Troubles alimentaires

Question 1

when elements are important to obtain on a history of a patient with a ?eating disorder

Answer 1

patients history + symptoms + behaviours

patients height + weight history

restrictive and binge eating

exercise patterns and their changes

purging and other compensatory behaviours

core attitudes regarding weight, shape and eating

associated psychiatric conditions

family hx of eating disorders or other psychiatric disorders (including etoh and SUDs)

family history of obesity

family interactiosn with regard to patients disorder

family attitudes towards eating, exercise and appearance

Question 2

what should you pay particular attention to on physical exam in patients with eating disorder

Answer 2

vital signs

height and weight

cardiovascular and peripheral vascular function

dermatological manifestations

evidence of self injurious behaviours

calculation of BMI

Question 3

who should be referred for bone density assessment

Answer 3

those who have been amenorrheic for more than 6 months

Question 4

what element of the history is particularly important to obtain in ?eating disorders

Answer 4

safety assessment

Question 5

at what weight does it become very difficult for someone to gain weight outside of a highly structure program

Answer 5

those who weigh less than approx. 85% of their individually estimated healthy weights

Question 6

list factors that suggest hospitalization may be appropriate for a patient with eating disorder

Answer 6

rapid or persistent decline in oral intake

decline in weight despite maximally intensive outpatient or partial hospitalization interventions

presence of additional stressors that may interfere with the patient’s ability to eat

knowledge of the weight at which instability previously occurred int he patient

co occurring psychiatric conditions that merit hospitalization

degree of the patient’s denial and resistance to participate in his or her own care in less intensively supervised settings

Question 7

what is the prevalence of BN in women? AN?

Answer 7

BN–> 3%

AN–> 1%

Question 8

what % of those with eating disorders achieve recovery? partial recovery?

Answer 8

40-45%–recovery

30%–partial recovery

Question 9

what % of those with eating disorders have a chronic course

Answer 9

about 25%

Question 10

what is the standardized mortality rate for eating disorders? what are usually the causes of mortality in eating disorders

Answer 10

SMR–> 5-15%

due to malnutrition, medical complications, suicide

up to 50% of deaths in AN are due to complications of starvation

remaining 50% due to suicide or comorbid substance use

Question 11

at what BMI does the APA guidelines recommend admission to a medical unit for AN

Answer 11

BMI of 15 at initial presentation (lectures slides indicate this is a bit of an arbitrary set point)

note that lower weight = longer weight restoration will take

Question 12

below what BMI are those with an eating disorder at risk

Answer 12

16 and below

Question 13

what lab result is associated with sudden death in AN

Answer 13

fasting BG below 2.5

indication of severe starvation

low sugars do not present

Question 14

how does AN affect the kidneys

Answer 14

chronic renal failure is common

biopsies done demonstrate injury due to repetitive volume insult to the renal tubules

kidneys affected by poor intake, volume loss, excess exercise, purging, laxative use or diuretic use

Question 15

what types of criteria are considered when deciding what level of care to offer a patient with an eating disorder

Answer 15

suicidality

% of healthy body weight

motivation to recover

co-occurring disorders

ability to control exercise

purging behavours

environmental stress

geographic availability of tx

Question 16

list the 9 criteria from a “medical status” standpoint considered for acute inpatient admission for ADULTS for eating disorders

Answer 16

1. heart rate below 50 bpm

HTO: Increase 30 bpm
20mmHg drop systolic

2. BP below 90/60
3. electrolyte imbalance

Hypokaliémie
Hyponatrémie
Hypoemagnésémie
Hypophosphatémie

5. temp below 36 C

IMC < 15

> 10% perte de poids en 6 mois
20% perte de poids en 2 ans

Comportements purgatoires fréquents

7. hepatic, renal or CV compromise requiring acute treatment

QTc > 450ms
Anomalies ECG significatives

Question 17

list the 6 criteria considered for KIDS AND TEENS for acute inpatient admission for eating disorder

Answer 17

1. heart rate below 40 bpm

HTO: Increase 40 bpm
20mmHg drop systolic

2. BP below 90/45
3. electrolyte imbalance

Hypokaliémie
Hyponatrémie
Hypoemagnésémie
Hypophosphatémie

5. temp below 36 C

<75% IMC pour âge et sexe

> 10% perte de poids en 6 mois
20% perte de poids en 2 ans

Comportements purgatoires fréquents

7. hepatic, renal or CV compromise requiring acute treatment

QTc > 450ms
Anomalies ECG significatives

Question 18

what weight as % of healthy body weight is considered appropriate for outpatient treatment of eating disorder

Answer 18

above 85%

Question 19

what type of patient, with regard to the following factors, would be appropriate for outpatient treatment for AN/eating disorder:

1. medical status
2. suicidality
3. weight as percentage of body weight
4. motivation to recover
5. co occuring disorders
6. structure needed to gain weight
7. ability to control compulsive exercising
8. purging behaviour
9. environmental stress
10. geographic availability of treatment program

Answer 19

1. medically stable to the extent that more extensive medical monitoring (as defined by levels 4 and 5 of level of care–see other cards–is not required)
2. depends on level of suicide risk on assessment; if felt to be low risk, outpatient may be appropriate
3. above 85% healthy body weight
4. fair to good motivation
5. comorbid conditions do not require inpatient treatment independently
6. self sufficient for eating/gaining weight, does not require significant support
7. can manage compulsive exercise through self control
8. can greatly reduce incidents of purging in an unstructured setting; no significant medical complications from purging like ECG changes
9. others are able to provide adequate emotional and practical support and structure
10. patient lives near treatment setting

Question 20

how do you treat hypoglycemia + low weight AN

Answer 20

indication for refeeding on a medical ward

treat with IV glucose and THIAMINE

watch amount of glucose you give while waiting for medical team

Question 21

what is “refeeding syndrome”

Answer 21

electrolytes shifting–> K, PO4, Mg

Question 22

what is one of the first signs of refeeding syndrome

Answer 22

tachycardia –> this is an indication to DECREASE feeding