Lecture 6 - Eating and Feeding Disorders Flashcards

1
Q

What are the most lethal of psychiatric conditions?

A

Eating Disorders (20% mortality rate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Eating disorders are a maladaptive coping mechanism to exercise….

A

Control.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the difference between an eating and a feeding disorder?

A

Eating
–> Socially acceptable coping mechanism gone wrong

Feeding
–> More of a direct result of food preferences and perceived intolerances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the formula for BMI?

A

Kg/ M^2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Is BMI an accurate reading of a person’s nutritional status?

A

No - it does not consider fitness level, muscle mass, body fat, or dietary habits.

BMI itself means nothing and must be considered as a measure to help understand the whole picture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Factors that contribute to the development of an eating disorder include…

A

Genetics, family, stressors and coping style, personality, and social and cultural factors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is anorexia nervosa? How is severity determined?

A

Restriction of energy intake and intense fear of gaining weight. Accompanied by a disturbance in body image perception.

Severity of AN is based on BMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the subtypes of anorexia nervosa?

A

Restrictive (AN-R)
–> In last three months, individual has not engaged in episodes of binge eating or purging

Bing-eating/Purging (AN-P)
–> In the last three months, in the individual has engaged in recurrent episodes of binge eating or purging.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is lanugo?

A

soft, fine hair that an indicate poor nutritional status. Seen in AN and BN.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does the nurse need to assess when suspecting AN?

A

Physical: Lytes, weight, integ + hair, pulse + BP + temp

Lifestyle: Hx of eating habits and dieting. Methods used to achieve ideal weight and value attached to weight.

MSE: Focus on mood, cognition, insight, anxiety, suicidal ideation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the goals during the acute care phase of AN?

A

Immediate medical stabilization if electrolyte imbalance or below 85% ideal body weight.
–> Inpatient management when nutrition is initiated d/t refeeding syndrome
–> Develop therapeutic relationship and monitor client for suicidal ideation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What pharmacological treatment can be helpful for AN?

A

SSRIS to help reduce obsessive-compulsive behaviour
–> May not be effective until patient reaches 90% of goal weight

Antipsychotics
–> Chlorpromazine for delusion or psychomotor agitation
–> Olanzapine for mood & obsessive behaviours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What nutritional therapy might be needed for someone with AN?

A

Increased caloric, protein, and fat intake
–> NG tube and supplements might be necessary.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What psychotherapy might be helpful to someone with AN?

A

Motivational Interviewing - normalize eating habit

CBT - resolve cognitive distortions like overgeneralizing, all-or-nothing thinking

Family therapy - families might feel powerless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What psychosocial interventions could help someone with AN?

A

Weight-restoration program for incremental weight gain + Milieu therapy for structures mealtimes, weigh-ins, monitoring.

Distraction, diversional activities, and therapeutic alliances can also help.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is refeeding syndrome? What are some risk factors for it? How long does it last?

A

Rapid refeeding following long periods of fasting switches body from catabolic to anabolic states and can cause serious electrolyte imbalances.
–> Usually presents in first 4 days, but can be present for up to two weeks.

Risk factors: Chronic malnutrition, anorexia nervosa, prolonged fasting.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some S/S of refeeding syndrome?

A

Resp depression, arrythmias, confusion, seizure, coma, death.

High BP

Hypo phosphatemia, K, Mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How can we prevent refeeding syndome?

A

Gradual refeeding and electrolyte monitoring
–> Multidisciplinary approach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is bulimia nervosa?

A

Characterized by recurrent episodes of binge eating and inappropriate compensatory mechanisms to prevent weight gain

20
Q

What is considered mild, moderate, and severe AN?

A

BMI used

Mild: >17
Moderate: 16-16.99
Severe: 15-15.99
Extreme <15

21
Q

What is considered mild, moderate, severe, and extreme bulimia nervosa?

A

Based on number of inappropriate compensatory behaviour per week.

Mild: 1-3 episodes
Moderate: 4-7 episodes
Severe: 8-13
Extreme: >14

22
Q

What is considered a binge?

A

Eating in a discrete amount of time (2 hours) an amount that is definitely larger than most would during a similar period of time and under similar circumstances.

23
Q

What might be seen in a physical assessment of BN?

A

Dental erosion + cavities, esophageal tears, abd pain, callus on knuckles.

Dehydration + electrolyte imbalance

24
Q

What psychological findings would be present for someone with BN?

A

Hx of AN, signs of depression and anxiety, poor self esteem

Difficulties with social relationships, substance use, presence of impulsive behaviours.

25
What treatment can be helpful to people with BN?
Interruption of binge eating and monitoring after mealtimes. CBT + antidepressants.
26
What is binge eating disorder?
Recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances for at least once a week over 3 months. --> Episodes marked by feelings of loss of control.
27
How is severity of BED determined?
By frequency of binging episodes per week. Mild: 1-3 Mod: 4-7 Severe: 8-13 Extreme 14 or more
28
What is the difference between overeating and binge-eating?
Overeating: Consuming more food than your body needs at a given time, most people overeat on occasion Bing-Eating: Marked by psychological distress and must include 3 of the following: - Eating very quickly - Regardless of hunger - Eating until uncomfortably full - Eating alone d/t embarrassment - Feelings of self-disgust, guilt, or depression
29
What is Avoidant/Restrictive Food Intake Disorder and who does it affect most?
Restrictive or inadequate eating not attributed to comorbidity or disturbances in perception of shape and weight. --> More common in children, can occur in adults
30
What are the three common clinical presentations of ARFID?
Lack of Interest in Food --> Of blunted response to physiological hunger Avoidance d/t Sensory Dislike --> Only eats narrow range of foods As a Reaction to Upsetting Event --> Like choking
31
What are the manifestations of ARFID?
Significant weight loss or lack of appropriate weight gain Significant nutritional deficiency + dependence on supplements Marked interference with psychosocial and or physical functioning
32
What is PICA?
Persistent eating of nonnutritive substances for at least one month where the behaviour is inappropriate for developmental level and not part of a culturally sanctioned practice. --> Can be diagnosed with another disorder or condition if it is severe enough
33
What is rumination disorder? What is it associated with?
Repeat regurgitation of food for at least 1 month, does not occur exclusively in the course of another diagnosed ED. --> Associated with intellectual development disorder and childhood neglect.
34
What is anorexia athletica? What are the symptoms?
A profound preoccupation with exercise S/S: --> Compulsive need to exercise and prioritizing exercise over other life events ---> Equating self worth to physical performance --> Rarely satisfied with one's physical achievements
35
What is Nocturnal Sleep-Related Eating Disorder?
Problematic eating behaviours that occur in the period between sleep and wakefulness
36
What is Orthorexia?
A problematic preoccupation wit health and relying on natural products. --> Finds more pleasure in eating clean than actually enjoying food --> Emotional satisfaction when sticking to goals and intense despair when they fail Can be a gateway to AN
37
What is ego-syntonic?
Ideas and behaviours that are acceptable with one's values and way of thinking. --> This can lead to a reluctance to change in maladaptive behaviours such as EDs.
38
What is the purpose of meal support?
To create a safe environment for patients to consume their meal (fine line between policing vs support)
39
What are some strategies for effective meal support?
Create a safe space, structure meal plans, and incorporate mindful eating practices.
40
In which ED is self worth largely influenced by body image and external validation?
Bulimia Nervosa
41
What are some risk factors for eating disorder development? Consider factors like sex, age, lifestyle, and previous life experiences.
--> Female, younger age --> Sexual and physical abuse --> Participation in easthetic or weight oriented sports --> Heritability
42
When do most eating disorders develop?
Early teens to mid-twenties - commonly following puberty. Bulimia generally occurs later in adolescence with prevalence peaking in young adulthood.
43
What other disorders tend to present comorbidly with EDs?
Depression, anxiety, OCD. Cluster C disorders: avoidant, dependent, OC, passive-aggressive.
44
What is the estimated heritability of AN?
60% (quite high)
45
Why so SSRIs not work until the individual has reaches 90% optimal weight with AN?
Malnutrition causes tryptophan (aa) deficiency. Tryptophan is necessary for serotonin synthesis. --> Drops is dietary intake can relieve symptoms of anxiety and dysphoria and reward caloric restriction --> feedback loop.
46
What kinds of cognitive distortions are common in eating disorders?
Overgeneralizations All-or-Nothing Thinking Catastrophizing Personalization Emotional Reasoning
47
What evidence informed approaches are used for treatment of AN, BN, and BED?
AN: none (family therapy appears promising in adolscents) BN: CBT, antidepressants (fluoxetine), interpersonla therapy BED: CBT, interpersonal therapy, antidepressants, lisdexamfetamine dimesylate to reduce binge eating and weight gain