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.
