lecture 4 Flashcards
eating disorders strongly associated with
-mood disorders
-anxiety
-impulse control
-substance abuse
main preoccupation w food, weight, body image
anorexia nervosa
UNDERWEGIHT
-lethal mental problem with the mortality risk 5x
-typically bc person starves themselves
-suicide?
anorexia nervosa stats
- found in females <15
F: 4%
M:<1%
begins in adolescence or young adult due to stressful event
anorexia DSM-5
-restriction of foo leading to low body weight according to norms of what is expected of their age, sex, developmental trajectory and physical health.
-intense fear of gaining weight or becoming fat even in slight gain weight
-disturbance of ones body weight or shape is experienced or lack of recognitions of the seriousness of low body weight
anorexia nervosa :
BMI?
persistent behaviors?
BMI <18.5
-persistent energy intake restriction lasting 3 months
persistent behaviors interfere weight gain:
-binging
-purging
-refusal to eat
-body image distortion
anorexia sx: behavior
-underweight
-restricted dietary intake
-binge eating: occur atleast once a week for 3 months and is eating at larger amounts for 2 hrs where pt has lack of control
-purges and induce vomiting
anorexia sx:
HYPOTHALMIC PITUITARY DYSFXN
-amenorrhea
-weakness
-abd. pain
-bloating
-cold intolerance
-depression
-anxiety
-orthostatic hypotension
HYPOTHALMIC PITUITARY DYSFXN
anorexia screening and evaluation:
-person worried about food, weight, body image
-eating disorder screen for primary care (ESP)
anorexia nervosa: screening and eval uses what questionnaire?
2+ yes = more eval
-SCOFF is a 5 ? screening tool to clarify suspicion that an eating disorder exists rather than make diagnosis.
S- do you make yourself SICK when too full?
C- control how much u eat?
O- loss ONE stone (14 lbs) in 3 months
F- think ur FAT when others say your thin?
F- FOOD dominates yo life?
Problems of anorexia lead to:
-result from direct starvation
-induces protein and fat catabolism
-loss of cell volume
-atrophy of the heart, liver, brain, intestines, kidneys
Anorexia tx:
-feed
-psychotherapy
-treat comobities
BEST TX IS INPT.
Anorexia nervosa tx:
feeding goals
- feeding
-slow weight gain is KEY
-target weight gain :
-inpt: 2-3 lbs weekly
outpt: 2-3 lbs weekly
-nutrition manag’t
-standard diet
criteria for admission for anorexia:
-unstable vital signs: [hypotn, bradycard]
-dysrhythmia
-BMI<15
-cardio, renal, heaptic compromised
-dehydrated
-electrolyte low
complication of anorexia if untreated:
-refeeding syndrome:
severe electrolyte disturb
-cardiac dysfxn [fluid overload, hypokalemia]
ALP IS BEST MARKER
-abd. bloating due to GI impaired
anorexia stats:
relapse:
prevention:
relapse:
35-41% in 18 months
stressor comes up
Prevention:
tx comorbities, psychotherapy
support group
nutritionist
bulimia nervosa:
NORMAL WEIGHT
-secret binge eating
-inappropriate measure to gain weight
-purging in secret
-excessive excercise
-laxatives
-diuretics
body image distortion: focus on body weight
NORMAL WEIGHT
bulimia presenting sx:
-Constipation
-anxiety
-parotitis
-eroded tooth enamel
-dyspepsia
-irregular menses
-calluses on knuckles
-dysphagia
Bulimia Nervosa DSM-5
-eating within any 2 hour with a large amount a food than what most people would eat
-feeling that one can not stop eating or control how much one is eating
-self induce vomiting or using laxatives, diuretics, exercising alot
-once a week for 3 months
-self eval influenced by body
Why is bulimia hard to diagnose?
-no screening measurements
-SCOFF isn’t sens
Bulimia Acute TX:
Chronic TX:
Acute tx:
-nutrition
-electrolyte correction
-dehydration
-esophageal rupture/bleed
-aspiration pneumonia
-Rib fracture
CHRONIC:
-psychotherapy
-treat comorbid tx
complications to bulimia nervosa:
-post binge pancreatitis die to forceful vomiting
-cardia dysfxn bc low K
-44 % relapse in 2 years
-most common PDD
Binge Eating disorder
MC eating disorder
OVERWIEGHT
Binge eating disorder criteria 2
binge eating episodes associated with 3+ of the following:
-eating hella fast
-eating until super full
-eating alot when not hungry
-eating alone bc embarrassed how much your eating
-feeling disgusted/guilty after overeating
Binge eating disorder criteria 1
-recurrent episodes of binge eating: by eating in secret within two hrs or eat a large amount of food than what most ppl would
-lack of contril
Binge eating disorder criteria 3
-distress causing binge eating
Binge eating disorder criteria 4
-1 day a week for 3 months
Binge eating DSM-5 sx:
Screening, Dx?
-bloating and discomfort
-dyspepsia
-depression
-anxiety
-overweight
screening: none
Dx: BMI>30 (obesity)
Binge eating TX:
FDA approved binge eating med:
CBT
meds:
-lisadexamfetamine dimesylate [psychostimulant used to treat ADHD]
-bupropion, SSRI, SNRI
binge eating disorder complications?
-same as OBESITY
-htn, heart dz, cancer, arthritis, sleep apnea, diabetes, CVA
Dissociation Disorders:
-mental disorder involved with experiencing a disconnection and lack of continuity btw thoughts, memory, surroundings, actions and identity
ppl with dissociative disroders escape reality in ways that…
-involuntary
-unhealthy
-impairment to everyday life
Dissociation Identity Disorder [DID]:
aka multiple personality disorder, split personality disorder
-disruption of identity characterized by 2 or more distinct personality states.
-difficult to determine
DID misdiagnosed as:
-depression w psychotic features
-seizures
-bipolar
-schizophrenia
-PTSD
-subs. use disorder
-personality disorder
Dissociation Identity Disorder [DID] DSM-5:
-identity characterized by 2+ personality states
-recurrent gaps in recall of everyday events, important info inconsistent w ordinary forgetting
-sx cause distress or impairment in social settings
-not normal part of accepted cultural /religious ( differentiate w imaginary friends)
-not attributed to substance (like alcohol)
Dissociative Amnesia Disorder:
-loss of memory of important recent events that is not the same as ordinary forgetfulness or fatigue.
triggered by traumatic events, part of fugue
fugue is sudden amnesia where person travel away from home w the new id.
DID Criteria:
-alter personalities
-triggered by stressors
D/c of oneself, switch of attitudes and cant remember what alter personality did
DID TX:
if untreated and complicated:
-support therapy
-stop triggers
-psychotherapy
untreated : memory loss, self harm, violence
Dissociative Amnesia Disorder DSM-5:
-unable to recall personal life that is inconsistent from ordinary forgetting.
-distress or impairment in functioning in social settings
-not correlated with substance
Dissociative Amnesia Disorder TX:
Acute: calm and memory can return
Chronic:
may need benz to recover memory, psychotherapy once memory recovered
Dissociative Amnesia Disorder TX:
-memories once lost cant be recovered but can be repressed
Dissociation Depersonalization /derealization disorder:
persistent or recurrent experiences of depersonalization, derealization, or both
depersonalization:
derealization:
-depers: detached feeling from oneself, mind
dereal: experience of feeling as if your the outside observer to SURROUNDINGS
Dissociation Depersonalization /derealization disorder:
occur due to
-emotional trauma
-witnessing domestic violence
-raised by a caregiver w mental illness
-substance use
-ketamine, Mj, ectasy
Dissociation Depersonalization /derealization disorder DSM-5:
-depersonalization
-derealization
-reality testing intact
-no subst, not tied to other mental disorder, impairm’t in social life
Dissociation Depersonalization /derealization disorder TX:
-psychotherapy
-cBT
meds: SSRI if anxiety
