Group- Eating Disorders Flashcards
- List diagnostic criteria for anorexia nervosa .
Anorexia Nervosa: restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex and development
- Intense fear of gaining weight or becoming fat, persistent behavior that interferes with gaining weight
- Disturbance in the way in which one’s body weight or shape is experienced
Can present as Restricting Type (3 mo) dieting, fasting or excessive exercise or Binge-eating/purging type (3mo)
- List the diagnostic criteria for bulimia.
Bulimia Nervosa: recurrent episodes of binge eating (eating more than other in a similar time/situation) and sense of lack of control over eating during the episode
- Recurrent inappropriate compensatory behaviors in order to prevent weight gain, ie. vomiting, misused laxatives, diuretics, other meds, fasting or excessive exercise; **not as many characteristics of restriction, less disconnect with body image
- At least twice a week for 3mo, self eval unduly influenced by body shape and weight, not exclusively during episodes of anorexia
- Describe the epidemiology of eating disorders.
prevalence of anorexia (1%) and bulimia (4%) mostly in HS and college aged women, more common in industrialized nations, often associated with occupation; onset is usually in adolescence, often co-morbid with social phobia and OCD
- Describe the pathophysiology of eating disorders.
variety of neurochemical disturbances: diminished noradrenergic activity, increased serotonergic activity, activation of HPA axis and suppression of thyroid function; possible endogenous opioids involved
genetic component, societal pressures and patient rigid or perfectionistic atitude, and close but troubled relationship with parents
- Describe the clinical presentation and medical complications of eating disorders.
anorexia: intense and irrational fear of gaining weight with a disturbed self-image (10% mortality) which leads to extreme dieting, obsessive interest in nutrition and exercise
can result in life threatening dehydration, hypothermia, bradycardia, hypogonadism and effects on mood, cognition and sleeping
bulimia: binging relieve tension in the patient but is quickly filled by feeling of guilt and disgust with inappropriate behaviors to reduce weight; can result in disturbance in electrolytes, metabolic alkalosis, ECG changes, fatty degeneration of liver and malnutrition; calluses on dorsal surface of hand, dental caries and esophageal tears
- Describe the psychological and physical effects of semi-starvation .
loss of body weight, intolerance to cold, decreased energy, pulse and BP decreases, constipation, decreased sex drive
thoughts of food dominate life, cravings, hoarding small amounts of food; problems with attention, interfering to learn new information
depression becomes rampant, increased smoking and caffeine intake
- List the acute concerns in treatment available for eating disorders.
goals to restore nutritional state, modify distorted eating behaviors, help change distorted beliefs about weight
hospitalization may be necessary; care to address re-feeding syndrome (shift from fat to carb metabolism and increase in insulin can lead to cellular uptake of phosphate, potassium, Mg, glucose, and thiamine)
- List the treatments available for eating disorders, including pharmacological behavioral and nutritional interventions
cognitive-behavior therapy can help monitor food intake and identifying associated emotions and challenging distorted beliefs about self-image and weight
interpersonal psychotherapy can also be helpful; Maudsley method: parents permission to set reasonable healthy expectations for anorexic child
SSRI fluoxetine can be effective in AN and BN, TCA are contraindicated due to the risk of cardiac rhythm disturbances
Atypial antipsychotics are used in tx. of severely distorted beliefs
Naltrexone and ondansetron (antimimetic) useful in bulimia nervosa
