Week 8- eating disorders

Question 1

what are some signs of an eating disorder in others?

Answer 1

• dramatic weight loss
• wearing baggy clothes
• skipping meals, lying about what they eat
• going to the toilet after eating
• eating a lot of food very fast
• over exercising

Question 2

what is anorexia nervosa? epidemiology and aetiology

Answer 2

• 8-13 per 100,000 population
• 90% female
• Usually starts late teens
• Increase risk among female siblings
• Considerable risk of mortality or
serious physical morbidity

Question 3

what are some of the diagnostic features for anorexia nervosa?

Answer 3

• Very low body weight, approx. BMI <17.5
• Refusal to maintain normal body weight over the minimal normal for age and height
• Intense fear of gaining weight or becoming fat
• Disturbance of body perception
• Amenorrhea in Females (lack of menstration)
• Often co-exists with other Psychiatric
conditions

Question 4

what are some physical features of Anorexia

Nervosa?

Answer 4

• Dizziness and Syncope
• Sensitivity to cold and cold hands and feet
• GI disturbances
• Erosion of teeth and gastro-oesophagus
• Amenorrhea
• Muscle wasting
• Bradycardia, hypotension and cardiac arrythmias
• Dry skin and fine downy hair
• Emaciation and faulted growth in young Patients
• Poor sleep

Question 5

what are some abnormalities on physical investigation?

Answer 5

• Metabolic Disturbances
• Electrolyte Disturbances e.g. hypocalemia
• Dehydration
• ECG abnormalities and QT prolongation
• Osteoporosis

Question 6

what is the treatment for anorexia?

Answer 6

-Very limited evidence base for the pharmacological treatment of
Anorexia Nervosa
-Prompt weight restoration, family therapy and structured
psychotherapy
-Antipsychotics, Benzodiazepines and Antihistamines are often
used to reduce high levels of anxiety associated with Anorexia
-Olanzapine and possibly Quetiapine (off licence) may reduce
agitation and possibly improve weight gain
-Treat co-existing psychiatric conditions
-Enteral feeding or TPN for severely emaciated

Question 7

what are some important Treatment and Management

Of Physical Aspects of Anorexia Nervosa?

Answer 7

• Promote good oral hygiene
• QT prolongation
• Vitamins and Minerals
• Osteoporosis
• GI symptoms
• Electrolytes and Re-feeding Syndrome

Question 8

what is the epidemiology and aetiology?

Answer 8

• prevalence= 1% of women and 0.1% of men
• usually starts late adolescence
• may have increased exposure to factors that specifically promote dieting, such as childhood obesity

Question 9

what are the main diagnostic features?

Answer 9

• recurrent binge eating and lack of control
• an urge to overeat
• regular self induced vomiting, laxative abuse, strict dieting and fasting
• maybe of normal body weight
• may have co-existing psychiatric conditions e.g. depression

Question 10

what are some physical consequences of repeated vomiting?

Answer 10

• Electrolyte disturbances
• Cardiac arrhythmia
• Renal Damage
• Seizures
• Pitted Teeth due to acid gastric contents

Question 11

whati is the treatment and
Management Of Bulimia
Nervosa?

Answer 11

-First line to offer self help programme and CBT
-Antidepressants as second line or additional first step
-Fluoxetine is the only licenced
antidepressant at a dose of 60mg daily
-Topiramate may reduce frequency of binge eating

Question 12

what is binge eating disorders?

Answer 12

• subgroup of EDNOS
• eating large amounts of food not followed by vomiting
• usually obese
• older age group
• high rate of co-morbid psychiatric conditions

Question 13

what is the treatment and management for binge eating?

Answer 13

-First line treatment should
be CBT (Cognitive behavioral therapy)
-A trial of an SSRI
(UNLICENCED) can be
considered as an alternative
or additional first step