032615 eating disorders

Question 1

DSM IV diagnosis of anorexia nervosa

Answer 1

weight loss to less than 85% of ideal body weight or failure to make expected weight gains in children and adolescents (changed to low weight in DSM 5)

intense fear of gaining weight

disturbance in how one perceives body

amenorrhea for 3 months in post-menarcheal females (removed in DSM V)

Question 2

subtypes of anorexia nervosa

Answer 2

restricting type (50%)
binge-eating/purging type (50%)

Question 3

physiologic effects of starvation

Answer 3

vitals: hypotension, bradycardia, hypothermia

Question 4

etiology of anorexia nervosa

Answer 4

multifactorial: biological, psychological, social factors

number one risk factor is dieting

Question 5

biological factors in etiology of anorexia nervosa

Answer 5

genetic, strong family hx for mood disoders

hormonal, biochemial, starvation effects:

• associated w onset of puberty
• endorphin increases
• HPA axis changes
• decreased NE turnover, decreased dopamine response, serotonin increases w food

Question 6

psychological factors in anorexia nervosa

Answer 6

temperament: perfectionist
control issues: feeling helpless
maturation fears: fear of becoming adult or shapely/sexual

demands to increase independence

beliefs: moral desires are greedy

Question 7

social factors in anorexia nervosa

Answer 7

media influence, obesity education, family concerns about weight, teasing about weight, dieting info, performance pressures in sports, interfamily conflicts

Question 8

tx for anorexia nervosa

Answer 8

may require hospitalization (goal to reinstate nutrition, correct metabolic abnormalities, maintain cooperation)

psychotherapy (goal to stabilize and improve primary relationships)

psychopharmacology (meds are actually generally used to tx psychiatric comorbidities like depression, social phobia, OCD)

Question 9

bulimia nervosa

Answer 9

episodes of overeating

compensatory behavior to prevent weight gain (may have normal weight, overweight or obese)

clinical signs and symptoms

Question 10

DSM IV diagnosing bulimia nervosa

Answer 10

recurrent episodes of binge eating followed by inapporpriate compensatory behavior

episodes occur at least twice a wk for 3 months (in DSM V, it’s once a wk for months)

self eval in unduly influenced by body shape/weight

disturbance doesn’t occur exclusively during anorexia nervosa

Question 11

clinical signs of bulimia nervosa

Answer 11

swollen cheeks (parotid gland hypertrophy or infection)

metacarpal-phalangeal calluses (Russel’s signs)

dental erosions and caries (front teeth chipped)

labs-fluid and electrolyte imbalance

GI: GERD, esophageal varices or rupture, melanoisis coli

cardiac: arrhythmias and myopathies
endocrine: menstrual abnormalities
neuro: neuropathy, faituge, cognitive slowing, seizures

Question 12

lab abnormalities in BN

Answer 12

associated w vomiting and diuretic use:

• metabolic aklalosis-low K, low Na, high bicarb
• hypochloremia

associated w laxative abuse:
-hyperchloremic metabolic acidosis: low K, high Cl, low bicarb

other: low Mg, etc

Question 13

lab abnormalities in BN

Answer 13

associated w vomiting and diuretic use:

• metabolic aklalosis-low K, low Na, high bicarb
• hypochloremia

associated w laxative abuse:
-hyperchloremic metabolic acidosis: low K, high Cl, low bicarb

other: low Mg, etc

Question 14

psychological factors of BN

Answer 14

temperament: overachiever, competitive, secretive, egodystonic, self-critical, outgoing, angry, impulsive

associated w depression, alcohol and other substance abuse, impulse control, personality disorders, emotional lability, anxiety, dissociative disorders, hx of abuse

Question 15

social factors for BN

Answer 15

media, anti-obesity ed, weight teasing
family conflict (less close, neglectful or rejecting)

Question 16

tx for BN

Answer 16

most don’t need hospitalization

most effective is therapy (CBT, dialectical behavioral therapy, family therapy, group therapy)

SSRI antidepressant med (fluoxetine, buproprion in contraindicated due to seizure risk)

Question 17

tx for BN

Answer 17

most don’t need hospitalization

most effective is therapy (CBT, dialectical behavioral therapy, family therapy, group therapy)

SSRI antidepressant med (fluoxetine, buproprion in contraindicated due to seizure risk)

Question 18

binge eating disorder

Answer 18

recurrent episodes of binge eating
marked distress regarding binge eating
occurs once/wk for 3 months

NOT associated w compensatory behavior

Question 19

avoidant/restrictive food intake disorder

Answer 19

similar features to AN: persistent failure to meet appropriate nutritional needs

distinguishing features: not assoc w a disturbance in way one’s body weight/shape is experienced

Question 20

tx for obesity

Answer 20

commercial dieting and weight loss programs-regain weight in 5 yrs

bariatric surgery (initially effec but questionable for long term weight loss)

pharm: variable efficacy and safety

best tx is sensible diet and exercise

Question 21

weight loss goals for children and teens

Answer 21

initial goal: MAINTAIN weight or slow weight gain by healthy eating and physicial activity

obesity: maintanence for 3 months, then slow weight loss (slower weight loss than w adults)

Question 22

what reasonable dietary changes are most successful?

Answer 22

behavioral modification (recognize external cues, keep food diary, eat slowly, use rewards)