Eating, sleep, and sexual disorders - Burton Flashcards
What is the male to female ratio of anorexia nervosa?
In what kinds of people is it also more common in?
1:10
Middle to upper socioeconomic groups
Models, gymnasts, and dancers
What is the mean age of onset of anorexia nervosa?
15-16 years old
Onset is rare after 30 years old
What are the precipitating factors of anorexia nervosa?
Biological - N/A
Psychological - N/A
Social - Stressors such as failing an exam or changing schools
What are the precipitating factors of anorexia nervosa?
Biological - Family history of eating disorder, mood disorder, or substance misuse
Psychological - Poor self-esteem, undue compliance or extreme perfectionism, personality disorder (esp. cluster C), premorbid anxiety or depressive disorder
Social - Pressure to diet in a society that emphazises individualism and idealises thinness as beauty, family environment (overprotection, rigidity, deep-rooted and often unspoken conflict), eating disorders in the peer group or in the media
What are the perpetuating factors of anorexia nervosa?
Biological - Starvation, leading to neuroendocrine changes that perpetuate anorexia
Psychological - N/A
Social - Same as precipitating
What are the diagnostic criteria for anorexia nervosa?
Restriction of energy intake leading to significantly low body weight for age, sex, developmental trajectory, and physical health
Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain
Disturbed perception of body weight or shape, undue influence of body weight or shape on self-evaluation, of persistent lack of recognition of the seriousness of the low body weight
Widespread endocrine disorder (amenorrhoea in women and loss of sexual interest and potency in men)
What are the possible complications of anorexia nervosa?
Metabolic: dehydration, hypoglycaemia, impaired glucose tolerance, hypoproteinaemia, hypokalaemia, hyponatraemia, hypocalcaemia, vitamin deficiencies, hypercholesterolaemia, deranged LFTs
Endocrine: decreased gonadotrophins, oestrogens, and testosterone, increased growth hormone and cortisol, decreased triidothyronine
Cardiovascular: ECG abnormalities and arrhythmias, hypotension, bradycardia, peripheral oedema, CCF, mitral valve prolapse
Gastrointestinal: parotid enlargement, erosion of tooth enamel, delayed gastric emptying, constipation, peptic ulceration, acute pancreatitis
Renal: renal failure, partial diabetes insipidus, renal calculi
Neurological: enlarged ventricles, seizures, peripheral neuropathy, autonomic dysfunction
Haematological: iron-deficiency anaemia, leucopaenia, thrombocytopaenia
MSK: Osteoporosis, muscle cramps
Other: Hypothermia, infections, dry skin, brittle hair and nailes, lanugo hairs
What is the management plan for anorexia nervosa?
Educate the patient and the family about the disorder and its treatment.
Negotiate a realistic treatment plan. Aim for a balanced diet of 3000 calories a day in the form of small meals and supplementary snacks.
Encourage the patient while gently challenging their disturbed body perception. Consider psychotherapy and support groups, CBT, or family therapy
Treat physical complications and address any associated mental disorder
Consider hospitalisation in severe and intractable cases
What is the prognosis of anorexia nervosa?
Very variable, and a younger age of onset and shorter history are important prognostic factors.
Half of sufferers recover completely, fifth experience chronic, severe illness.
The remainder make a recovery of sorts, but retain abnormal eating habits and sometimes become bulimic.
Long-term mortality from suicide and the complications of starvation is over 5%, higher than for any other mental disorder.
