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Psychiatry > 3: Eating Disorders and Obesity > Flashcards

3: Eating Disorders and Obesity Flashcards

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1
Q

What are 3 main eating disorders

A
  • Anorexia Nervosa
  • Bulimia Nervosa
  • Other specific feeding and eating disorder (OSFED)
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2
Q

What does other specific feeding and eating disorder include

A

Binge-eating disorder

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3
Q

Define anorexia nervosa

A

Condition characterised by deliberate weight-loss induced and sustained by the patient

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4
Q

What is a way to remember DSM-V criteria for anorexia

A

RID

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5
Q

What is the DSM-V criteria for anorexia

A

Reduced energy intake

Intense fear of gaining weight, despite being underweight

Disturbance in how they perceive their body image, shape or size

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6
Q

What gender is more common to have anorexia

A

Female (90%)

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7
Q

What age is anorexia more common

A

Just after puberty (12-13 years-old)

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8
Q

What is the most common cause of admission to paediatric mental health inpatient wards

A

Anorexia nervosa

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9
Q

What model is used to describe aetiology of anorexia

A

Biopyschosocial

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10
Q

What biological factors correlate to anorexia

A
  • Genetics: 50-80% concordance

- NT disturbance

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11
Q

What conditions is anorexia associated with

A
  • Anorexia

- OCD

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12
Q

What social factors lead to anorexia

A
  • High parental pressure
  • Difficultly establishing autonomy
  • Childhood adversity
  • Poor ability to resolve conflicts
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13
Q

What are symptoms of anorexia nervosa

A
  • BMI <17.5
  • Hypothermia

(Other symptoms relate to specific symptoms)

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14
Q

What endocrine anomalies are seen in anorexia nervosa

A
  • Secondary amenorrhoea
  • Hypokalaemia
  • Impaired glucose tolerance
  • Raised cortisol
  • Raised GH
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15
Q

What causes hypokalaemia in anorexia

A

Laxative abuse

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16
Q

What is problem with hypokalaemia

A

Lead to arrhythmias and seizures

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17
Q

What are cardiac symptoms of anorexia

A

Hypotension

Bradycardia

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18
Q

What are MSK symptoms of anorexia

A

Osteoporosis, fractures

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19
Q

What are skin symptoms of anorexia

A
  • Lanugo
  • Dry skin
  • Russell sign
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20
Q

What is russell sign

A

Calluses over knuckles - from when they brush over the molars on inducing vomiting

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21
Q

What are two oral signs of anorexia nervosa

A
  • Enlarged salivary glands

- Loss of tooth enamel

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22
Q

What is there a loss of tooth enamel

A

Due to stomach acid causing loss

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23
Q

What behaviours may an anorexia person use to induce weight loss

A
  • Reduced food intake
  • Excessive exercise
  • Vomiting
  • Laxative mis-use
  • Diuretic mis-use
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24
Q

What pathology is present in anorexia

A

Fear of normal body weight

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25
What does a fear of normal body weight lead to in anorexia
- Excessive activity | - Restrict intake
26
What can endocrine disturbance lead to in anorexia
- Secondary amenorrhoea - Emotional immaturity - Decrease libido
27
What should all people with an eating disorder receive
Physical and psychiatry assessment
28
What does physical assessment involve
- BMI - BP - Glucose, TFT, U+E - ECG (Look for bradycardia, arrhythmias)
29
How often should individuals with anorexia be assessed
Annually
30
What are indications for bone mineral density scan in anorexia
- Adult: 2 years underweight, bone pain or fractures | - Child/Young-Person: 1-year underweight, bone pain or fractures
31
What are the main principles of managing anorexia
- Monitor body weight | - Psychoeducation
32
What is a key-goal of managing anorexia
Help individuals achieve a normal BMI
33
What 'medical'' treatment is offered for anorexia nervosa
Dietician counselling | - Mineral supplementation and multi-vitamins
34
If a low bone-mineral density and 13-17 years what is given
Oestradiol
35
If a low bone-mineral density and over 18-years what is given
Bisphosphonates
36
For adults, what psychological interventions are recommended
CBT-ED MANTRA: maudsley anorexia treatment for adults SSCM: special supportive clinical management
37
What is first line for managing anorexia in children
Anorexia-Focused Family Therapy
38
What is second line for managing anorexia in children
CBT-ED
39
Where are patients with anorexia normally managed
Day care
40
What is the criteria for admission of patient to psychiatric ward with anorexia
- Bradycardia <40 - ECG: Prolong QT - Weight-loss >1Kg in one week - Physical risk - Parent's cannot keep them from harm - Acute mental health risk
41
When may patient's be admitted to hospital
Require medical stabilisation
42
What should all anorexia patients in hospital receive
Liaison psychiatry
43
What is the usual prognosis of anorexia
Treated in 4-5 years
44
If anorexia persists beyond 7-years what is it called
Severe enduring anorexia
45
What are the three features of severe enduring anorexia
- Resistant - Persistent - Severe
46
What is persistent
There are no periods of remission
47
What is resistant
Resistant to psychotherapy, despite multiple psychotherapists
48
What is severe
Individuals become ego-synchronically attached to their low body-weight. They see any intervention as trying to change their personality
49
What is re-feeding syndrome
Feeding a person after a prolonged period of starvation
50
What are 3 electrolyte abnormalities seen in re-feeding syndrome
Hypokalaemia Hypomagnesaemia Hypophosphataemia
51
What are the following criteria patient needs one of to be at risk of re-feeding syndrome
- BMI <16 - Weight loss 15% in 3-6 months - Poor nutrition for 10d - Low K+, Low Mg2+, Low Phosphate
52
What are the following criteria a patient needs two of to be at risk of re-feeding
- BMI <18.5 - Weight loss 10% in 3-6 months - Poor nutrition for 5d - History alcohol abuse, drug therapy
53
Explain re-feeding a patient if they have not eaten for 5-days
Aim to re-feed at no more than 50% for 2-days
54
Define bulimia
Disorder characterised by binge eating followed by intentional purgative behaviours including vomiting, exercise, laxatives and diuretics
55
What is the DSM-V criteria for bulimia
- Recurrent episodes of binge eating - Loss of control over eating - Occurs at least once a week for 3 months - Purgative behaviours - Self-esteem unduly influenced by body image - Disturbance does not occur exclusively during episode anorexia
56
What demographic does bulimia tend to occur in
Young females (90%)
57
Explain onset of bulimia nervosa compared to anorexia nervosa
Bulimia onsets later in early 20's
58
Explain onset of bulimia nervosa
- Bing eating starts at 18-years - Vomiting starts at 21-years - Present to services at 23-years
59
What condition is associated with higher incidence of bulimia nervosa
PCOS
60
Explain weight in bulimia nervosa
Often patients are normal or over-weight. Weight fluctuates according to starving-purging behaviour. Weight unduly influences self-esteem
61
Explain behaviour in bulimia nervosa
Individual looses control during periods of binge eating. Purgative behaviours include: - Recurrent bing eating - Compensatory behaviours - Low self-esteem - Lack of control leads to depression, anxiety and anger
62
What are mouth features of bulimia
Parotitis
63
What are 3 GI symptoms of bulimia nervosa
Gastritis Oesophagitis Parotitis
64
What are endocrine symptoms of bulimia nervosa
Hypokalaemia (Can be due to laxative abuse)
65
What are skin symptoms of bulimia nervosa
Russell sign - calluses of the knuckles
66
What are cardiovascular symptoms of bulimia nervosa
Hypotension
67
What are CNS symptoms of bulimia nervosa
Seizures (secondary to hypokalaemia)
68
Explain how pathophysiology of bulimia is different to anorexia
Anorexia - there is a fear of normal weight Bulimia - there is NO fear of normal weight. individuals just see themselves as inadequate body weight - image
69
Explain assessment in bulimia
All individuals should have physical and psychiatric assessment as soon as possible
70
What physical examinations should individuals with bulimia recieve
BMI BP TFT, Glucose, U+E ECG
71
What is first-line for bulimia
Bulimia focused guided self-help
72
What is second-line for bulimia
CBT-ED
73
When is CBT-ED offered
If no improvement after 4W with bulimia focused guided self-help
74
How is bulimia managed in children
Bulimia nervosa focused self-help
75
What BMI defines overweight
25-30
76
What is BMI 25-30
Overweight
77
What BMI defines obese type I
30-35
78
What does BMI 30 - 35 indicate
Obese type I
79
What does BMI: 35-40 indicate
Obese type II
80
What dose BMI above 40 indicate
Obese type 3

Psychiatry (13 decks)

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