First Aid: Eating Disorders Flashcards
What are the 2 main divisions of anorexia nervosa?
Restrictive type
Binge eating/purging type
What are characteristics of the restrictive type of anorexia nervosa?
Eat very little
May vigorously exercise
Withdrawn
OCD traits
What are characteristics of the binge eating/purging type of anorexia nervosa?
- Eat in binges followed by purging, laxatives, excessive exercise and/or diuretics
- Associated with increased incidence of major depression and substance abuse
What is the DSM-IV criteria for anorexia nervosa?
- Body weight at least 15% below normal
- Intense fear of gaining weight or becoming fat
- Disturbed body image
- Amenorrhea
What is lanugo?
fine body hair (complication of anorexia nervosa)
What is melanosis coli?
darkened area of colon 2/2 laxative abuse
What are other complications of anorexia nervosa?
- Electrolyte imbalances (hypochloremic hyperkalemic alkalosis)
- Hypercholesterolemia
- Arrhythmias
- Leukopenia
- Osteoporosis
What is the gender differences with anorexia nervosa?
Women 10-20X more common
What is the prevalence of anorexia nervosa?
occurs in 4% of adolescents and young adults
When does anorexia nervosa usually start?
between 10 and 30
How might you tell the difference between someone who is thin due to anorexia nervosa versus someone who is thin due to MDD?
- anorexia nervosa patients have good appetite but starve themselves (usually preoccupied with food)
- MDD patients usually have poor appetite and have no interest in food
What is the differential diagnosis for anorexia nervosa?
- Cancer (or other medical condition)
- MDD
- Bulimia
- Somatization d/o
- Schizophrenia
What is the mortality rate for anorexia nervosa?
10% (starvation, suicide, or electrolyte disturbance)
When should someone with anorexia nervosa be treated on an inpatient basis?
when they are 20% below ideal body weight should be hospitalized
What is the treatment for anorexia nervosa?
- Family therapy
- Behavioral therapy
- Supervised weight gain programs
- Antidepressants like paroxetine or mirtazapine (promote weight gain)
What are the major differences between someone with anorexia nervosa and someone with bulimia nervosa?
Bulimic patients:
- usually maintain a normal body weight
- symptoms are more ego-dystonic (distressing)
- more likely to seek help
What are the two types of bulimia nervosa?
Purging type
Nonpurging type
What are features of the purging type of bulimia nervosa?
vomiting
laxatives
diuretics
What are features of the nonpurging type of bulimia nervosa?
excessive exercise
fasting
What is binge eating?
excessive food intake within a 2 hour period accompanied by a sense of lack of control
What is the DSM-IV diagnostic criteria for bulimia nervosa?
- Recurrent episodes of binge eating
- Recurrent, inappropriate attempts to compensate for overeating and prevent weight gain (such as laxative abuse, vomiting, etc.)
- The binge eating and compensatory behaviors occur at least twice a week for 3 months
- Perception of self-worth is excessively influenced by body weight and shape
What are common complications of bulimia nervosa?
- Hypochloremic hypokalemic alkalosis
- esophagitis
- dental erosion
- calloused knuckles
- salivary gland hypertrophy
What is the prevalence of bulimia nervosa?
1-3% of adolescent and young females
What are common comorbidities of bulimia nervosa?
- Mood disorders
- Impulse control disorders
- Alcohol abuse/dependence
Which has a better prognosis, anorexia or bulimia?
bulimia nervosa
What is the prognosis for bulimia nervosa?
- 50% recover fully with treatment
- 50% have chronic course with fluctuating s/s
What are the treatment options for bulimia nervosa?
- Individual psychotherapy
- Cognitive-behavioral therapy
- Group therapy
- SSRIs (first line), TCAs (second line)
How is obesity defined?
being at least 20% over ideal body weight
What is the prevalence of obesity in the USA?
over 50%
Where does binge eating d/o fall in the DSM-IV?
under eating d/o NOS
What is the DSM-IV criteria for binge eating disorder?
- Recurrent episodes of binge eating
- Severe distress over binge eating
- Bingeing occurs at least 2 days a week for 6 months and is not associated with compensatory behaviors (like vomiting, laxative use, etc.)
- 3 or more s/s are present: eating very fast, eating until uncomfortably full, eating large amounts when not hungry, eating alone due to embarrassment over eating habits, feeling disgusted, depressed or guilty after over-eating
What therapies are used for treating binge eating disorder?
- Individual psychotherapy
- Behavioral therapy
- Strict diet and exercise program
- Pharmacotherapy to promote weight loss
What are drugs used to promote weight loss?
- Stimulants (phentermine and amphetamine) to suppress appetite
- Orlistat (Xenical)
- Sibutramine (Meridia)
What is the MOA of orlistat?
- inhibits panreatic lipase
- inhibits amount of fat absorbed from GI tract
What is the MOA of sibutramine?
-inhibits reuptake of NE, serotonin, and dopamine
