Eating Disorders Flashcards
AN px
Intentional weight loss Fear of fatness Distrubed body image Endocrine distrubance -ICD10- 15% below expected weight, BMI 17.5 or less. Self induced wl. Body image distortion. Dread of fatness. Endocrine HPA disorders eg amen, low libido, high GH and cortisol, alt TFT and insulin.
Mx AN
-bio- Fluoxetine esp if obsessional. Chlorpromazine rarely.
-psycho- family therapy 1st line bef drugs, CBT, self help groups, IPT, focal psychodynam therapy.
-social- nutritional education.
Admission if: v rapid wl not responding to tx, sev electrolyte imbal, serious physiological complics (obs), cardiac complics, alt mental state, psychosis, suicide risk.
Once admitted: tx physical and psych issues, meal plan, underlying conflicts eg slef esteem and coping, communication skills. Weight and fluid charts. Behav regimen. Multivit.
Diffs
Chronic physical disease Brain tum GI eg crohns, malabs Loss appetite due to drugs eg SSRI, amphetamines. Dep or OCD
ICD10 types
Anorexia nervosa AN atypical Bulimia nervosa BN atypical Other ED eg pica in adults, psychogenic loss of appetite. ED unspecified.
BN px
Recurrent episodes of overeating.
Persistent preoccupation with and compulsion to eat.
Compensatory behaviour eg slef induced vom, drugs (laxative, diuretic, diet pill, amphetamines, thyroxin), excess exercise, insulin omission, starvation.
Intrusive fear of fatness and perception of being too fat.
AN prevalence
0.3% of yng women.
Peak onset 15-19yo.
Stable over last decade.
BN prevalence
1% in females, 0.1% males.
Stable over time.
Earlier detection/px over time.
Early 20s.
Aetiology
Predisposition (bio and psycho) eg personality traits, physio abn.
Psychological and bio stressors
Socio cultural stressors
-bio- genetics, neurots, brain dysfunction, horms (incr cortiol and GH), dieting, anim models. Hypothalamic dysfunction. Neuropsyhcological deficit eg low attention, visiospatial ability, associative mem. Ventricle and sulci enlargement. Reduc GM and WM. Temporal and parietal hypoperfusion.
Family hx of obesity, dep, subst misuse etc, esp for BN.
?low 5HT causing R supersensitivity, esp for BN.
Delayed gastric emptying in AN. Loss gag reflex, spont oes refluc and incr gastric capac in BN.
Mx general
-social: Education- carers too, MOPED risks, misconceptions, tx choice, outcomes. Coordination of care. Engagement- empathy, motivations to change etc. Tiered care Condition specific tx Special cases- DM, pregnancy. Physical and mental comorbidity.
Cycle of change
Pre contemplation Contemplation Preparation Action Maintenance Relapse
Psychiatric comorbidity and common traits
Dep, anx and substance misuse more in BN
Obsessional and social withdrawal more in AN
Impaired conc in both
Negative self esteem and perfectionism in both
Impulsivity more in BN
Insomnia, loss libido.
Alcoholism and obesity linked with both.
Complications AN
Liver fail Refeed synd Reduced gut motility Pancreatitis BM suppression and anaemia Low K and vits and other elec Metab bone dis Cardiomyopathy Infertility Sick euthyroid Renal stones Dry skin and hair Peripheral neuropathy
Investigation
Symptoms, comrobidity, complications, impact.
Why ill abd why px now.
Insight and will to change.
What help is relevant and acceptable.
Need to assess the ED, general mental health by full psych hx, and physical health.
Hx of their weight incl diets, bullying, puberty, family, their ideal, checking.
Hx of eating and substance misuse to lose weight.
Ideas, attitudes, thoughts, feelings.
Physical assesment for purging- what doing, how often, blood, washing out, UE.
For low weight- FBC, UE, LFT, TFT, CVS obs, ECG, Ca, P, Mg, ESR. Glucose, albumin, chol, sex horms, GH.
Prognosis
- good facs- short duration of illness, onset during adolescence, hysterical PD, good family function.
- poor facs- initial severity and long duration, high psychopathology, personality and mood probs, social withdrawal, poor family rels and maternal criticism, long inpt tx, vomiting, purgative abuse, male, poor childhood social adjustment.
- AN- impr is slow, binge eating and relapse common, 30-75% compl recovery, up to 25% still anorexic, 40-80% partially recover. Up to 15% mort if untreated. Some dev BN.
- BN- 50-74% compl recover, lower mortality than AN.
Re feeding
Risk cardiac decomp esp first 2 wk.
Symps- bloating, oedema, CCF.
Mx- measure and tx UEs before re feeding. Check UEs ev 3d for 1st 7d, then weekly. Increase by 2-300kcal every 3-5d til sustained wg of 1-2 pounds per wk. Monitor for tachyc and oedema.
