Psychological Aspects of Eating Disorders Flashcards
Who is functional GI disease more common in?
Younger people
What are psychological problems caused by GI disease?
Conditioning Nausea and vomiting Loss of appetite / weight loss Diarrhoea Sexual problems Stress
What psychological problems can present as GI disease?
Stress Anxiety Depression Somatisation Eating Disorders
Definition of somatisation
Mental disorder characterised by recurring, multiple and current clinically significant complaints about somatic symptoms
When do somatic symptoms occur?
When a patient feels extreme anxiety about physical symptoms such as pain or fatigue
How do you assess nutritional risk?
BMI <20 = 1 BMI < 18 = 2 Weight loss 5% = 1 Weight 10% = 2 Have you eaten anything for 5 days 1. yes 2. no Score > 2 significant risk off malnutrition
Definition of refeeding syndrome
If you have been starving for a long period of time then get fed normally - can get very ill very quickly
Pathology of refeeding syndrome
Major electrolyte shifts - Ca - K - P - Mg Giving rise to MI
Definition of adapted starvation
The body enters this state to shut down as much as it can to reduce the energy it needs
Pathology of adapted starvation
Reduced intake of carbohydrate
Reduced secretion of insulin
What are the major energy sources?
Fat
Protein
How does the body have low expenditure of energy?
Lethargy
Lack of physical activity
How do you determine if someone is at high risk of developing refeeding problems?
Patients has one or more of the following
- BMI < 16
- Unintentional weight loss greater than 15% within the last 3 - 6 months
- little or no nutritional intake for more than 10 days
- low levels of potassium phosphate or magnesium prior to feeding
Patient has two or more of the following
- BMI < 18.5
- Unintentional weight loss > 10% within the last 3 - 6 months
- Little or nutritional intake for more than 5 days
- A history of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics
Treatment of malnutrition / eating disorder
Start slow - correct fluid depletion (cautiously) - thiamine (Vit B12) at least 30 mins before feeding starts Feed at 5-10kcal/kg over 24 hours - VERY SLOW Replace - Phosphate (IV) < 0.3 - K < 2.5 - Mg < 0.5 Thiamine
What are the eating disorders?
Binge Eating Disorder
Bulimia nervosa
Anorexia nervosa
Features of binge eating disorder
Binges, purging (getting rid)
Fails to compensate
Gain weight
Features of bulimia nervosa
Restriction Binges Purging (getting rid) Compensates for restriction by binging which then they compensate for by purging Normal or near normal weight
Features of anorexia nervosa
Restriction leading to significant weight loss Obsessive fear of gaining weight - perfectionism - SIDMA Obsessive compulsive disorder Body dysmorphia - distorted self image Over exercising Amenorrhoea
Definition of amenorrhoea
Absence of menstruation
Which gender has eating disorders more than the other?
F > M 9:1
What are some of the behaviours used in the pursuit of thinness?
Self starvation Self induced vomiting Compulsive activity and exercise Use of laxatives Diet pills Herbal medicines Deliberate exposure to the cold
People who are obese, if they lose weight, how long can they manage this for before they struggle?
3 - 4 months
Tiers of weight management
2; programmes for 2 months
3; specialist weight management dieticians and psychologists
4; Surgery
In a sleeve gastrectomy, how much of the stomach is taken away?
4 / 5ths
