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Psychiatry / Addiction Medicine > Factitious and Eating Disorders > Flashcards

Factitious and Eating Disorders Flashcards

1
Q

Anorexia Nervosa prevalence ?

A

0.3-1% in women, 0.1-0.3% in men

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2
Q

Anorexia Nervosa Etiology and risk factors ?

A

Commonly begins during adolescence or young adulthood

Family history of eating disorders

Perfectionistic personality

Difficulty communicating negative emotions

Difficulty resolving conflict

Low self-esteem

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3
Q

Anorexia Nervosa genetics ?

A

Unclear but early research shows it could be significant

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4
Q

Anorexia Nervosa DDx ?

A 
Celiac Sprue
Chronic Mesenteric Ischemia
Hyperthyroidism
Irritable Bowel Syndrome
Malabsorption
Panhypopituitarism
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5
Q

Anorexia Nervosa comorbidities ?

A

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

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6
Q

Anorexia Nervosa work up ?

A

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.

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7
Q

Anorexia Nervosa prognosis ?

A

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

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8
Q

Anorexia Nervosa tx ?

A

Psychotherapy

Psychopharmacology

Mecial Tx

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9
Q

Anorexia Nervosa tx: Psychotherapy ?

A

Intensive behavioral therapy. Including cognitive restructuring to identify automatic thoughts and challenge their core beliefs. Learning coping skills

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10
Q

Anorexia Nervosa tx: Psychopharmacology ?

A

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)

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11
Q

Anorexia Nervosa tx: Medical treatment ?

A

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

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12
Q

Bulimia Nervosa prevalence ?

A

0.5% for males and 1.5% for females ( F>M)

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13
Q

Bulimia Nervosa Etiology and risk factors ?

A

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

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14
Q

Bulimia Nervosa genetics ?

A

Unclear

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15
Q

Bulimia Nervosa DDx ?

A 
Depression
Gastric Outlet Obstruction
Insulinoma
Obsessive-Compulsive Disorder
Labs:
CBC, UA, Preg Test, Urine Tox, Amylase
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16
Q

Bulimia Nervosa prognosis ?

A

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.

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17
Q

Bulimia Nervosa Poor Prognosis factors ?

A

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

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18
Q

Bulimia Nervosa work up ?

A

CBC, CMP, UA, Preg Test, Urine Tox, Amylase
Fluid and electrolyte abnormalities
Loss of gastric acid may produce metabolic alkalosis
Hypokalemia

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19
Q

Bulimia Nervosa PE ?

A

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

20
Q

Bulimia Nervosa tx: Psychotherapy ?

A

CBT is first line (usually over 5-6 months)

21
Q

Bulimia Nervosa tx: Psychopharmacology ?

A

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

22
Q

Bulimia Nervosa tx: medical tx ?

A

Usually NOT hospitalized

23
Q

Binge Eating Disorder characteristics ?

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 is being eaten

Feeling disgusted with oneself, depressed, or very guilty afterward

24
Q

Binge Eating Disorder prevalence ?

A

3.5 percent of women and 2 percent of men

25
Q

Binge Eating Disorder etiology and risk factors ?

A

Depression

Hx of dieting

Family Hx

26
Q

Binge Eating Disorder genetics ?

A

More evidence exits for genetic link

27
Q

Binge Eating Disorder DDx ?

A 
Bulimia
Obesity
Mood disorders
Anxiety disorders
Tumor of ventromedial hypothalamus or paraventricular nucleus
Nutritional deficiency states
28
Q

Binge Eating Disorder prognosis ?

A

Variable depending on length and severity

29
Q

Binge Eating Disorder medications ?

A

SSRIs

The goals of pharmacotherapy are to stop or reduce the compulsive behavior, to reduce morbidity, and to prevent complications.

30
Q

Binge Eating Disorder procedures / therapy / surgery ?

A

Interdisciplinary approach

Psychiatrist, psychotherapist, and nutritionist/dietitian

31
Q

Obesity epidemiology ?

A

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

32
Q

Obesity etiology: satiety ?

A

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

33
Q

Obesity etiology: appetite ?

A

the desire for food; can induce a person to overeat past the point of satiety; may be increased by psychological factors

34
Q

Obesity etiology: genetic factors ?

A

80% of patients who are obese have a family history of obesity; no specific genetic marker for obesity has been found

35
Q

Obesity etiology: physical activity factors ?

A

decrease in physical activity major factor in rise of obesity

36
Q

Obesity etiology: psychotropic drugs ?

A

crucial to development of obesity; but how such factors result in obesity is unknown

37
Q

Obesity etiology: psychological factors ?

A

crucial to development of obesity; but how such factors result in obesity is unknown

38
Q

Obesity in general ?

A

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

39
Q

BMI Below 18.5 ?

A

Underweight

40
Q

BMI 18.5-24.9 ?

A

NL

41
Q

BMI 25-29.9 ?

A

Overweight

42
Q

BMI 30 and above ?

A

Obese

43
Q

Obesity course and prognosis ?

A

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

44
Q

Metabolic Syndrome in general ?

A

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

45
Q

Metabolic Syndrome is dx. w/ a patient that has 3 or more of the following?

A

Abdominal obesity

High triglyceride level

Low HDL cholesterol level

Hypertension

Elevated fasting blood
glucose level

46
Q

Metabolic Syndrome course and prognosis ?

A

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

Psychiatry / Addiction Medicine (11 decks)

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