L15 - Anorexia Nervosa

Question 1

What are the 2 Anorexia Nervosa subtypes?

Answer 1

1. Restricting .

2. Binge-purging.

Question 2

Is Anorexia Nervosa a result of a loss of appetite?

Answer 2

• No, at least not in the early stages of illness.

- Patients deliberately don’t eat even when extremely hungry.

Question 3

Who coined the term Anorexia Nervosa?

Answer 3

Sir William Gull in 1874.

Question 4

What was the treatment for Anorexia Nervosa around 1930?

Answer 4

In 1930 there was belief that:

• Patients can be persuaded to eat.
• The condition is hysterical and no patient should go uncured.
• Doctor should fight for every mouthful of food.
• Doctor must never lose temper.
• Cure AN before starting on psychological symptoms.
• Specialist nurses usually needed.

Question 5

Does Anorexia Nervosa only affect women?

Answer 5

• No; about 10% of all cases are males, however this is likely to be an underestimation.
• Younger ages tend to have more equal numbers between genders.

Question 6

What are some of the associated symptoms of AN?

Answer 6

• AN is a psychosomatic syndrome of self-induced weight loss.
• Associated with obsessionality, depression and low self-esteem.
• Characterised by excessive use of behaviours directed at bringing about weight loss.
• Social effects (individualism, regression and isolation).
• Physical consequences.

Question 7

What are some of the physical consequences of AN?

Answer 7

• Oestrogen suppression -> osteoporosis.
• Lanugo hair growth.
• Pseudo-atrophy of the brain.
• Hyperthermia, dehydration.
• Hypotension, prolonged QT interval, arrhythmia.
• Iron deficiency anaemia.
• Acute/chronic renal failure.
• Amenorrhoea.
• Severe constipation.
• Immunodeficiency.

Question 8

Are there any medication based treatments for AN?

Answer 8

• There are no current RCT’s of medications to treat AN in children/adolescence, however antipsychotics may be used for adults at low doses.
• RCT on Olanzapine for adults showed a reduction in patient’s distress.

Question 9

What is the clinical course of AN?

Answer 9

• ~20% fully recover.
• ~60% improve.
• ~20% die as a result.
• Average illness duration of 7 years.
• 32x higher suicide risk than expected.
• Younger patients are more likely to improve.

Question 10

What did Keys et al. (1950) find in their study ‘Biology of human starvation”?

Answer 10

• Starved healthy young men who chose not to go to war.
• Intended to last 6 months, had to stop at 3 months.
• Found similar symptoms to AN (obsession with food, hypothermia, insomnia).

Question 11

What is re-feeding syndrome?

Answer 11

• Re-feeding syndrome refers to a potentially fatal shift of fluid and electrolytes that occurs when re-feeding a malnourished patient.
• Serious consequences include cardiac (phosphates: heart -> digestion) & respiratory failure, gastrointestinal problems, delirium, death.

Question 12

Outline a study which showed that AN is not due to a perceptual disfunction:

Answer 12

• Touyz et al. (1974) took a picture of patients and made it able to be distorted (more/less weight) asking participants to rate how they looked and how they felt they looked.
• Patients could accurately rate how they looked, while how they felt they looked was inaccurate.

Question 13

What do brain scans and fMRI’s indicate about AN?

Answer 13

• Flight/fight response to images of high caloric foods.

fMRI:
- When looking at others, AN patient’s brain activity matched those of healthy young people looking at others, however, when viewing themselves there was a large decrease in activation (brain froze: fear response).

Question 14

What has been demonstrated about the insula in AN patients?

Answer 14

• Underperformance/activation in AN.
• Tend to focus on minute details, rather than whole picture.
• Show increased perseveration, “set-shifting” similar to Alzheimer’s patients (card sorting tasks).