Psych - Eating Disorders Flashcards

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1
Q

Anorexia nervosa: definition and diagnostic criteria

A

-People restrict what they eat, compulsively exercise to maintain an excessively low body weight

Diagnostic criteria:

  • Morbid fear of fatness, even though are underweight
  • Restriction of energy intake relative to requirements leading to a significant low body weight in the context of age, sex, developmental trajectory and physical health
  • Distorted body image/denial of the seriousness of current low body weight
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2
Q

Anorexia: epidemiology

A
  • Onset age typically between 13-20 (men later)
  • Prevalence: 1-2% of schoolgirls and female students
  • Sex ratio F:M = 3:1
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3
Q

Anorexia: differential diagnosis

A
  • Psychosis: schizophrenia (delusions about food)
  • Organic: DM (which may coexist with anorexia)
  • More unlikely causes: addison’s, malabsorption, malignancy
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4
Q

Anorexia nervosa: clinical manifestations

A

-Emaciation
-Dry/yellow skin
-Fine lanugo hair on face/trunk
-Bradycardia/hypotension
alkalosis, pitted teeth, parotid swelling, Russell’s sign (scarring of dorsum of hand)

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5
Q

Anorexia nervosa: what physiological abnormalities occur?

A
  • Hypokalaemia
  • Anaemia and/or leukopenia
  • Low FSH, LH, oestrogens and testosterone
  • Raised cortisol and growth hormone
  • Impaired glucose tolerance
  • Hypercholesterolaemia
  • Hypercarotinaemia
  • Low T3
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7
Q

Anorexia nervosa: what are the criteria for hospitalisation?

A
  • Severe or rapid weight loss or BMI <13.5 - patients are at high risk of arrhythmia or hypoglycaemia
  • Significant suicide risk
  • Physical sequelae from starvation/purging
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8
Q

Bulimia nervosa: definition and criteria

A
  • Morbid fear of fatness, distorted body image
  • Cravings for food and uncontrolled binge-eating (>2000kcal in 1 session)
  • Sense of lack of control during over eating during binge episodes
  • Recurrent behaviours to prevent weight gain: purging/vomiting/laxative abuse
  • Binge eating and compensatory behaviours both occur, on average, at least/week for 3 months
  • Fluctuating (normal or excessive) weight
  • Weight disturbance does not occur exclusively during episodes of anorexia nervosa
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9
Q

Bulimia: epidemiology

A
  • Onset usually at age 15-30
  • Prevalence: 1-3%
  • Sex ratio F:M = 3:1
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10
Q

Bulimia: differential diagnosis

A
  • Anorexia nervosa
  • Kleine-Levin: rare sleep disorder where patients can experience hyperphagia
  • Kluver-Bucy: syndrome resulting from bilateral lesions to medial temporal lobe - can present with compulsive eating
  • Prader-Willi syndrome: overeating
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11
Q

Bulimia nervosa: management

A
  • Referral for specialist care
  • Dietitian input
  • Adults: bulimia nervosa focused guided self help, if ineffective after 4/52, eating disorder focused CBT
  • Children: bulimia nervosa focused family therapy
  • Pharmacological tx: limited role, high dose Fluoxetine is currently licensed for bulimia but long-term data is lacking
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12
Q

What is eating disorder not otherwise specified

A

-Patient has a mix of sx: purging, binging and periods of anorexia

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13
Q

Andrea is nervosa: outline the Mx

A

Adults with anorexia

  • Individual eating-disorder focused CBT, IPT, focal psychodynamic therapy and family therapy
  • Maudsley anorexia nervosa treatment pathway
  • Specialised supportive clinical management

Children and young people

  • Anorexia focused family therapy
  • CBT
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