Test 6: Eating and Sleep-Wake Disorders Flashcards
What are the characteristics of Bulimia Nervosa?
1) Binge eating
- Excess amounts in discrete time period
- Perceived as uncontrollable
- Associated with guilt, shame, or regret (may be)
- Hide from family members (may)
- High in sugar, fat, or carbs (often)
2) Compensatory behaviors:
- purging (most common)
– most common: self-induced vomiting
– other: diuretics or laxatives
- Excessive exercise
- Fasting or food restriction
What are the associated physical features of Bulimia Nervosa?
- Most within 10% normal body weight, have more body fat
- Purging can result in severe medical problems
– death
– electrolyte imbalance
– kidney failure, cardiac arrhythmia, seizures, intestinal problems, permanent colon damage
– erosion of dental enamel
What are the associated psychological features of Bulimia Nervosa?
- Overly concerned with body shape (most)
- Fear of gaining weight, but most have normal body weight
- Comorbid psychological disorders (80% anxiety)
What are medical consequences of Bulimia Nervosa?
- Salivary gland enlargement causes by repeated vomiting (cubby face)
- Erosion of dental enamel
- Electrolyte imbalance –> cardiac arrhythmia and renal failure
- Intestinal problems from laxative abuse
- Calluses on fingers and hands from stimulating gag reflex
What are the defining characteristics of anorexia nervosa?
Extreme weight loss
- calorie restriction below energy requirements
- binging and purging (may)
- 15% below expected weight
- intense fear of weight gain and losing control over-eating
- relentless pursuit of thinness
- often begins with dieting
What are the associated features of anorexia nervosa?
- Marked disturbance in body image (most)
- Comorbid with other psychological disorders (most)
- Organ damage: cardiac damage (heart attack and death)
What are the defining features of binge eating disorder?
(New to DSM)
- No compensatory behaviors
- Associated with distress and/or functional impairment
What are the associated features of BED?
- Obesity (many)
- Concerns about shape and weight (some)
- Older than bulimics and anorexics
- More psychopathology than non-binging obese people
What are the facts and statistics of Bulimia Nervosa?
- Majority are female: 90%+
- Onset: typically adolescence
- Median age: 18-21
- Lifetime prevalence: 1.1% females, 0.1% males
- College women: 6-7%
- Tends to be chronic if left untreated
What are the facts and statistics of Anorexia Nervosa?
- Majority: female & white, middle-to upper-middle-class families
– High expectations,
– perfectionistic
– Non-communcative
– Concerned with outward appearance - Usually develops around early adolescence
- More chronic and resistant than bulimia
What are the causes of Bulimia and Anorexia?
1) Culture
- media portrayals: thinness linked to success and happiness
- Cultural emphasis on dieting
- Standards of ideal body size: change like fashion, difficult or impossible to achieve
2) Biological
- partial genetic component
- deficits in serotonin (binging)
3) Psychological and behavioral
- low sense of personal control and self-confidence
- perfectionistic attitudes
- distorted body image
- preoccupation with food
- comorbidity: anxiety and mood disorders
(Interacting: dietary restraint, family influences, biological & psychological dimensions)
What is the psychosocial treatments of bulimia nervosa?
CBT
- treatment of choice
- identifying maladaptive thinking patterns and behavioral habits, then gradual practice of new habits
- learn to eat small, frequent meals,
What is the medical treatment of Bulimia Nervosa?
Antidepressants
- Have some effectiveness
- Can help reduce binging and purging behavior
- Usually not efficacious in the long-term
What is the psychological treatment of binge eating disorder?
- CBT: similar to that used for bulimia, appears efficacious
- Interpersonal: equally effective as CBT
- Self-help techniques: also appear effective
What goals of psychological treatment of Anorexia Nervosa?
- Weight restoration: first and easiest goal to achieve
- Psychoeducation
- Rx: have not been found to be effective
- Behavioral and cognitive interventions: targets food, weight, body image, thought, and emotion
- Treatment often involves the family
- Long-term prognosis for anorexia is poorer than for bulimia
What is the background and overview of obesity?
- BMI of 30+
- Not DSM disorder but may be a consequence
- 2008: 33.8% US adults
- 2010: 37.5% US adults
- Mortality rates: closely associated with smoking
- Increasing more rapidly in children/teens and developing countries
What is night eating syndrome?
- Occurs in 7-19% obesity treatment seekers
- Occurs in 55% bariatric surgery seekers
- Features:
– consume 1/3+ daily caloric intake
– get up during the night to eat
– patients are wide awake, not binge eating, eat high caloric foods
– often skip breakfast next morning
What are causes of obesity?
- technological advancement
- more common in affluent families
- 30% by genetics
- biological, psychosocial, and personality factors also contribute
What are obesity treatments?
- efficacy: moderate success with adults, greater in children and adolescents
- treatment progression: least to most intrusive options
1) Self-directed weight loss programs: not effective for most people
2) Commercial self-help programs
3) Behavior modification programs
4) Bariatric surgery
What is the difference between the two major types of sleep disorders?
- Dyssomnias: difficulties in amount, quality, or timing of sleep
- Parasomnias: abnormal behavioral and physiological events during sleep
Why is sleep important?
- Just a few hour’s sleep deprivation decreases immune functioning
- Sleep deprivation affects all aspects of daily functioning: energy, mood, memory, concentration, attention
- Sleep loss may bring on feelings of depression in non-depressed individuals: can have antidepressant effects in depressed individuals
What can be used to evaluate sleep?
Polysomnographic evaluation
- Electroencephalograph (EEG): brain wave activity
- Electrooculograph (EOG): eye movements
- Electromyography (EMG): muscle movements
- detailed history, assessment of sleep hygiene and sleep efficiency
Actigraph: portable wearable device sensitive to movement: can detect different stages of wakefulness/sleep
What are the defining features of insomnia?
- Problems initiating/maintaining sleep
- Only diagnosed as sleep disorder if not better explained by different condition (GAD)
- One of most common sleep disorders (33% adults)
- Important to inquire about awake behavior
- 35% adults report feeling tired during the day
What are the facts and statistics of insomnia?
- Often associated with medical and/or psychological conditions
- Affects females twice as often as males
What are the associated features of insomnia?
- Unrealistic expectations about sleep
- Believe lack of sleep will be more disruptive than it usually is
What are the defining features of hypersomnolence disorder?
- Sleeping too much/excessive sleep: long nights of sleep or frequent napping
- Experience excessive sleepiness as a problem
What are the facts and statistics of hypersomnolence disorder?
- Often associated with medical and/or psychological conditions
- Only diagnosed if other conditions don’t adequately explain hypersomnia, which should be primary complaint
What are the associated features of hypersomnolence?
- Complain of sleepiness throughout the day
- Able to sleep through the night
What are the defining features of narcolepsy?
- Principle symptom: recurrent intense need for sleep, lapses into sleep or napping
- with at least one of:
– Cataplexy: can range from slight muscle weakness to sudden loss of muscle tone or physical collapse
– Hypocretin deficiency
– Going into REM sleep abnormally fast (<15min), as evidenced by polysomnographic measures
What are the facts and statistics of narcolepsy?
Rare condition
- 0.03%-0.16%
- Males = Females
- Onset: adolescence
- Typically improves over time
What are the associated features of Narcolepsy?
- Cataplexy, sleep paralysis, and hypnagogic hallucinations
- Daytime sleepiness does not remit without treatment
What are the breathing-related sleep disorders?
- Obstructive Sleep Apnea Hypopnea: airflow stops, respiratory system works
- Central Sleep Apnea (CSA): Respiratory system stops for brief periods
- Sleep-Related Hypoventilation: Decreased breathing during sleep not better explained by another sleep disorder
What are the facts and statistics of breathing-related sleep disorders?
- Obstructive sleep apnea occurs in 10-20% of population
- More common in males
- Associated with obesity and increasing age
What are the associated features of breathing-related disorders?
- Persons are usually minimally aware of apnea problem
- Sleeps for a normal amount of time but never feels rested
- Often snore, sweat during sleep, wake frequently
- May have morning headaches
- May experience episodes of falling asleep during the day (due to poor sleep quality at night)
What is Circadian Rhythm Sleep-Wake disorder?
- Disturbed sleep leading to distress and/or functional impairment
- Due to brain’s inability to synchronize day and night
- Nature of circadian rhythms:
– Circadian rhythms: do not follow a 24 hour clock
– Suprachiasmatic nucleus: Brain’s biological clock, stimulates melatonin - Examples: Shift work type (job leads to irregular hours), familial type (associated with family history of dysregulated rhythms)
What are the medical treatments for sleep disorders?
1) Insomnia
- benzodiazepines and over-the-counter sleep medications
- prolonged use: rebound insomnia, dependence, excessive sleepiness, benzos-overdose = death
- best as short-term solution
2) Hypersomnia and narcolepsy:
- stimulants (Ritalin)
- Cataplexy usually treated with antidepressants
3) Breathing-related sleep disorders:
- Medications, weight loss, mechanical devices, surgery
4) Circadian rhythm sleep-wake disorders
- Phase delays: move bedtime later (best approach)
- Phase advances: move bedtime earlier (more difficult)
- Use of very bright light: trick brain’s biological clock
What are psychological treatments for sleep disorders?
- CBT:
– psychoeducation about sleep
– changing beliefs about sleep
– extensive monitoring using sleep diary
– practicing better sleep-related habits - Relaxation and stress reduction:
– reduces stress and assists with sleep
– modify unrealistic expectations about sleep - Stimulus control procedures
– improved sleep hygiene, lifestyle behaviors that facilitate sleep
– For children: setting a regular bedtime routine
What is the nature and classes of parasomnias?
- Nature
– problem not with sleep itself
– problem is abnormal events during sleep or shortly after waking - Classes
1) those that occur during REM (i.e. dream) sleep
2) those that occur during non-REM sleep
What are the types of Non-REM Sleep Arousal Disorders?
- Recurrent episodes of either/or:
– Sleep terrors: recurrent episodes of panic-like symptoms during non-REM sleep
– Sleepwalking - Individual has no memory of the episodes
- Typically occurs within first few hours of deep sleep
What are the facts, associated features, and treatments of sleep terrors?
- More common in children (~6%)
- Child cannot be easily awakened during episode
- Child has little memory of it the next day
- A wait-and-see posture of treatment
– Scheduled awakenings prior to the sleep terror
– severe cases: antidepressants (Imipramine) or benzodiazepines
What are the facts and associated features of sleep walking?
Somnamulism
- Person must leave the bed
- Problem is more common in children than adults
- Problem usually resolves on its own without treatment
- Seems to run in families
- May be accompanied by nocturnal eating
What are the characteristics of the nightmare disorder?
- Repeated episodes of extended, extremely dysphoric dreams leading to distress and/or impairment in daily life
- Not adequately explained by other conditions
What are the facts and associated features of the nightmare disorder?
- 10-50% children
- 1% adults
- During REM sleep
- Often awakens sleeper
- Treatment may involve antidepressants and/or relaxation
What are the characteristics of REM Sleep Behavior Disorder?
- Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors
- Causes impairment or distress: often major problem is injury to self or sleeping partner
