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Mental Health Nursing > Lecture 6 - Eating and Feeding Disorders > Flashcards

Lecture 6 - Eating and Feeding Disorders Flashcards

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1
Q

What are the most lethal of psychiatric conditions?

A

Eating Disorders (20% mortality rate)

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2
Q

Eating disorders are a maladaptive coping mechanism to exercise….

A

Control.

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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

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4
Q

What is the formula for BMI?

A

Kg/ M^2

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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.

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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.

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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

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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.

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9
Q

What is lanugo?

A

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

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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.

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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

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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

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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.

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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

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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.

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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.

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17
Q

What are some S/S of refeeding syndrome?

A

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

High BP

Hypo phosphatemia, K, Mg

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18
Q

How can we prevent refeeding syndome?

A

Gradual refeeding and electrolyte monitoring
–> Multidisciplinary approach

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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
Q

What treatment can be helpful to people with BN?

A

Interruption of binge eating and monitoring after mealtimes.

CBT + antidepressants.

26
Q

What is binge eating disorder?

A

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
Q

How is severity of BED determined?

A

By frequency of binging episodes per week.

Mild: 1-3
Mod: 4-7
Severe: 8-13
Extreme 14 or more

28
Q

What is the difference between overeating and binge-eating?

A

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
Q

What is Avoidant/Restrictive Food Intake Disorder and who does it affect most?

A

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
Q

What are the three common clinical presentations of ARFID?

A

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
Q

What are the manifestations of ARFID?

A

Significant weight loss or lack of appropriate weight gain

Significant nutritional deficiency + dependence on supplements

Marked interference with psychosocial and or physical functioning

32
Q

What is PICA?

A

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
Q

What is rumination disorder? What is it associated with?

A

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
Q

What is anorexia athletica? What are the symptoms?

A

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
Q

What is Nocturnal Sleep-Related Eating Disorder?

A

Problematic eating behaviours that occur in the period between sleep and wakefulness

36
Q

What is Orthorexia?

A

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
Q

What is ego-syntonic?

A

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
Q

What is the purpose of meal support?

A

To create a safe environment for patients to consume their meal (fine line between policing vs support)

39
Q

What are some strategies for effective meal support?

A

Create a safe space, structure meal plans, and incorporate mindful eating practices.

40
Q

In which ED is self worth largely influenced by body image and external validation?

A

Bulimia Nervosa

41
Q

What are some risk factors for eating disorder development?

Consider factors like sex, age, lifestyle, and previous life experiences.

A

–> Female, younger age
–> Sexual and physical abuse
–> Participation in easthetic or weight oriented sports
–> Heritability

42
Q

When do most eating disorders develop?

A

Early teens to mid-twenties - commonly following puberty.

Bulimia generally occurs later in adolescence with prevalence peaking in young adulthood.

43
Q

What other disorders tend to present comorbidly with EDs?

A

Depression, anxiety, OCD.

Cluster C disorders: avoidant, dependent, OC, passive-aggressive.

44
Q

What is the estimated heritability of AN?

A

60% (quite high)

45
Q

Why so SSRIs not work until the individual has reaches 90% optimal weight with AN?

A

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
Q

What kinds of cognitive distortions are common in eating disorders?

A

Overgeneralizations
All-or-Nothing Thinking
Catastrophizing
Personalization
Emotional Reasoning

47
Q

What evidence informed approaches are used for treatment of AN, BN, and BED?

A

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

Mental Health Nursing (18 decks)

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