ED Flashcards
What are the main characteristic features of bulimia?
- persistent preoccupation with eating and irresistible cravings for food
- episodes of overeating in which large amounts of food are consumed in short periods
- efforts made to counteract by: self-induced vomiting, purgative abuse, periods of starving, use of drugs
- morbid dread of fatness
- patients set weight threshold below healthy weight
What is Atypical anorexia nervosa?
Atypical anorexia nervosa is the term used for those individuals in whom one or more of the key features of anorexia nervosa, such as amenorrhoea or significant weight loss, is absent but who otherwise present a fairly typical clinical picture
The most likely electrolyte abnormality of refeeding a grossly anorexic patient in a medical ward is?
Hypophosphatemia
This is usually normal even in severely malnourished patients in anorexia nervosa
Serum albumin levels
Characterisitcs of families of people with anorexia
- Rigidity
- conflict avoidance
- overprotection
- enmeshment
Risk factors for Eating Disroders
female sex adolescence and early adulthood western cultural adaptation family hx of ED, depression adverse parenting early menarche (bulimia) past hx of obesity (bulimia)
physical signs and symptoms of ED
constipation, dizziness, amenrrhooea, poor sleep, dry skin, lanugo hairs, parotid swellling, bradycardia, dependent oedema
What is Russell’s sign?
calluses on kncukles due to repeated vomit induction
what is perimylolysis?
erosion of inner surface of teetch
Endocrine abnormalites in ED
Low LH, FSH, oestradiol Low T3, but normal T4 and TSH Severe hypoglycaemia increase in cortisol increase in growth hormone low leptin
cardiovascular abnormalites in ED
QTc prolongation
myopathy in ipecac (emetic substance) use
hypotension, arrhythmia, VT
sudden death
gastrointestinal abnormalites in ED
delayed gastric emptying
decreased colonic motility
haematological abnormalites in ED
normocytic norochromic anaemia
mild leucopenia
thrombocytopaenia
metabolic abnormalites in ED
raised cholesterol
raised serum carotene
hypophosphataemia (exaggerated in refeeding)
dehydration
hyponatraemia, hypokalemia, metabolic acidosis
other abnormalites in ED
osteopenia osteoperosis enlarged cerebral ventricles depression pancreatitis
effects of ED on pregancy
decreased fertility higher rates of hypermesis gravidarum, anaemia compromised intrauterine foetal growth premature delivery more likely high rates of c-section low birth weight low APGAR score microcephaly neonate hypoglycaemia
Management of Bulimia
self-help programme for 4 weeks
CBT/IPT/family therapy in young people
antidepressants - SSRIs (fluoxetine) first line at high dose BUT NOT ALONE
managment of anorexia
Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
Specialist supportive clinical management (SSCM)
Consider IPT, family therapy (especially in addolescents), psychodymanic psychotherpay
Anorexia nervosa M:F ratio
1:9
Bulimia nervosa M:F ratio
1:9
Longterm prognosis of anorexia
Half recovered completely
A third recovered partially
20% had a chronic eating disorder
5% dies
Poor prognostic factors for anorexia
Patients with a long duration of hospital care Psychiatric co-morbidity Being adopted Growing up in a one-parent household Having a young mother Lower minimum weight Poor family relationships Failed treatment Late age of onset Social problems
High risk features in anorexia that suggest admission to hospital
BMI < 13 Pulse < 40bpm SUSS test < 2* Sodium < 130 mmol/L Potassium < 3 mmol/L Serum glucose < 3 mmol/L QTc > 450 ms
What is the SUSS test?
*The SUSS test (sit up squat stand test)
In the SUSS Test, the patient is asked to sit up from lying supine on a flat surface without using
the hands, if possible. They are then asked to squat and to rise without using the hands, if possible.
0 completely unable to rise
1 able to rise only with use of hands
2 able to rise with noticeable difficulty
3 able to rise without difficulty
Diagnostic criteria for anorexia according to DSM V
- Restriction of energy intake relative to requirements, leading to a significantly low body weight (generally speaking a BMI < 18.5)
- Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight (the intense fear is not usually alleviated by weight loss)
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Two divisions of anorexia
a) Restricting type (weight loss attained through diet, fasting and exercise alone – in previous 3 months)
b) Binge eating / purging type (in previous 3 months has purged or engaged in binge eating)
Criteria for rating severity of anorexia
Mild = BMI > 17 Moderate = BMI 16 – 16.99 Severe = BMI 15 – 15.99 Extreme = BMI < 15
The 12-month prevalence of anorexia in females?
The 12-month prevalence in females is approx. 0.4%.
What score on SCOFF questionnaire indicates likely bulimia or anorexia?
2 or more
84.6% sensitivity and 98.6% specificity
NPV 99.3%
SCOFF quetionnaire
Do you ever make yourself Sick because you feel uncomfortably full?
Do you ever worry that you have lost Control over how much you eat?
Have you recently lost more than One stone in a three month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say Food dominates you life?
Risk factors for bulimia
Childhood sexual abuse Male homosexuality Having an occupation that focuses on weight Low self-esteem Female gender
estimated prevalence of bulimia
2-3%
Managent of Binge eating
- self-help
2. CBT (group)
When to consider a bone mineral density?
after 2 years of underweight in adults, or earlier if they have bone pain or recurrent fractures
fter 1 year of underweight in children and young people, or earlier if they have bone pain or recurrent fractures
How does vomiting affect electrolytes?
sodium - may be increased, decreased or normal
potassium - decreased
chloride - decreased
pH - increased
How does laxative use affect electrolytes?
sodium - may be increased or normal
potassium - decreased
chloride - increased or decreased
pH - increased or decreased
How do diuertics affect electrolytes?
sodium - may be decreased or normal
potassium - decreased
chloride - decreased
pH - increased
Whath happens to phosphate levels in ED?
raised in bulimia
reduced in anorexia
When is Metabolic alkalosis seen in bullimia?
if induced vomiting is main method
When is Metabolic acidosis seen in bullimia?
if purging is main method
What is the most common comorbid illness in those with anorexia nervosa?
Depression
What is a positive prognostic factor for anorexia?
young age
Use of ipecac in patients with eating disorders is associated with?
Cardiomyopathy
The hormone cholecystokinin offers a theoretical treatment for which condition?
Bulimia
% people with binge eating disorder that are male
25%
Bloods in refeeding syndrome
Hyponatraemia, Hypokalemia
Anorexia nervosa in adulthood is most commonly associated with which mental disorder
Anxiety disorders
Common cardiac problem in anorexia?
Congestive heart failure
Who is credited with developing an enhanced form of CBT used for eating disorders?
Fairburn
How long should psychological therapy in BDD continue to avoid relapse?
12 months
