eating disorders / psychiatry and gi

Question 1

how is a diagnosis of anorexia made ?

Answer 1

-significant weight loss
-BMI of 17.5 or below
OR 15% below expected
-in children: failure to make expected weight gain in growth

Question 2

what abnormalities would you see with anorexia ?

Answer 2

• decreased Na, K, Mg, insulin and glucose, thyroid (secondary to starvation)
• bradycardia/arrhythmia
• bone health
• amenorrhea / loss of sexual interest (pituitary/hypothalamic/potency)
• elevated GH/ cortisol /cholesterol

Question 3

how is bulimia nervosa diagnosed ?

Answer 3

• has the same core pyschopathology to AN
• attempt to restrict intake but fail which leads to binge eating > therefore people with BN can range in terms of weight (low /normal /increased weight)
• they have no endocrine abnormalities
• 1/3 of patients have a pmh of AN

Question 4

who gets AN/BN ?

Answer 4

• women are a lot higher risk
• more common with westernisation (in cultures that focus on thinness)
• BN is more prevalent than AN

Question 5

what is globus ?

Answer 5

sensation of tightness of throat but no actual abnormality there

-caused by acid reflux, maybe post nasal drip, and stress and tiredness

Question 6

how to treat globus ?

Answer 6

• reassurance
• anti-reflux tx
• smoking cessation/ avoid carbonated, alcoholic, caffeinated drinks
• tx for stress ie CBT, antidepressants
• sometimes referral to SALT

Question 7

aetiology of eating disorders ?

Answer 7

socio-cultural pressures

family dysfunction (AN/BN might be a way of reclaiming control)

personal vulnerability factors

biological vulnerability

Question 8

what is the treatment for eating disorders ?

Answer 8

> establish therapeutic alliance (ie focus on the low self esteem, perfectionisms)

> weight gain is essential

> psychological intervention

Question 9

are drugs effective in treating eating disorders ?

Answer 9

not really - antidepressants are useful in treating the co-morbidities

Question 10

why are eating disorders so dangerous ?

Answer 10

• 20% of patients die after 20 years of illness
• suicide accounts for 50% of that
• 25% of AN develop BN

-if the onset is before puberty then the prognosis is a lot worse

Question 11

side effects of antidepressants ?

Answer 11

upset stomach, nausea, even hepatitis

Question 12

side effects of antipsychotics ?

Answer 12

cause metabolic syndrome

*clozapine can lead to life threatening constipation (toxic megacolon)