Lecture 62 + 63 - Pharmacotherapy of Eating Disorders

Question 1

Overview of eating disorders

Answer 1

anorexia, bulimia binge and purge, healthy eating, binge eating, obesity

Question 2

Anorexia Nervosa

Answer 2

Restriction of energy intake leading to a significantly low body weight
Intense fear of gaining weight or becoming fat
Depression is a comorbidity

Question 3

Specifiers of Anorexia Nervosa

Answer 3

Restricting type
Binge-eating/purging type

Question 4

Restricting type

Answer 4

 During the last 3 months, the individual has NOT engaged in recurrent episodes of binge eating or purging behavior
 Weight loss is accomplished primarily through dieting, fasting, and/or
excessive exercise

Question 5

Binge-eating/Purging Type

Answer 5

 During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
 **The difference between purging subgroup and bulimia nervosa disorder is the low body weight for AN

Question 6

Specifiers of Anorexia Nervosa for ICD-10

Answer 6

Severity: mild, moderate, severe, extreme
18.5 kg/m^2 to be the low end of normal

Question 7

Anorexia Nervosa - Health Consequences

Answer 7

Abnormally slow heart rate, low blood pressure
Decreased bone density
Weakness
Electrolyte abnormalities, hypoglycemia
Dry skin, hair loss
Severe dehydration
Downy layer of hair (lanugo) all over body
Cold intolerance; Delayed gastric emptying;
constipation

Question 8

Inpatient vs Outpatient Treatment

Answer 8

Inpatient: treatment of acute risks
Outpatient: treatment of chronic symptoms and relapse prevention (psychotherapy, group therapy, nutritional counseling, family systems work)

Question 9

Anorexia Nervosa – Re-Feeding Syndrome

Answer 9

Re-feeding results in shift from fat metabolism to glucose metabolism.
Hypokalemia, water retention, and severe edema
Multiple organ failure

Question 10

Anorexia Nervosa Treatment

Answer 10

increase calories slowly (often eating as low as 300-700 kcal/day)
* Inpatient re-feeding: Increase by 500 kcal/day every 4 days up to 3500 kcal/day
* Outpatient re-feeding: Initial re-feeding 1200 – 1500 kcal/day (increase weekly by 500 kcal)

Question 11

Anorexia Nervosa Therapy Treatment

Answer 11

cognitive behavioral (best outcomes)
pharmacotherapy: bupropion contraindicated; no drug therapy is FDA approved

Question 12

Binge Eating Disorder

Answer 12

recurrent episodes of binge eating characterized by both of the following: Eating, in a discrete period of time an amount of food that is larger than what most people would eat in a similar period of time; A sense of lack of control over eating during the episode
Occurs on average at least once a week for 3 months; NOT associated with the recurrent use of inappropriate compensatory behavior

Question 13

Severity Specifiers for Binge-Eating Disorder

Answer 13

characterized by episodes: mild, moderate, severe, extreme

Question 14

Binge Eating Disorders - Health Consequences

Answer 14

similar to what is observed in obesity
HTN, elevated cholesterol, cardiovascular disease, type 2 diabetes, gallbladder disease

Question 15

Binge Eating Disorder - Treatment

Answer 15

• Lisdexamfetamine (Vyvanse®) is FDA-approved
  CBT + medication provides best outcomes

Question 16

Bulimia Nervosa

Answer 16

Recurrent episodes of binge eating characterized by both of the following:
 Eating, in a discrete period of time an amount of food that is larger than what most individuals would eat in a similar period of time
 A sense of lack of control over eating during the episode
 Recurrent inappropriate compensatory behaviors in order to prevent weight gain (self-induced vomiting or misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise)
occur on average at least once a week for 3 months

Question 17

Severity Specifiers for Bulimia Nervosa

Answer 17

characterized by episodes: mild, moderate, severe, extreme

Question 18

Bulimia Nervosa - Health Consequences

Answer 18

• Electrolyte imbalances due to dehydration and loss of electrolytes through purging (risk for irregular heartbeats and even heart failure and death)
• Inflammation, gastric rupture, and esophageal rupture from frequent vomiting (Mallory Weiss Tears)
• Tooth decay, staining, and permanent loss of dental enamel from stomach acids released during frequent vomiting
• Chronic irregular bowel movements and constipation as a result of laxative abuse
• Physical sores from exercising too much
• Diabetic Ketoacidosis from withholding insulin in type 1 DM

Question 19

Bulimia Nervosa - Methods of Purging

Answer 19

vomiting, laxatives, diuretics, excessive exercise, diabulimia - pts with type 1 diabetes and bulimia give themselves less insulin than they need or stop taking insulin to promote weight loss

Question 20

Bulimia Nervosa Outward Signs of Purging

Answer 20

Russell’s sign
canker sores
Mallory-weiss tear
blood shot eyes
tooth decay

Question 21

Bulimia Nervosa Treatment

Answer 21

Fluoxetine is FDA-approved (60 mg/day)