119b - Eating Disorders

Question 1

How can anorexia: binge/purge subtype be differentiated from bulemia nervosa?

Answer 1

• Anorexia
  
  • Characterized by intense fear of gaining weight, history of significant weight loss
  • Binging then subsequent purge are to minimize calorie intake
  • More likely to have v low BMI
• Bulemia nervosa
  
  • Characterized by loss of control during binges, purge to regain control
  • Weight may fluctuate
  • May also have fear of gaining weight, body dysmorphia

Question 2

What are the two types of anorexia nervosa?

Answer 2

• Restrictive
• Binge-purge

Question 3

List some of the clinical findings of anorexia nervosa

Answer 3

Clinical findings

• Baby hairs on body
• Hair loss on head
• Electrolyte abnormalities
• Dehydration,
• Hypotension
• Edema
• Constipation
• Osteoporosis

Question 4

What medication can be used to help manage binge eating disorder?

Answer 4

Lisdexamfetamine

Question 5

Describe the clinical management of anorexia nervosa

Answer 5

Goal = weight restoration

• Phosphorous: may need to replete
• Psychotherapy = mainstay of treatment
  
  • CBT for adult patient
  • Family-based for younger patient
• Nutritionist
• Hospitalization if necessary

Medications are not effective: food is the medication!

But medication may be helpful to manage anxiety, comorbidities

Question 6

Which psychological disorder has the highest mortality rate?

Answer 6

Anorexia nervosa

Question 7

Anorexia restrictive type is associated with cluster personality disorders

Anorexia binge/puge type is associated with cluster personality disorders

Answer 7

Anorexia restrictive type is associated with cluster c personality disorders

Anorexia binge/puge type is associated with cluster b personality disorders

Question 8

Which SSRI can be used to manage bulemia?

Answer 8

Fluoxetine (an SSRI)

But psychotherapy (CBT or DBT) is the mainstay of treatment

Question 9

A patient has intense fear of gaining weight, body dysmorphia, and restricted food intake

Which eating disorder is most likely?

Answer 9

Anorexia nervosa

Question 10

The severity of buimia is based on what behavior?

Answer 10

Severity is based on the number of inappropriate compensatory behaviors (not number of binges)

• Mild = 1-3/week
• Moderate = 4-7/week
• Severe = 8-12/week
• Extreme = 14+/week

Question 11

What is Russel’s sign?

What is it indicative of?

Answer 11

Lacerations/abrasions on the backs of hands/fingers

Due to frequent contact with teeth

Indicative of bulimia nervosa

Question 12

The prognosis of anorexia is [better/worse] than for bulemia

Answer 12

The prognosis of anorexia is worse​ than for bulemia

Question 13

How is bulemia nervosa managed clinically?

Answer 13

• Cognitive behavioral therapy
  
  • Esp. dialectial behaviorla therapy
• Medication
  
  • Fluoxetine (SSRI) - better for adult patients than adolescents

Question 14

What factors predict good prognosis for anorexia nervosa?

Answer 14

• Younger age of onset
• Restrictive type (vs binge/purge)
• Shorter chronicity of illness
• Higher weight at treatment
• Good social functioning, support