Hovland-Feeding, Eating and Elimination Disorders Flashcards
What is diathesis?
Presdisposition toward disorder
What is stress?
The response of an individual to perceived demands that tax or exceed coping abilities
What are protective factors?
Influences that modify responses to environmental stressors?
What is resilience?
The ability to adapt successfully to difficult stressors w/out becoming seriously ill
What is Pica?
- Eating non-nutritious and non-food substances for more than one month.
- Eating is inappropriate developmentally
How do you treat Pica?
- Remove the stimulus
- arm splints/face
- reinforce positive behaviors
- correct deficiencies in nutrition
What is rumination?
Regurgitating food that is either spit out, chewed or swallowed again.
Must occur for period of at least 1 month.
Occurs in absence of a clinical reason.
Most commonly seen in infants, children or adults under stress or experiencing anxiety.
How do you assess rumination?
- rule out other causes for rumination
- check for malnutrition
- note whether behavior is self soothing/ self-stimulating
- assess parent child relationship for signs of attachment
How do you treat rumination?
Behavior techniques- aversion training, distraction and diversion
Improve environment
Model good interactions
What is avoidant/restrictive food intake disorder?
Avoidance of food or failure to eat an appropriate quantity of food.
children: may look like growth retardation or FTT
adults: significant weight loss, malnutrition, deteriorating psychological funcitoning
What two questions do primary care physicians find to be 100% sensitive and 90% specific in identifying specific in identifying patients with bulimia?
Are you satisfied with your eating patterns?
do you ever eat in secret?
What is the diagnostic criteria for anorexia nervoasa
- Restriction of energy intake related to requirements leading to low body weight
- intense fear of gaining weight or becoming fat, behavior that interferes with weight gain
What is the prevalence and onset of anorexia nervosa?
Female > Male 10:1
Early adolescence/adulthood (17)
What are the risk factors for anorexia?
- anxiety disorders, obsessional traits
- cultural values of thinness
- 1st degree relative w/ anorexia
- post industrialized/high income countries
What is the prognosis for anorexia?
Death often occurs from too rapid weight gain rather than from starvation. Sudden increase in weight can lead to cardiac failure/hypokalemia.
*AN is more serious though less common than bulimia
What is the neurochemistry of Anorexia?
REduction in brain serotonergic activity which is usually part of the normal regulation of satiety.
How do you manage anorexia?
Assess suicide risk
Evaluate medical status-cardiac indicators
Correct electrolyte and vitamin deficiencies slowly
How do you treat anorexia with psychopharmacology?
Antidepressants-TCA and MAO don’t usually help unless depression is also evident, some may also worsen anorexia because they’re appetite suppressants
Anxiolytics-for fear of eating
What percentage of pts w/ anorexia also have bulimia?
40-50%
Those w/ both disorders often have older onset and worse prognosis.
What is the diagnostic criteria for bulimia?
- Recurrent episodes of binge eating.
- eating an amt of food that is larger than most people would eat during a similar period/lack of control over eating - Compensatory behavior to lose weight
- Bing eating at least once a week for three months
What is the prevalence of bulimia and what is the common age of onset?
Female > male 81
Often seen in early adolescence
What percent of bulimics are single white college women?
50%
Most wait 4-5 yrs before seeking tx
What are comorbidities associated with bulimia for women?
- greater incidence of childhood physical abuse
- alcoholism and kleptomania
- panic disorder, depression, GAD
- weight normal to slightly below normal
What are comorbidities associated with bulimia in men?
- higher incidence substance abuse
- family hx of affective disorders
- more common in gay/bisexual men
What is the best way to manage bulimia pharmacologically?
Antidepressants:
- TCA- imipramine and desipramine
- MAO inhibitors- phenelzine
- Fluoxetine- helpful but it is also an appetite supressant
What is the prognosis for bulimia?
When viewed from a 5 year perspecitve bulimia is an episodic illness characterized by frequent relapses and remissions (uncommon after age 40)
