Lecture 62 + 63 - Pharmacotherapy of Eating Disorders Flashcards
Overview of eating disorders
anorexia, bulimia binge and purge, healthy eating, binge eating, obesity
Anorexia Nervosa
Restriction of energy intake leading to a significantly low body weight
Intense fear of gaining weight or becoming fat
Depression is a comorbidity
Specifiers of Anorexia Nervosa
Restricting type
Binge-eating/purging type
Restricting type
During the last 3 months, the individual has NOT engaged in recurrent episodes of binge eating or purging behavior
Weight loss is accomplished primarily through dieting, fasting, and/or
excessive exercise
Binge-eating/Purging Type
During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
**The difference between purging subgroup and bulimia nervosa disorder is the low body weight for AN
Specifiers of Anorexia Nervosa for ICD-10
Severity: mild, moderate, severe, extreme
18.5 kg/m^2 to be the low end of normal
Anorexia Nervosa - Health Consequences
Abnormally slow heart rate, low blood pressure
Decreased bone density
Weakness
Electrolyte abnormalities, hypoglycemia
Dry skin, hair loss
Severe dehydration
Downy layer of hair (lanugo) all over body
Cold intolerance; Delayed gastric emptying;
constipation
Inpatient vs Outpatient Treatment
Inpatient: treatment of acute risks
Outpatient: treatment of chronic symptoms and relapse prevention (psychotherapy, group therapy, nutritional counseling, family systems work)
Anorexia Nervosa – Re-Feeding Syndrome
Re-feeding results in shift from fat metabolism to glucose metabolism.
Hypokalemia, water retention, and severe edema
Multiple organ failure
Anorexia Nervosa Treatment
increase calories slowly (often eating as low as 300-700 kcal/day)
* Inpatient re-feeding: Increase by 500 kcal/day every 4 days up to 3500 kcal/day
* Outpatient re-feeding: Initial re-feeding 1200 – 1500 kcal/day (increase weekly by 500 kcal)
Anorexia Nervosa Therapy Treatment
cognitive behavioral (best outcomes)
pharmacotherapy: bupropion contraindicated; no drug therapy is FDA approved
Binge Eating Disorder
recurrent episodes of binge eating characterized by both of the following: Eating, in a discrete period of time an amount of food that is larger than what most people would eat in a similar period of time; A sense of lack of control over eating during the episode
Occurs on average at least once a week for 3 months; NOT associated with the recurrent use of inappropriate compensatory behavior
Severity Specifiers for Binge-Eating Disorder
characterized by episodes: mild, moderate, severe, extreme
Binge Eating Disorders - Health Consequences
similar to what is observed in obesity
HTN, elevated cholesterol, cardiovascular disease, type 2 diabetes, gallbladder disease
Binge Eating Disorder - Treatment
- Lisdexamfetamine (Vyvanse®) is FDA-approved
CBT + medication provides best outcomes