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Psychiatric Principles > Final: ED > Flashcards

Final: ED Flashcards

1
Q

prevalence of body image fears

A

80% of 4th graders are afraid of being fat

50% kids in middle school believe they are overweight and are on diets

1/2 teen girls and 1/3 teen boys use unhealthy methods to control weight

50% ED clients >30yo, 13% of W >50yo have sx of ED

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2
Q

DSM IV categories re ED

A

Anorexia Nervosa, Bulimia Nervosa, EDNOS

(DSM V includes BED, Other specified Feeding or ED (OSFED) & unspecified feeding or eating disorder

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3
Q

DSM IV criteria for Anorexia Nervosa

A

a. refusal to maintain BW @ or above minimally appropriate (ie to B, and took out D re amenorrhea

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4
Q

issue with DSM IV criteria for AN

A

what about M? they don’t have periods.

Also, <85% may not occur till later in dz.. hard to get insurance coverage with this criterion

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5
Q

DSM IV criteria Bulimia Nervosa

A

A. Recurrent binge episodes char by BOTH

  1. eating in short time, large amt
  2. sense of lack of control

B. Recurrent compensatory behavior to prevent wt gain

  1. self induced vomiting
  2. laxative/diuretic, enemas or other meds
  3. Fasting
  4. Excessive exercise

C. Binges and compensatory acts average at least 2x/wk for 3 mth

D. Self eval unduly influence by body shape and weight

E. Disturbance does not occur exclusively during episodes of AN

two types: purging, nonpurging

*DSM V changes to ONCE a wk

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6
Q

what did BED used to be classified under in DSM IV

A

EDNOS

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7
Q

DSM IV criteria EDNOS

A

disorders of eating that do not meet criteria for AN or Bulimia nervosa

  • subclinical AN, BN
  • refusal to maintain wt w/o AN or BN
  • night eating
  • orthorexia
  • diabulimia
  • BED

*now this is OSFED

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8
Q

what are some less common feeding and eating disorders

A

PICA - eating non nutritive substances ie chalk

Rumination d/o: regurgitating food, re swallowing or spitting

Avoidant/restrictive food intake disorder: refusing to eat but no body image disturbance

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9
Q

Co-morbid dx wth Ed include

A

Anxiety: OCD, GAD, SAD, panic

Depression: MDD, Bipolar, Dysthymia

Addiction: drugs, lcohol, pills, gambling, shopping

ADHD: inattentive, hyperactive/impulse

PTSD: flashbacks, nightmares, avoid triggers

Personality disorder: BORDERLINE* Narcissictic (axis II)

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10
Q

what should we remember to assess for in ED pt?

A

distorted body image and desire to lose weight

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11
Q

Mental health disorders a/w ED

A

MDD, bipolar, OCD, ADHD, Somatization, Substance abuse

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12
Q

Physical health d/o a/w ED

A

hyperthyroidism, malignancy, IBD, immunodeficiency, malabsorption, chronic infections, Addison’s dz, DM

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13
Q

Epidemiology ED

A

average onset age 14-19
80% F
affects all races, ethnicities, income levels

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14
Q

Prevalence of ED

A

F:
anorexia 0.9%, Bulimia 1.5%, BED 3.5%

M
AN 0.3%, Bulimia 0.5%, BED 2%

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15
Q

genetic vs environment and ED

A

40% genetics

60% environment

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16
Q

Genetics/biology contributing to ED

A

Predisposition for mental illness
- anxiety/ocd, depression, addiction, adhd

Emotional dysregulation

Personality traits: perfectionistic, people pleaser, emotionally sensitive, strong willed, impulsive

Body shape/size: body size larger than avg, distribution of fat, thyroid function

Adolescence and puberty: hormonal changes, higher risk tolerance

17
Q

Environment contributors..

A

Family relationships

Trauma/abuse (physical, psych/emotional, sexual, neglect)

Parental modeling (eating, body image, exercise)

Peer relationships, bullying

Appearance-focused culture

Body focused sports

18
Q

what is the function of ED

A

NOT about food/vanity

“creative coping mechanisms”
- numb emotions, manage anxiety, feel in control, feel successful at something, safely express emotions, hurt self

19
Q

how to ID ED

A

they may address it.. trying to gain/lose wt, seeking meds, needing medical clearance for sport/school/work

or they may not

20
Q

THus… observable s/sx

A

consistent wt fluctuations, sig under/overwt, swollen parotid glands, scar tissue on fingers, cold hands/feet, persistent cough/sore throat, tooth enamel damage, esophageal damage or inflame, dry or brittle hair/nails/skin, lanugo on face arms, baggy clothing, vague answers when asked about what they eat

21
Q

Med complications

A

amenorrhea, dehydration, electrolyte, irreg heart beat, hypoTN, osteopenia, infertility, sore throat/cough, GERD, bloating, constipation, diarrhea, dizzy/faint, unexplained stomach pain, DM

22
Q

what questions to ask

A
  • think about food/body a lot
  • feel in control of relationship w/ food
  • changed diet?
  • doing anything to control weight?
  • how freq/long do you exercise
  • how do you feel about your body
23
Q

How to respond…

A
  • create warm, safe environment for them to open up
  • don’t comment on appearance
  • probe and ask questions
  • provide education about medical/physical consequences of their behaviors WITHOUT SHAMING THEM
  • thank them for being brave enough to tell you the truth
  • provide referrals
24
Q

tx ED

A

SSRI: Prozac, Zoloft, LEXAPRO, celexa
*Prozac only approved med for ED (specifically bulimia)

SNRI: pristiq, Cymbalta, Effexor

atypical antipsychotics

  • abilify, Risperdal, Seroquel
  • help tx OCD, unstable mood, sleep problems, borderline PD, impulsivity, cutting
  • CI: possible wt gain

BZ: Xanax, Klonopin
-may help before meals with anxiety
CI: habit forming, numb emotions

ADHD: decrease urge to use substances
- CI: decreased appetite, wt loss

anticonvulsants: topomax, lamictal
CI: underwt, purging

25
Q

when prescribing meds.. consider

A 
-low BW can reduce med effectiveness
increased seizure risk (electrolytes off from purging/restricting)
- increased risk appetite loss, wt gain
- hx addiction
- family hx of successful meds
26
Q

Levels of care

A

hosp: 3-5d
inpt: 45-60
partial hospitalization/residential: 45-60
intensive outpt 1-3 mth
outpt 2-5 yr
support groups

27
Q

when is inpt tx needed

A

medically unstable
refuses or unable to follow oupt tx recommendations
-needs or wants break from day to day life to focus on recovery

28
Q

az centers

A

rosewood, remuda, mirasol, sierra tucson

29
Q

tx team minimum and additional

A

PCP/pediatrician, Clinical therapist, RD

addition: psychiatrist, Gyne, GI, school counselor, Dentist

30
Q

Outpt tx options

A

individual therapy, family therapy, couple therapy, group, ntr, physical fitness/training

31
Q

things to focus on

A

beliefs about self

emotional experiences

trauma: experiences that serve as “evidence” for negative beliefs

Healthy v toxic relationships

not just: eating, exercise, purging, body image, fear of food

32
Q

DSM V additions

A

BED,
OSFED (used to be EDNOS),
Unspecified feeding or eating disorder [[*clinician chooses to not specify reason - good for ER or urgent care]]

33
Q

DSM V OSFED

A

feeding or eating behaviros that cause clinically sig distress/impairment in areas of function but do not meet criteria for other

34
Q

BED DSM V

A

A. episodes, lack of control

B. 3 or more during episodes: fast, uncomfortable fullness, not actually hungry, alone, disgust/depression/guilt

C. distress

d. avg 1x/wk for 3 mth
e. not other dx

Psychiatric Principles (9 decks)

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