Feeding and Eating disorders Flashcards
how long does eating of nonfood items have to be present for a dx of pica
at least 1 month
what is the minimum age for pic dx
2
when does pica tend to come to clinical attention?
after a complication like infection or mechanical bowel issue
when does pica manifest
usually in early childhood
typically if older it is in the context of developmental disability
when would you make a pica dx in pregnancy
when symptoms are severe enough to possibly cause medical complications
when would anorexia be the appropriate dx over pica
when nonnutritive eating is done as a means of hunger control
what are the most common pica comorbidities
autism and intellectual disability
when would pica be associated with trichotillomania and/or excoriation disorder
when there is ingestion of hair and/or skin
definition of rumination disorder
repeated food regurgitation not d/t another medical/mental condition
when would pica be associated with avoidant/restrictive food intake disorder
when there is a strong sensory component to the presentation
how long do sx have to be present to meet criteria for rumination disorder
at least 1 month
how do infants present when attempting to regurgitate
straining and arching back while making sucking movements with tongue
features of rumination disorder in infants
-may gain satisfaction from behavior
-may be irritable/hungry between episodes
-may result in malnutrition
-weight loss/failure to gain common
what are some differential diagnoses for rumination disorder
GI conditions that would cause vomiting
anorexia and bulimia
basic definition of avoidant/restrictive food intake disorder
avoiding eating d/t lack of interest or sensory issues with at least 1 manifestation
what are possible manifestations of avoidant/restrictive food intake disorder and how many are required for dx
at least 1:
-significant weight loss/failure to gain
-significant nutritional deficiency
-dependence on enteral feeding or nutritional supplements
-marked interference with psychosocial functioning
temperamental risk factors for avoidant/restrictive food intake disorder
risk is increased if anxiety disorders, autism, OCD, ADHD are present
what are the 3 main criteria for dx of anorexia
-restriction of intake that results in significantly underweight
-preoccupation with thinness or fear of fatness
-disturbance in body image perception and lack of recognition of serioussness
what are the 2 subtypes of anorexia
restricting type
binge/purge type
what is the qualifier for anorexia restricting type
no binging/purging behavior for at least 3 months
anorexia binging/purging type
may purge after small amounts of food
purging typically involves vomiting, laxatives, or diuretics
mild anorexia
BMT >= 17
moderate anorexia
BMI 16-16.99
severe anorexia
BMI 15-15.99
Extreme anorexia
BMI <15
what are some associated features of anorexia
-amenorrhea
-bone mineral density loss
-depressive symptoms
-OCD sx
what behaviors are more likely to occur in anorexia binge/purge type than restricting type
more likely to be impulsive and abuse substances
when is anorexia onset and what is it associated with
adolescence to early adulthood usually associated with stressful life event
hematology labs in anorexia
leukopenia
mild anemia
rarely bleeding problems
chemistry results in anorexia
dehydration may raise BUN
hypercholesterolemia
elevated hepatic enzymes
why would someone with anorexia have an elevated bicarb level
if they were in metabolic alkalosis d/t vomiting
endocrine abnormalities with anorexia
low estrogen in females and low testosterone in males
what is the main difference between bulimia and anorexia binge/purge type
anorexia may purge after small ingestion of food and bulimia tends to maintain normal or slightly above weight
general definition of bulimia
recurrent episodes of binge eating with compensatory purging behaviors to avoid gaining weight
what constitutes a binge eating episode
-eating significantly more food than normal in a discrete time period
-sense of lack of control over eating
how often do binge/purge episodes have to occur for a dx of bulimia
at least weekly for at least 3 months
mild bulimia
1-3 episodes weekly
moderate bulimia
4-7 episodes weekly
severe bulimia
8-13 episodes weekly
extreme bulimia
14+ episodes weekly
common electrolyte imbalances in bulimia
hypokalemia
hypochloremia
hyponatremia
what can cause metabolic alkalosis and metabolic acidosis in bulimia
vomiting can cause alkalosis d/t fluid loss (elevated bicarb)
laxative/diuretic use can cause acidosis
what disorders are frequently comorbid with bulimia
personality disorders
substance use disorders
depression
bipolar
basic definition of binge eating disorder
recurrent episodes of binge eating not associated with purging
what are characteristics of binge eating episodes in binge eating disorder and how many must be present for dx
At least 3
-eating more rapidly than usual
-eating until uncomfortably full
-eating large amounts when not hungry
-eating alone d/t embarassment
-feeling disgusted/guilty or depressed afterward
how often do binge eating episodes have to occur for dx of binge eating disorder
at least weekly for at least 3 months
mild binge eating disorder
1-3 episodes weekly
moderate binge eating disorder
4-7 episodes weekly
severe binge eating disorder
8-13 episodes weeklyx
treme binge eating disorder
14+ episodes weekly
what are the other specified feeding or eating disorders
-atypical anorexia nervosa
-bulimia of low frequency or limited duration
-binge eating of low frequency or limited duration
-purging disorder
-night eating syndrome
atypical anorexia
criteria for anorexia met except weight is still WNL
bulimia of low frequency/limited duration
criteria for bulimia met except frequency of episodes or duration of symptoms
binge eating disorder of low frequency/limited duration
criteria met for binge eating disorder except frequency of episodes or duration of symptoms
purging disorder
purging behaviors in the absence of binge eating
night eating syndrome
-eating large quantities after evening meal
-there is awareness of eating
-not better explained by another disorder
geophagia
when pregnant women eat clay
amylophagia
when pregnant women eat excessive starch
characteristic of regurgitation in rumination disorder
effortless and painless
no nausea, retching, or disgust
how do you rule out pyloric stenosis when diagnosing rumination disorder
pyloric stenosis is associated with projectile vomiting and usually manifests prior to 3 months
treatment of rumination disorder
education/behavioral combo
aversive techniques sometimes
common age range affected by rumination disorder
3-12 months
appetite loss in anorexia
usually not present until late in disease
odd behaviors with anorexia
will hide food around the house
carry large amounts of candy
somatic complaints
may compulsively steal
decreased interest in sex
what are some physical signs of anorexia
hypothermia, dependent edema, bradycardia, hypotension, and lanugo
when does an anorexic patient need to be hospitalized
when 20% below desired weight
if 30% below likely will need treatment for 2-6 months
3 types of psychotherapy used for anorexia
family-based
CBT
dynamic psychotherapy
3 phases of family based psychotherapy in anorexia
1 - restoration of physical health
2 - patient gradually takes responsibility for eating decisions
3 - focus on patient’s growth/development
first-line treatment for bulimia
CBT
what med is usually used to treat bulimia
fluoxetine (60-80mg)
higher dose than used in depression
what med is contraindicated in the treatment of bulimia and why
wellbutrin because of seizure risk
first-line tx for binge eating disorder
CBT
better results when used with SSRI
medication for treatment of binge eating disorder with strong evidence for reduction of episodes and weight loss
lisdexamfetamine
