Feeding Disorders

Question 1

Define anorexia nervosa

Answer 1

Characterised by self-imposed starvation and a relentless pursuit of extreme thinness. Individiuals have a distorted body image and view themselves as overweight

Question 2

What are the two subtypes of anorexia nervosa?

Answer 2

1. Restrictive subtype: Minimal food intake and excessive exercise
2. Bulimic subtype: Episodic binge eating followed by behaviours like laxative use or induced vomiting

Question 3

What are the main 4 categories that individuals with anorexia nervosa must exhibit to meet the ICD-11 criteria?

Answer 3

1. Significantly low body weight
2. Fear of gaining weight
3. Distorted body image
4. Restricitve eating

Question 4

Sx of anorexia nervosa

Answer 4

• Preoccupation w/food + exercise
• Starvation
• Poor insight
• Intrusive obsession w/ weight and shape
• Fear of becoming fat
• Amenorrhoea

Question 5

Examination findings in individuals with anorexia nervosa

Answer 5

• BMI <17.5 kg/m2
• Hypotension
• Bradychardia
• Enlarged salivary glands
• Lanugo hair (fine hair covering skin)

If bulimic can also see:
* Pitted teeth
* Parotid swelling
* Scarring of dorsum of hand

Question 6

Blood test findings in a person with anorexia nervosa?

Answer 6

Electrolytes (Ca, Mg, K) - low
Sex hormones (FSH, LH, oestrogen and testosterone) - low
Leukopenia
Stress hormones (growth hormone and cortisol) - high
Metabolic alkalosis - due to vomiting or diuretic use

Question 7

What special test is done for an inpatient admission of anorexia nervosa?

Answer 7

SUSS test (sit-up, squat and stand) - inability to perform this indicates for specialist inpatient programs.

Question 8

Tx for anorexia nervosa

Answer 8

Psychological:
* CBT-ED
* MANTRA (Maudsley Model of Anorexia Nervosa Treatment for Adults)
* Specialist Supportive Clinical Management (SSCM)

Note: If under 18, 1st line - AN-focused family therapy, 2nd line - CBT-ED

Pharmacological:
* SSRIs - comorbid mental health issues (depression/anxiety)

Question 9

Complications of anorexia nervosa (3)

Answer 9

1. Refeeding syndrome - fatal disorder when nutritional intake is resumed too rapidly after a period of low caloric intake. As rapid increase in insulin leads to shifts of K, Mg and PO4.
2. Cardiac arrhythmias - bradychardia and prolonged QTc
3. Osteoporosis

Note:
* Refeeding syndrome can be prevented via high-dose vitamins (e.g. Pabrinex) before feeding commences + building caloric intake gradually.

Question 10

Define bulimia nervosa

Answer 10

Recurrent binge eating episodes with a loss of control followed by inappropriate compensatory behaviours (i.e. self-induced vomiting, laxative, fasting, excessive exercise) to prevent weight gain.

Episodes occur once a week or more for a month.

Question 11

Sx of bulimia nervosa?

Answer 11

• Binge eating - loss of control
• Purging (vomiting, laxative etc)
• Body image distortion
• Dental erosion - from self-induced vomiting
• Parotid gland swelling
• Scarring on dorsum of hand (Russell’s sign)
• Amenorrhoea

Question 12

Mx of bulimia nervosa - adults and children

Answer 12

Adults:
* Bulimia Nervosa Focused Guided Self-Help
* Specialist referral

Children:
* Bulimia Nervosa Focused Family Therapy
* High-Dose Fluoxetine

Question 13

What are the two main important electrolytes to check for in malnutrition?

Answer 13

Magnesium and Potassium