Unit 10: Bulimia Nervosa: additional information Flashcards
What is body dysmorphia?
When a persons spends a large amount of time worrying about a flaw in their appearance, a flaw that is often not noticeable to other people.
Become fixated on this flaw, and often adopt behaviour to correct this flaw alongside a negative self image.
Often view their body not as it really is
AN: seen as fat whilst in reality they are too thin.
What are some of the cognitive processes why people with eatng disorders continue their habits?
Anorexic voice: constant critic, overrides healthy thoughts, often start to recognise these thoughts and give them this idneity to separate from self during recovery
Control: lack of control elsewhere and are now able to control diet
Perfectionism: Eating behaviour interpreted as an achievement, self control or valued by others
Punishsment: feeling underserving of love or pleasure so use negative eating patterns as a punishment
What are the NICE recomennded treatments for Bulima Nervosa?
Over 18 - guided self help program, including recording meal plans supported by a therapist that may involve an emelment of CBT-ED
Under 18 - offered family therapy, typically in a community setting that they can attend with a parent
What conditions might people with Bulimia Nervosa present to the doctors with?
Dental Problems
Anemia/ electrolyte imbalance
Fertility problems
Muscle weakness
Bone problems - osteopenia
Hair loss and brittle nails
Heart, kidney or bowel problems
Trouble regulating their own body temperature
How complications might a person with anorexia nervosa present with?
Lanugo - fine covering of hair to help maintain body temperature
Cold peripherals
Heart palpitations/arrythmias
Confusion or change in mental reasoning
What are the key features of hypokalaemia shown on an ECG?
QT prolongation
T wave flattening
Prominenet U wave
Due to hypokalemia causing delayed repolarisation of the ventricles, particularly the purkinji fibres.
What are the changes associated with eating disorders shown in the ECG?
QT prolongation
T wave flattening
Prominenet U wave
Due to hypokalemia causing delayed repolarisation of the ventricles, particularly the purkinji fibres
What congenital condition is often investigated as a differential diagnosis to Bulimia Nervosa when a young indivual present with collapse during exercise with a prolonged QT interval?
Congenital long QT syndrome
* T wave notches - often confused with the prominent U wave shown in Bulimia Nervosa
Is often asymptomatic and only identified during strenuous exercise or an ECG.
Brings on heart palpitations and potentially cardiac death during exercise in young healthy individual, can cause slow heart rate at sleep.
How does hypokalaemia cause muscle weakness?
Decreased potassium in the ECF results in an increased gradient between the ICF and the ECF (relatively much higher in the ICF)
Potassium ions move out of ICF into ECF down a conc gradient
Results in a more negative or hyperpolarised membrane potential
Meaning a greater than normal stimuli is needed to generate an action potential at the neuromuscular junction - leading to muscle weakness
How does hypokalaemia cause problems for heart cells?
Problem in severe hypokalemia, cells try to retain K+ store
Increased rate of funny currents down a voltage gradient (as ICF K+ lower)
Leading to more rapid phase 4 depolarization
This leads to an increased heart rate
Delayed efflux of potassium during repolarisation can result in delayed ventricular repolarisation, leading to ventricular tachycardia
What tends to be included in UK administered oral rehydration solutions?
WHo recommends: 2.6grams NaCl, KCl 1.5g, Soidum cirtrate 2.9gramsn, anhydrous glucose 13.5grams dissolved in sufficient water to produce One liter of solution
UK tends to use less sodium as patients have less sodium loss in general
Why does a patient suffering from chronic vomiting and diuretic abuse tend to have a high potassium:creatininte ratio in their urine?
- Low sodium/aldosterone effect leads to more excretion of potassium out of the kidney
- creatinine level stays constant as muscle breakdown is constant (may be elevated in hypoglycemic patients where muscle breakdown is used to produce glucose) but always lower than potassium levels.
What support does BEAT charity offer to those suffering from an eating disorder?
1.Support groups - via online chats - including Pheonix group for under 25yrs and kingfisher specific for Bulimia
2. Information on the treatment likely to receive
3. Stories from recovered patients - provides motivation
4. Offer one-to-one support via email, social media and telephone during scheduled hours at the weekend and weekdays, speak to trained support worker, can provide signposting to other services or support on what treatment might work for you.
What support does BEAT offer for carers of someone with an eating disorder?
- Carers can share and read other carers stories - sense of community
- Information on the symptoms of eating disorders and stories of people with eating disorders, help better understand their loved ones’ illness
- Offer training platforms for teachers to learn more about eating disorders
- Offer advice on what to do if you suspect someone has an eating disorder
Why is CBT recommended for eating disorders?
Tackle to cause of the eating disorders - focus on food, weight and shape are often cognitive in nature
Challenge the autonomic thoughts and core beliefs (such as low self esteem or needing comfort) - leading to changes in how a person can handle their emotions hence leading to a behavioural change.
What is the cycle like system that causes metabolic alkalosis?
1.Na+ and Cl- loss
2. Hypovolemia
3. Increases renin production
4. Increased aldosterone production
5. Increased renal K+ loss
How does pseudobarter syndrome and barter syndrome differ?
Barter syndrome - caused by kidney injury and loss of electrolytes by renal excretion
Pseudo - brought on by chronic vomiting and abuse of diuretics
What are some of the supposed brain changes in anoreixa nervosa?
Variant of 5HT2A receptor - increase amount of seratonin in the non-starved state leading to acute stress and anxiety that is relieved by starvation, paradoxically increases seratonin receptor levels
Also thought to have increases cortisol and dopmaine leading to appetite suppression
What are some of the suggested brain changes in Bulimia Nervosa?
Low seratonin - emotional low that requires comfort eating
Decreased sensitivity or number of dopmaine receptors - require to eat larger amounts of food to feel happy.
What is the difference between nausea, retching and vomitting?
Nausea: feeling of wanting to vomit, often accompanies by retropulsion of material from duo to stomach and paleing of the skin
Rethcing: forceful involuntary contraction of diaphragm and abdominal muscles
Vomitting: expulsion of food by the vomiting refles
What is the difference between CBT and Behavioural therapy?
CBT - change thoughts underalying behviour
BT- focus on identifying practical ways of changing the observable behaviour, used operant and classical conditioning
What is the difference between a lapse, replase and a collapse in ED recovery?
Lapse - short term and self managed, typically an isolated behaviour that is learned from
Relapse - a longer episode, struggle to contain, often occur during times or stress or pressure, often require help from others may need support from external resources but do manage to control behaviour
Collapse - unable to control behaviour, requires more constant support and higher level of care such as hospitalisation or residential care.
What factors can make an individual more likley to replase during ED recovery?
Poor body image
Lack of strong social support network
Slower response to treatment interventions
Low motivation to recover during or after treatment
Rapid weight loss or return of eating disorder thoughts upon discharge.
What is the suffix for problems with chloride?
Chloremia
What is the suffix for people with problems with calcium?
Calcemia
What is the suffix for people with problems with magnesium?
Magnesemia
What is the suffix for people with problems with glucose levels?
Glycemia
What are some common causes of prominenet U-waves?
Hypocalcemia
Hypomagnesaemia
hypothermia
Bradykinia
Left ventricular hypertrophy
Hypertrophic cardiomypothay
Eating disorders - causing hypokalaemia
Why might people delay coming to the doctors when they are ill?
Anxiety
Embarrasement/stigma
Lack of awareness around symptoms
Competing social demands
Problematic doctor-patient interactions
Structural barriers
Tendendcy to normalise symptoms
