Lecture 6 - Eating and Feeding Disorders Flashcards
What are the most lethal of psychiatric conditions?
Eating Disorders (20% mortality rate)
Eating disorders are a maladaptive coping mechanism to exercise….
Control.
What is the difference between an eating and a feeding disorder?
Eating
–> Socially acceptable coping mechanism gone wrong
Feeding
–> More of a direct result of food preferences and perceived intolerances
What is the formula for BMI?
Kg/ M^2
Is BMI an accurate reading of a person’s nutritional status?
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.
Factors that contribute to the development of an eating disorder include…
Genetics, family, stressors and coping style, personality, and social and cultural factors.
What is anorexia nervosa? How is severity determined?
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
What are the subtypes of anorexia nervosa?
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.
What is lanugo?
soft, fine hair that an indicate poor nutritional status. Seen in AN and BN.
What does the nurse need to assess when suspecting AN?
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.
What are the goals during the acute care phase of AN?
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
What pharmacological treatment can be helpful for AN?
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
What nutritional therapy might be needed for someone with AN?
Increased caloric, protein, and fat intake
–> NG tube and supplements might be necessary.
What psychotherapy might be helpful to someone with AN?
Motivational Interviewing - normalize eating habit
CBT - resolve cognitive distortions like overgeneralizing, all-or-nothing thinking
Family therapy - families might feel powerless
What psychosocial interventions could help someone with AN?
Weight-restoration program for incremental weight gain + Milieu therapy for structures mealtimes, weigh-ins, monitoring.
Distraction, diversional activities, and therapeutic alliances can also help.
What is refeeding syndrome? What are some risk factors for it? How long does it last?
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.
What are some S/S of refeeding syndrome?
Resp depression, arrythmias, confusion, seizure, coma, death.
High BP
Hypo phosphatemia, K, Mg
How can we prevent refeeding syndome?
Gradual refeeding and electrolyte monitoring
–> Multidisciplinary approach
What is bulimia nervosa?
Characterized by recurrent episodes of binge eating and inappropriate compensatory mechanisms to prevent weight gain
What is considered mild, moderate, and severe AN?
BMI used
Mild: >17
Moderate: 16-16.99
Severe: 15-15.99
Extreme <15
What is considered mild, moderate, severe, and extreme bulimia nervosa?
Based on number of inappropriate compensatory behaviour per week.
Mild: 1-3 episodes
Moderate: 4-7 episodes
Severe: 8-13
Extreme: >14
What is considered a binge?
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.
What might be seen in a physical assessment of BN?
Dental erosion + cavities, esophageal tears, abd pain, callus on knuckles.
Dehydration + electrolyte imbalance
What psychological findings would be present for someone with BN?
Hx of AN, signs of depression and anxiety, poor self esteem
Difficulties with social relationships, substance use, presence of impulsive behaviours.