Feeding/Eating, Elimination, and Sleep-Wake Disorders Flashcards
Pica definition
Eating nonfoods that have no nutrition
Considerations when diagnosing pica
- Developmental level
- Cultural practices
Common pica populations
- Children
- Pregnant women
Anorexia Nervosa definition
Restricting food that results in low body weight
Anorexia criteria
- Fear of weight gain
- Distortions in perceptions of weight/shape
Anorexia specifiers
- Type (restricting or binging/purging)
- Course (in partial/full remission)
- Severity (based on BMI)
Common co-morbidities for anorexia, bulimia, and BED
- Depression
- Anxiety disorder (especially OCD for anorexia), often before eating disorder
Anorexia prognosis
- Relapses common
- Difficult to treat (lack of insight)
- Generally better than bulimia, with mixed findings
Eddy et al (2017) study about recovery rates for anorexia and bulimia
9 years = anorexia recovery was half of bulimia recovery
22 years = similar recovery
Initial treatment goals for anorexia
- Healthy weight
- Address physical complications
Secondary treatment goals for anorexia
- Motivation for treatment
- Psychoeducation
- Identify beliefs, attitudes, emotions
- Treat contributing psychological factors
- Family support
- Relapse prevention
Treatments for anorexia
- CBT for anorexia
- CBT-E for eating disorders
- FBT for anorexia
- Inconsistent support for medication
CBT for anorexia
- Post-hospitalization
- Behavioral strategies for eating patterns
- Reduce body-checking
- Replace thinking errors
CBT-E for eating disorders
- Individualized based on client factors
- Assumes core problem is over-valuing weight/shape
FBT for anorexia nervosa
- Outpatient for medically stable adolescents
- Three phases
Three phases of FBT for anorexia nervosa
- Parent control over weight/nutrition for adolescent
- Control gradually returned to adolescent
- Address development factors (independence, parent-child relationship)
Medications for anorexia
- Olanzapine for initial weight gain
- Fluoxetine for weight maintenance
- Some support for treating co-morbidities rather than anorexia
Bulimia Nervosa definition
Binge eating with compensatory behaviors to prevent weight gain
Bulimia criteria
- Binge and compensatory behavior 1x/week
- Symptoms 3+ months
Bulimia specifiers
- Couse (in partial/full remission)
- Severity (based on episodes of compensatory behavior per week)
Typical weight for anorexia, bulimia, and BED
Anorexia - far below average
Bulimia - average to overweight
BED - average to obese
Bulimia treatment
- CBT-E**
- Nutritional rehab and CBT*
- IPT (longer time to produce results)
- FBT for bulimia nervosa
- Some evidence for medication
Three phases of FBT for bulimia nervosa
- Disrupt binging and compensatory behaviors, build healthy eating patterns
- Collaboration between parent and adolescent due to lack of insight, control back to adolescent over time
- Teen returns to normal development overall
Insight and treatment motivation for anorexia v. bulimia
Anorexia - little to no insight, little to no motivation
Bulimia - insight w/ distress and motivation
Medications for bulimia
- SSRIs (fluoxetine) for comorbid depression and reducing binging/purging without depression
- Some evidence that combined SSRI and CBT is better
Four stages of CBT-E for bulimia
- Education and monitoring
- Review and revise as needed
- Address overvaluation of weight/shape, other factors
- Maintainance and relapse prevention
Telehealth v. in-person for bulimia
Both positive outcomes for acceptability and retention
Better abstinence and lower rates of cognitive distortions in-person
Binge-Eating Disorder (BED) definition
Eating larger amounts than typical with a sense of being out of control
BED criteria
- 3+ symptoms (rapid eating, eating until uncomfortably full, large amounts w/o hunger, alone/hiding, negative emotions)
- Episodes 1x/week
- Symptoms 3+ months
BED specifier
- Severity (based on episodes per week)
BED prevalence
2-3x more common in women than men
BED v. bulimia
BED - no compensatory behaviors, better treatment response, followed by dieting
Bulimia - compensatory behaviors, poorer treatment response, preceded by dieting
BED treatment
- CBT-E*
- IPT
- Some evidence for medication
- Focus on binging before or alongside weight loss
Medications for BED
- SSRIs (fluoxetine, paroxetine, sertraline)
- Topiramate
- Lisdexamphetamine
- Less effective than CBT alone or combined CBT and medication
Enuresis criteria
- Involuntary peeing in bed or clothing
- 2+ times/week
- Symptoms 3+ months OR distress/impairment
- Not due to substance, medical conditions
- 5+ years old (age or developmentally)
Enuresis specifiers
- Subtype (nocturnal only, diurnal only, both)
Enuresis treatment
- Moisture alarm*
- Desmopressin (high risk for relapse when discontinued)
Insomnia Disorder criteria
- 1+ symptoms
- 3+ nights/week
- Symptoms 3+ months
- Symptoms despite sufficient opportunity to sleep
- Distress or impairment
Insomnia types
- Sleep-onset
- Sleep maintenance
- Late insomnia
Combination of three types is most common
Subjective reports of insomnia
Tend to overestimate time awake and underestimate time asleep
Insomnia treatment
- Cognitive-behavioral w/ stimulus control, sleep restriction, sleep hygiene, relaxation, cognitive therapy, etc.
Narcolepsy criteria
- Sleep or naps 3+ times/week
- Symptoms 3+ months
- Cataplexy, hypocretin deficiency, or REM latency <15 minutes
Narcolepsy common co-occurring problems
- Hallucinations before sleeping or after waking
- Sleep paralysis when falling asleep or waking
Narcolepsy treatment
Behavioral strategies combined with medications to improve alertness and reduce cataplexy
Medications for narcolepsy
- Modafinil and armodafinil (newer)
- Antidepressant (venlafaxine, fluoxetine, clomipramine) for cataplexy
- Sodium oxybate (if unresponsive to others)
Non-Rapid Eye Movement Sleep Arousal Disorders
Incomplete waking w/ difficulty fully waking and little memory of episodes
- Sleepwalking
- Sleep terrors
Nightmare Disorder criteria
Nightmares:
1. Extended
2. Dysphoric
3. Well-remembered
4. Threats to safety
Typically occur during REM or second half of major sleep
