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Year Three - Psychiatry > Bulimia Nervosa > Flashcards

Bulimia Nervosa Flashcards

1
Q

What is bulimia nervosa?

A

It is an eating disorder characterised by episodes of binge eating followed by compensatory behaviours

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2
Q

What BMI do bulimia patients have?

A

Normal BMI

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3
Q

What are the three types of purging compensatory behaviours?

A

Self-induced vomiting

Laxative abuse

Diuretic abuse

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4
Q

What can purging compensatory behaviours lead to?

A

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

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5
Q

What is a feature of laxative abuse on colonoscopy?

A

Pigmetn laden macrophages

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6
Q

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

A

Excessive exercise

Fasting

Strict diets

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7
Q

What are the eight risk factors associated with bulimia nervosa?

A

Female Gender

Young Age, 15 - 25 Years Old

Family History

Pregnancy Complications

Puberty

Depression

Anxiety

Traumatic Life Events

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8
Q

What are the eleven clinical features of bulimia nervosa?

A

Fatigue

Delayed Puberty

Amenorrhoea

Pharyngeal Trauma

Swollen Parotid Glands

Teeth Erosion

Russel’s Sign

Heartburn

Syncope

Bradycardia

Hypotension

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9
Q

What is Russel’s sign? How is it associated with bulimia nervosa?

A

It is defined as calluses on the knuckles or back of the hand

It results due to repeated self induced vomiting

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10
Q

What are the three ABG features which indicate bulimia nervosa with self-induced vomiting?

A

Metabolic alkalosis

Hypokalemia

Hypochloraemia

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11
Q

What screening questionnaire can be used to diagnose eating disorders?

A

SCOFF Questionnaire

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12
Q

What are the five questions included in the SCOFF questionnaire?

A

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?

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13
Q

What SCOFF questionnaire result would indicate an eating disorder?

A

2 positive answers

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14
Q

What three investigations can be used to diagnose bulimia nervosa?

A

Blood Tests

Arterial Blood Gas

ECG Scan

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15
Q

What six blood test results indicate bulimia nervosa?

A

Decreased Haemoglobin Levels

Decreased Potassium Levels

Decreased Magnesium Levels

Increased Creatinine Levels

Increased Bicarbonate Levels

Increased ALT Levels

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16
Q

What are the two feautres of bulimia nervosa on ECG scans?

A

Bradycardia

Hypokalaemia Features

17
Q

What are the five features of hypokalaemia on ECG scans?

A

Increased P wave amplitude

Prolonged PR interval

ST depression

T wave flattening/inversion

Prominent U waves

18
Q

What are the six DSM-5 diagnostic criteria of bulimia nervosa?

A

The recurrence of binge eating episodes, in which individuals eat an amount of food that is definitely larger than most people would eat during a similar period of time and circumstances

A sense of lack of control over eating during the binge eating episodes

A recurrence of inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting, laxative abuse, diuretic abuse, fasting or excessive exercise

The binge eating and compensatory behaviours occur on average at least once a week for three months

A self-evaluation unduly influenced by body weight and shape

The disturbance doesn’t occur exclusively during episodes of anorexia nervosa

19
Q

What is the most appropriate step in suspected bulimia nervosa?

A

A specialist referral is recommended in all cases

20
Q

What are the three psychological treatment options for bulimia nervosa?

A

Psychoeducation

Cognitive Behaviour Therapy (CBT)

Focused Family Therapy (FT)

21
Q

What is psychoeducation?

A

It involves providing patients with information about anorexia nervosa and ways in which they can control and minimise it

22
Q

What is CBT?

A

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

23
Q

What is the first line management option of bulimia nervosa?

A

Self-guided CBT

24
Q

How long should self-guided CBT be trialled for, before INDIVIDUAL CBT is recommended?

A

Four weeks

25
Q

When is FFT recommended in bulimia nervosa?

A

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

26
Q

When is pharmacological management of bulimia nervosa recommended?

A

It is a second line management option, in which CBT is unavailable or has been deemed as ineffective

27
Q

What is the pharmcological management option of bulimia nervosa? Name an example

A

SSRIs (Fluoxetine)

28
Q

How do we manage hypokalaemia in bulimia patients?

A

40mmol potassium in normal saline for 4 hours

29
Q

What is the maximum rate of IV potassium infusion without monitoring?

A

10mmol/hour

Year Three - Psychiatry (23 decks)

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