psych eating disorders

Question 1

two type of anorexia nervosa

Answer 1

restrictive type and binge-eating/purging type

Question 2

bing-eating/purging type

Answer 2

eats in binges followed by self-induced vomitting, using laxative, excessively exercising, and/or using diuretics

Question 3

dsm criteria for anorexia

Answer 3

BMI less than 17.5 or less than 85% of ideal body weight; absence of at least three consec menstrual cycles; disturbed body image; intense fear of gaining weight

Question 4

mortality rate of anorexia

Answer 4

10 percent; cumulative from starvation, suicide, or cardiac failure

Question 5

hospitalization versus outpatient for anorexia

Answer 5

patients can be treated outpatient unless they are less than 20% below ideal body weight or if there are serious medical or psych complication or if there are serious medical or psych complications

Question 6

why are SSRIs not effective in anorexia

Answer 6

thought to be because of decr tryptophan in diet (precursor to seratoning)

Question 7

treatment for anorexia

Answer 7

therapy, low dose second generation anti-psychotics; benzos administered prior to meals

Question 8

bulimia nervosa

Answer 8

binge eating along with behaviors intended to counteract weight gain; unlike anorexic patients, they usually maintain normal weight (and may be overweight)

Question 9

two subcategories of bulimia

Answer 9

purging type (vomitting, laxatives, enemas, or diuretics) and nonpurging type (excessive exercise or fasting)

Question 10

dsm criteria for bullimia

Answer 10

the binge eating and compensatory behaviors occur at least twice a week for 3 mos

Question 11

physical manifestations in bullimia nervosa

Answer 11

salivary gland enlargement (sialadenosis), dental erosion, callouses on dorsum of hand, petechiae, peripheral edema, aspiration

Question 12

Russell’s sign

Answer 12

callouses on the dorsum of hand from self induced vomiting

Question 13

lab findings in bullimia

Answer 13

hypochloremic hypokalemic alkalosis, metabolic acidosis (laxative abuse), elevated bicarb (compensation); hypernatremia; incr BUN, incr amylase, altered thyroid hormone and cortisol homeostasis, esophagitis

Question 14

prognosis for bullimia

Answer 14

better prognosis than for anorexia; one half recover fully with treatment and one half have chronic course

Question 15

treatment for bullimia

Answer 15

antidepressants plus therapy; SSRIs are first line (fluoxetine is the only FDA approved one for bullimia); therapy too; avoid buproprion for its potential to lower seizure threshold

Question 16

binge eating disorder

Answer 16

eating disorder NOS; these patients suffer emotional distress from their binge eating but do not try to control their weight by purging or restricting; not fixated on body shape and weight

Question 17

DSM criteria for binge eating disorder

Answer 17

recurrent episodes of binge eating; severe distress over binge eating; binge eating occurs at least two days a week for 6 mos

Question 18

treatment for binge eating disorder

Answer 18

psychotherapy; strict diet and exercise; pharmacotherapy (stimulants to suppress appetite; orlistat to inhibit pancreatic lipase to decr fat absorption; sibutramine to inhibit reuptake of norepi, serotonin, dopamine)

Question 19

refeeding syndrome

Answer 19

when severely malnourished patients are refed too quickly; look for fluid retention and decr level of phos, mag, and calcium; complications incl arrythmias, resp failure, delirium, and seixures; replace electrolytes and slow the feedings

Question 20

cortisol in anorexic patients

Answer 20

often increased (maybe this is why they are amnenorrheic)