Anorexia Nervosa

Question 1

What is anorexia nervosa?

Answer 1

It is an eating disorder characterised by weight loss, difficulties in maintaining an appropriate body weight for their height, age and stature: and, in many individuals, distorted body image

This can be achieved through a reduction of intake; however, it also relies on compulsive compensatory behaviours when food cannot be avoided

Question 2

What are the two clinical definitions of anorexia nervosa?

Answer 2

BMI less than 17.5

15% reduction in ideal body weight

Question 3

In children, BMI measurements are not used in anorexia nervosa. What other measurement is used?

Answer 3

Weight to height

Question 4

What are the three types of purging compensatory behaviours?

Answer 4

Self-induced vomiting

Laxative abuse

Diuretic abuse

Question 5

What can purging compensatory behaviours lead to?

Answer 5

Neuro-chemical disruption with specific damage to the brain (seizures) and heart (arrythmias)

Question 6

What is a feature of laxative abuse on colonoscopy?

Answer 6

Pigment laden macrophages

Question 7

What are the three types of non-purging compensatory behaviours?

Answer 7

Excessive exercise

Fasting

Strict diets

Question 8

What is the pathophysiological cause of anorexia nervosa?

Answer 8

A lesion in the lateral nuclei

Question 9

What are the nine risk factors of anorexia nervosa?

Answer 9

Young Adults

Female Gender

Family History

Pregnancy Complications

Puberty

Depression

Anxiety

Traumatic Life Events

Drug Administration

Question 10

What two drugs are associated with anorexia nervosa?

Answer 10

Levodopa

Digoxin

Question 11

What are the twelve clinical features of anorexia nervosa?

Answer 11

Fatigue

Cold Peripheries

Delayed Puberty

Amenorrhoea

Alopecia

Lanugo Hair

Osteopenia

Infections

Syncope

Bradycardia

Hypotension

Enlarged Salivary Glands

Question 12

What is lanugo hair?

Answer 12

It is defined as fine unpigmented hair

Question 13

What screening questionnaire can be used to diagnose eating disorders?

Answer 13

SCOFF Questionnaire

Question 14

What are the five questions included in the SCOFF questionnaire?

Answer 14

Do You Make Yourself Sick Because You Feel Uncomfortably Full?

Do You Worry You Have Lost Control Over How Much You Eat?

Have You Recently Lost More Than One Stone In A Three Month Period?

Do You Believe Yourself To Be Fat When Others Say You Are Too Thin?

Would You Say That Food Dominates Your Life?

Question 15

What SCOFF questionnaire result would indicate an eating disorder?

Answer 15

2 positive answers

Question 16

What is the screening questionnaire used to detect malnutrition?

Answer 16

MUST score

Question 17

What two investigations can be used to diagnose anorexia nervosa?

Answer 17

Blood Tests

ECG Scan

Question 18

What seven blood test results indicate anorexia nervosa?

Answer 18

Decreased Potassium Levels

Increased Cholesterol Levels

Increased Carotene Levels

Decreased T3 Levels

Decreased LH & FSH Levels

Decreased Oestrogen & Testosterone Levels

Decreased Glucose Levels

Question 19

What are the two features of anorexia nervosa on ECG scan?

Answer 19

Bradycardia

Hypokalaemia Features

Question 20

What are the five features of hypokalaemia on ECG scans?

Answer 20

Increased P wave amplitude

Prolonged PR interval

ST depression

T wave flattening/inversion

Prominent U waves

Question 21

What are the three diagnostric criteria of anorexia nervosa?

Answer 21

A restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health

An intense fear of gaining weight or becoming fat, even though underweight

A disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight

Question 22

What are the five psychological management options for anorexia nervosa?

Answer 22

Psychoeducation

Cognitive Behaviour Therapy (CBT)

Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)

Specialist Supportive Clinical Management (SSCM)

Focused Family Therapy (FT)

Question 23

What is psychoeducation?

Answer 23

It involves providing patients with information about their eating disorder and ways in which they can control and minimise it

Question 24

What is CBT?

Answer 24

It is a talking therapy used to manage the way in which patients think, feel and behave

Question 25

What does eating disorder focussed CBT programmes involve?

Answer 25

They encourage healthy eating and reaching a healthy body weight through the creation of a personalised treatment plan based on the processes that appear to be maintaining the eating problem

Question 26

What is MANTRA?

Answer 26

It is a focussed therapy technique that has been developed for the treatment of anorexia nervosa

It aims to address the factors which maintain anorexia nervosa and gradually helping them to find alternative and more adaptive ways of coping

Question 27

What is SSCM?

Answer 27

It utilises clinical management skills and supportive therapy techniques to guide people towards meeting their own treatment goals

Question 28

When is FFT used to manage anorexia nervosa?

Answer 28

It is the first line management option in children and young people

Question 29

What is the second line manageemnt option of anorexia nervosa in children and young people?

Answer 29

CBT

Question 30

How do we manage eating disorders in primary care?

Answer 30

Once an eating disorder has been identified, referral to a community based eating disorder service for further assessment should be conducted