone.
    *
46
Q

Treatment settings for BN?

A

The majority of adolescents with bulimia nervosa can be treated in an outpatient setting (outpatient clinic or partial hospitalization).

47
Q

Medical and nutritional intervention for AN

A

Nutritional rehabilitation, weight restoration and reversal of the acute medical complications.

48
Q

Psychological intervention for AN

A

Includes family psychoeducation, interpersonal therapy, and family therapy. Family-based treatment has been found to be effective in adolescents.

lecture mentions CBT as being best

49
Q

Pharmacologic treatment for AN

A

Fluoxetine does not appear to be effective in treating the primary symptoms of AN. Studies using fluoxetine have shown inconsistent results with respect to preventing relapse in older adolescents. The most common medications used have included the selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram. These medications are also useful in treating comorbid depression or obsessive-compulsive disorder (OCD).

50
Q

Treatment settings for AN

A

Includes inpatient treatment, outpatient treatment, partial hospitalization, and residential treatment

51
Q

Treatment of amenorrhea and low BMD in AN

A

Weight restoration results in resumption of menses, usually within 3 to 6 months of achieving treatment goal weight. Hormone replacement therapy has not been proven to be effective in increasing BMD. Recommendations include weight restoration, resumption of spontaneous menses, calcium and vitamin D supplementation, and moderate weight-bearing exercise

52
Q

Why would you admit a pt with an ED?

A
  • Hypovolemia/ hypotension
  • Severe malnutrition - <75% IBW
  • Cardiac dysfunction, arrhythmias, prolonged QT interval
  • Bradycardia <45 beats/minute
  • Electrolyte disturbance – hypokalemia, hypoglycemia
  • Rapid weight loss despite interventions
  • Intractable binge-purge episodes
  • Suicidal thoughts or gestures
  • Highly dysfunctional or abusive family
  • Failure of outpatient therapy
53
Q

Most promising therapy type for EDs?

A

Family Based Treatment = Maudsley Family Therapy

(family and individual, e.g., CBT, have similar outcomes but FBT is superior at 6-12mths post Tx. Skills may persist longer

54
Q

Phase I of Maudsley Approach

A
  • Weight restoration
  • Support and empathy towards the patient
  • Encouraging age-appropriate social bonds
  • Externalization of illness
  • Parents are firm, yet encouraging

100% in charge of food! - tough

55
Q

Phase II of Maudsley Approach

A
  • Transitioned when: patient has accepted parental control, positive weight trend, change in mood of the family.
  • Patient must be 90% IBW
  • Transition of control over food back to the patient
  • Continued weight gain with less conflict
56
Q

Phase II of Maudsley Approach

A
  • Progression requires weight maintenance above 95% IBW
  • Increased autonomy for the adolescent
  • Appropriate boundaries with parent

PC Ado (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions