Psych Eating DOs Flashcards
Patient will present as → a 19-year-old female who has lost 40 pounds over the last 6 months. Her body mass index is 16. When asked about her most recent meal, the patient reports that she ate an apple the previous morning.
Anorexia Nervosa
Anorexia Nervosa
Anorexia Nervosa:
→ Disease Presentation:
Patient who refuses to eat due to fear of being overweight
→ DSM-5:
Intense fear of becoming fat - even though underweight
Frequent weight checks and denial
Restricted intake + fear of gaining weight + distorted body image
** BMI 17.5 or less / < 85% of ideal weight **
Mild: >17, Mod: 16-16.99, Sev: 15-15.99, Extr: <15
Ego-syntonic: acceptable behavior to them
Female Athletes Triad: Decreased Energy + menstrual disturbances + Low BMD
Amenorrhea, cold, constipated, fatigue, irritability, low libido
BRADYCARDIA/HYPOTENSION
→ Restrictive Type: reduced/strict intake, fasting, excessive exercise, diet pills
→ Binge/Purge: self-induced vomiting/laxative/diuretic use
Russell Sign: knuckle calluses
Salivary/Parotid glands enlarged
→ Dx:
EKG: arrhythmias (Prolonged QT)
HYPOkalemia
Metabolic Alkalosis
HYPOcholridemia
Elevated BUN/Creatinine from Dehydration
→ Treatment:
#1 = WEIGHT GAIN
HOSPITALIZE <75% BW
CBT (Maudsley Approach in teens)
Positive/Negative Reinforcements
Rx: SSRI
Or Olanzapine if needed for weight gain
Patient will present as → a 14-year-old is female who is brought to your clinic by her mother who claims to hear the child vomiting after dinner in the evenings. The patient reportedly denies vomiting and feels fine. On physical exam, you notice petechial hemorrhages of the soft palate and conjunctiva. Further exam reveals scars on her knuckles, swollen parotid glands, dental erosions. Her weight is normal. Lab tests reveal hypochloremia and hypokalemia.
Bulimia Nervosa
Bulimia Nervosa
Bulimia Nervosa:
→ Disease Presentation:
Patient who has episodes of mass eating followed by self-induced vomiting or intense exercise
→ DSM-5:
Binge eating combined with inappropriate compensatory behaviors at least once a week for 3 months
Patient is NORMAL or OVER WEIGHT**
Ego-Dystonic: troublesome to the patient
** Cardiac Arrhythmias = Common due to Hypokalemia ***
HYPOtension, dry skin
Teeth Pitting/Enamel Erosion/Caries
Russell Sign
Parotid gland hypertrophy
DX:
Hypokalemia/Hypomagnesemia
INCREASED AMYLASE (from parotid gland hypertrophy)
Metabolic Alkalosis
Hypochloremic, Hypokalemia
QT Prolongation
→ Treatment:
CBT
** FLUOXETINE: 60-80 **
** C/I = Bupropion = increased seizure risk **
