Factitious and Eating Disorders Flashcards
Anorexia Nervosa prevalence ?
0.3-1% in women, 0.1-0.3% in men
Anorexia Nervosa Etiology and risk factors ?
Commonly begins during adolescence or young adulthood
Family history of eating disorders
Perfectionistic personality
Difficulty communicating negative emotions
Difficulty resolving conflict
Low self-esteem
Anorexia Nervosa genetics ?
Unclear but early research shows it could be significant
Anorexia Nervosa DDx ?
Celiac Sprue Chronic Mesenteric Ischemia Hyperthyroidism Irritable Bowel Syndrome Malabsorption Panhypopituitarism
Anorexia Nervosa comorbidities ?
Physiological disturbances associated with malnutrition (amenorrhea, vital signs)
Depressive signs and symptoms (depressed mood, social w/d, irritability, insomnia and diminished interest in sex)
OCD features (preoccupied with thought of food; collect recipes or hoard food,)
Concerns about eating in public, feeling ineffective, strong desire to control one’s environment, overly restrained emotional expression
Anorexia Nervosa work up ?
Labs may show: Leukopenia, elevated BUN, hypocholesteremia, mild anemia, elevated hepatic enzymes, metabolic alkalosis, hypochloremia, hypokalemia, Low T3/T4, low serum estrogen or testosterone.
Sinus bradycardia, long QTc interval. Low bone mass density. Hypotension, peripheral edema, petechiae or ecchymosis.
Hypertrophy of the parotid glands and dental enamel erosion causing dental carries.
Anorexia Nervosa prognosis ?
Morbidity rates range from 10-20%, with only 50% of patients making a complete recovery.
Hospitalization may be required to restore weight and address medical complications
Most experience remission within 5 years of presentation
Death most commonly results from medical complication associated with the disorder itself or from suicide
Anorexia Nervosa tx ?
Psychotherapy
Psychopharmacology
Mecial Tx
Anorexia Nervosa tx: Psychotherapy ?
Intensive behavioral therapy. Including cognitive restructuring to identify automatic thoughts and challenge their core beliefs. Learning coping skills
Anorexia Nervosa tx: Psychopharmacology ?
Unclear that any yield results. Possibly:
Selective serotonin reuptake inhibitors (SSRIs) (e.g., fluoxetine) are commonly considered.
Tricyclic antidepressants are also effective in treating eating disorders.
can help but cause weight / OD easily / suicide
Periactin (cyproheptadine) for pt with restricting type
Elavil (amitriptyline) reported to have some benefit
Orap (pimozide), Thorazine (chlorpromazine) and clomipramine have been tried with variable results ( 1st gen antipsychotic)
Anorexia Nervosa tx: Medical treatment ?
Hospitalization
restore nutritional state, dehydration, starvation and electrolyte imbalances
20% below expected weight - inpatient programs
30% below expected weight – psychiatric hospitalization for 3-6 months
Bulimia Nervosa prevalence ?
0.5% for males and 1.5% for females ( F>M)
Bulimia Nervosa Etiology and risk factors ?
Commonly begins in adolescence or young adulthood
Certain vocations such as acting, modeling, and ballet dancing also appear to be associated with higher risk for these disorders
Bulimia Nervosa genetics ?
Unclear
Bulimia Nervosa DDx ?
Depression Gastric Outlet Obstruction Insulinoma Obsessive-Compulsive Disorder Labs: CBC, UA, Preg Test, Urine Tox, Amylase
Bulimia Nervosa prognosis ?
Bulimia is a long-term illness. Many people will still have some symptoms, even with treatment.
Short-term success is 50% to 70%, with relapse rates between 30% and 50% after 6 months. ( not as great as depression)
Overall better prognosis as compared with anorexia nervosa patients.
Bulimia Nervosa Poor Prognosis factors ?
hospitalization
higher frequency of vomiting
poor social and occupational functioning
poor motivation for recovery
severity of purging
presence of medical complications
high levels of impulsivity
longer duration of illness
delayed treatment
premorbid history of obesity and substance abuse
Bulimia Nervosa work up ?
CBC, CMP, UA, Preg Test, Urine Tox, Amylase
Fluid and electrolyte abnormalities
Loss of gastric acid may produce metabolic alkalosis
Hypokalemia
Bulimia Nervosa PE ?
Russell’s sign – calluses on the knuckles from repeated forced vomiting ( on fingers)
Broken blood vessels in the eyes due to strain from vomiting
Dental exam – cavities or gum infections
repeated acid exposure on teeth
Bulimia Nervosa tx: Psychotherapy ?
CBT is first line (usually over 5-6 months)
Bulimia Nervosa tx: Psychopharmacology ?
The only medication approved by the U.S. Food and Drug Administration for bulimia nervosa is the SSRI fluoxetine (Prozac).
Several studies have demonstrated efficacy of other SSRIs including sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa).
Lithium (maybe) for refractory cases
Bulimia Nervosa tx: medical tx ?
Usually NOT hospitalized
Binge Eating Disorder characteristics ?
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 is being eaten
Feeling disgusted with oneself, depressed, or very guilty afterward
Binge Eating Disorder prevalence ?
3.5 percent of women and 2 percent of men
Binge Eating Disorder etiology and risk factors ?
Depression
Hx of dieting
Family Hx
Binge Eating Disorder genetics ?
More evidence exits for genetic link
Binge Eating Disorder DDx ?
Bulimia Obesity Mood disorders Anxiety disorders Tumor of ventromedial hypothalamus or paraventricular nucleus Nutritional deficiency states
Binge Eating Disorder prognosis ?
Variable depending on length and severity
Binge Eating Disorder medications ?
SSRIs
The goals of pharmacotherapy are to stop or reduce the compulsive behavior, to reduce morbidity, and to prevent complications.
Binge Eating Disorder procedures / therapy / surgery ?
Interdisciplinary approach
Psychiatrist, psychotherapist, and nutritionist/dietitian
Obesity epidemiology ?
36% of US population is obese (BMI > 29.9)
Obesity rates in adolescents in US have increased from 15% in 2000 to 35% in 2012
14%-25% of 6-11 year olds are overweight
Obesity etiology: satiety ?
feeling that results when hunger is satisfied; Occurs soon after the beginning of the meal; happens before the total caloric content of the meal has been absorbed
Obesity etiology: appetite ?
the desire for food; can induce a person to overeat past the point of satiety; may be increased by psychological factors
Obesity etiology: genetic factors ?
80% of patients who are obese have a family history of obesity; no specific genetic marker for obesity has been found
Obesity etiology: physical activity factors ?
decrease in physical activity major factor in rise of obesity
Obesity etiology: psychotropic drugs ?
crucial to development of obesity; but how such factors result in obesity is unknown
Obesity etiology: psychological factors ?
crucial to development of obesity; but how such factors result in obesity is unknown
Obesity in general ?
Not included in DSM V as mental disorder
Complex disease resulting from:
genetic susceptibility
increased availability of high-energy foods, and
decreased requirement for physical activity in modern society
Leading cause of preventable death in US.
Obesity (excess body fat) results from long term excess of energy intake relative to energy expenditure
Range of factors vary across individual to contribute to development of obesity, thus obesity is not considered a mental disorder
BMI Below 18.5 ?
Underweight
BMI 18.5-24.9 ?
NL
BMI 25-29.9 ?
Overweight
BMI 30 and above ?
Obese
Obesity course and prognosis ?
NIH obese men have higher mortality from colon, rectal and prostate cancer than men of normal weight
Obese women have higher mortality from cancer of gallbladder, biliary passages, breast, uterus and ovaries than women of normal weight
Metabolic Syndrome in general ?
Believed to occur in 30% of American population
Cause of syndrome is unknown but obesity, insulin resistance and genetics are involved
Consists of cluster of metabolic abnormalities associated with obesity and contribute to increased risk of cardiovascular disease and type II diabetes
Metabolic Syndrome is dx. w/ a patient that has 3 or more of the following?
Abdominal obesity
High triglyceride level
Low HDL cholesterol level
Hypertension
Elevated fasting blood
glucose level
Metabolic Syndrome course and prognosis ?
Adverse effects on health
Strong correlation between obesity and cardiovascular disorders
Blood pressure and cholesterol levels can be reduced by weight reduction
Diabetes can often be reversed with weight reduction
