eating disorders

Question 1

anorexia nervosa: dx

Answer 1

• refusal to maintain minimally normal body weight (<17.5)
• intense FEAR of gaining weight/becoming fat
• disturbed body image OR denial of seriousness of current low weight
• amenorrhea in postmenarchal females

Question 2

anorexia nervosa: physical manifestations

Answer 2

• amenorrhea
• cold intolerance, hypothermia
• hypoT (esp orthostatic)
• bradycardia, arrhythmia, acute coronary syndrome, cardiomyopathy, MVP
• constipation
• lanugo, alopecia
• edema, dehydration
• peripheral neuropathy
• sz
• hypothyroidism
• osteopenia, osteoporosis

Question 3

anorexia nervosa: lab findins

Answer 3

• hyponatremia, hypochloremic hypokalemic alkalosis (if vomiting)
• QTc prolongation
• hypercholesterolemia
• transaminitis
• leukopenia, anemia
• elevated BUN
• increased GH, cortisol
• reduced LH, FSH, estrogen/T

Question 4

anorexia nervosa: epidem

Answer 4

• 90-95% women
• 1% lifetime prev
• bimodal age of onset (13-14, 17-18)
• more common in industrialized countries and sports that involve thinness

Question 5

refeeding syndrome

Answer 5

• fluid retention
• decreased phos, Mg, Ca
• arrhythmias, resp failure
• delirium, sz
• replace electrolytes and slow feedings

Question 6

anorexia nervosa: prognosis

Answer 6

• chronic and relapsing
• 10% mortality due to starvation, suicide, cardiac failure
• rates of suicide ~ 57x normal

Question 7

anorexia nervosa: tx

Answer 7

• outpatient unless >20% below ideal weight or serious medical/psych complications
• behavioral tx, family tx, supervised programs
• SSRIs ARE NOT EFFECTIVE (inadequate dietary tryptophan?)
• low-dose atypicals?
• BZOs (preprandial anxiety)

Question 8

bulimia nervosa: dx

Answer 8

• recurrent episodes of binge eating
• recurrent inappropriate attempts to compensate (laxatives, vomiting, exercise, etc)
• behaviors occur 2+ times per week for 3 months
• perception of self-worth excessively influenced by body weight and shape

Question 9

definition: binge eating

Answer 9

excessive food intake within 2 hour period accompanied by sense of lack of control

Question 10

bulimia: physical manifestations

Answer 10

• salivary gland enlargement
• dental erosions/caries
• callouses/abrasions on dorsum of hand
• petechieae
• peripheral edema
• aspiration

Question 11

bulimia: lab findings

Answer 11

• hypochloremic hypokalemic alkalosis (vomiting)
• metabolic acidosis (laxative abuse)
• elevated bicarb
• hypernatremia
• increased BUN
• increased amylase
• altered thyroid and cortisol lvls
• esophagitis

Question 12

bulimia: epidem

Answer 12

• 1-4% lifetime prev
• women 90-95%
• onset in late adol or early adult
• more common in developed countries
• high incidence of comorbid mood disorders, anxiety disorders, impulse control dos (KLEPTOMANIA), substance abuse, sexual abuse
• increased prev of cluster B and C personality dos

Question 13

bulimia: prognosis

Answer 13

• chornic and relapsing
• better prog than anorexia
• sx exacerbated by stressful conditions
• 1/2 fully recover with tx; 1/2 chronic course with fluctuating sx

Question 14

bulimia: tx

Answer 14

• FLUOXETINE is FDA approved
• SSRIs + therapy (CBT, psychotherapy, group, family)
• AVOID buproprion: lowers sz threshold

Question 15

binge eating do: dx

Answer 15

• recurrent episodes of binge eating
• severe distress over binge eating
• 2+ days per week for 6 months
• NOT ASSOC with compensatory behaviors
  3+ of:
• eating v rapidly
• eating until uncomfortably full
• eating large amounts when not hungry
• eating alone bc of embarrassment
• eating alone due to embarrassment over eating habits
• feeling disgusted, depressed, guilty

Question 16

binge eating do: tx

Answer 16

• individual psychotherapy and behavioral tx
• strict diet and exercise program
• tx comorbid mood or anxiety dos

pharmacotherapy to promote weight loss:

• stimulants
• orlistat (inhibits lipase –> decreased fat absorption)
• sibutramine (inhibits NE/5HT/DA reuptake)