6/11- Eating Disorders Flashcards Preview

Term 5: Behavioral Science > 6/11- Eating Disorders > Flashcards

Flashcards in 6/11- Eating Disorders Deck (43):
1

Case:

- 16 yo female with weight loss as chief complaint

- Hx of bullying, teased for weight, has had significant weight loss in the past 3 mo (lost 60 lb)

- No suicidal ideation or substance use

- Not involved in many extra-curricular activities

- Often skipping breakfast and dinner with only a small lunch (~salad)

- Weight: 100.6 lbs, height: 61.5 in (5'1")

- Growth curve (picture)

What is Mae's diagnosis?

A. Anorexia Nervosa

B. Bulimia Nervosa

C. Neither

Q image thumb

A. Anorexia Nerovsa (binge-purge subtype)

2

What percentage of people (high school) are trying NOT to lose weight?

- 52% total

- 37% girls

- 67% boys

3

What percentage of people (high school) did not eat for 24 hours to try to lose weight?

- 13% total

- 19% girls

- 7% boys

4

What percentage of people (high school) took diet pills, powders, liquids in past 30 days without doctor's recommendation?

- 5% total

- 6.6% girls

- 3.5% boys

5

What percentage of people (high school) took laxatives to lose weight or to keep from gaining weight in the past 30 days?

- 4.4% total

- 6.6% girls

- 2.2% boys

6

Prevalence of eating disorders?

Average age for anorexia?

How many cases are male?

Growing number of people affected by eating disorders:

- 2-5% have bulimia nervosa

- 0.5-2% have anorexia nervosa (avg age 13.5)

- 5% other specified eating disorder

Up to 10% of cases are male

7

Individual risk factors for an eating disorder?

- Adolescent female

- Low self esteem

- Conflicts about personal identity and autonomy

- Negative attitude towards body at puberty

8

Cultural risk factors for an eating disorder?

- Thin ideal for beauty and happiness

- Acculturation to Western value

9

Family risk factors for an eating disorder?

- Achievement oriented

- Limited emotional support, nurturance or encouragement

- Maternal preoccupation with appearance, diet, weight or physical fitness

- Family history of eating disorders of mood disorder

10

Sports risk factors for an eating disorder?

- Weight loss for performance

- "Under-fueling" due to schedule and excessive practices

11

How does DSM 5 address eating disorders?

- Included as mental disorders

- Broadens AN and BN

- Adds other feeding disorders into the category (pica-eating ice/dirt, rumination, avoidant feeling...)

- Eliminating eating disorder NOS as a category but leaves an unspecified category

12

What is Anorexia Nervosa?

Characteristics?

- Restriction leading to clinically significant low weight

- Intense fear of gaining weight OR behavior that interferes with gaining weight

- Disturbance in how body weight or shape is experienced or persistent lack of recognition of seriousness of low body weight

13

What are two-subtypes of Anorexia Nervosa?

- Restricting type: does not binge or purge, typically use dieting, fasting, or excessive exercise

- Binge-eating/purging type: recurrent bingeing and purging over the last 3 mo, purging includes self-induced vomiting, misuse of laxatives/diuretics/enemas...

14

How is severity given to cases of Anorexia Nervosa?

Severity is based on BMI

- Mild: BMI > 17

- Moderate: BMI 16-16.99

- Severe: BMI 15-15.99

- Extreme: BMI < 15

15

What is Bulimia Nervosa? Characteristics?

- Recurrent binge eating, includes both eating in a discrete period of time an amount more than most individuals, and having a sense of lack of control over this

- Recurrent inappropriate compensatory behaviors to prevent weight gain (self-induced vomiting, misuse of laxatives, diuretics or other meds, fasting, excessive exercise)

- Once a week for 3 mo (average)

- Self-evaluation unduly influenced by body shape and weight

- Disturbance not only during episodes of anorexia nervosa

16

How is severity given to Bulimia Nervosa?

Severity based on frequency of purging

- Mild: 1-3 episodes/wk

- Moderate: 4-7 episodes/wk

- Severe: 8-13 episodes/wk

- Extreme: 14+ episodes/wk

17

How is BN different from the bingeing/purging subtype of AN?

AN involves chronic low weight

18

How to calculate % ideal body weight (%IBW)

Determine using NHANES table, BMI, HAMWI method

% IBW = current body weight/ideal body weight x 100 OR

% IBW = current BMI/ideal BMI x 100

19

What are the different categories for degree of malnutrition?

Determined by %IBW (ideal body weight)

- Normal: 90-110%

- Mild: 80-89.9%

- Moderate: 70-79.9%

- Severe: < 70%

20

Common chief complaints for individuals with eating disorders?

- Well child check

- Weight loss

- Fatigue

- Amenorrhea

- GI complaints

21

What should you look for in vital signs?

- Low weight (look at growth charts!)

- Possibly stunted height

- Hypotension

22

What are some questions you can use for screening? Results?

SCOFF screening questions:

- Do you make yourself SICK because you feel uncomfortably full?

- Do you worry that you've lost CONTROL over how much you eat?

- Have you recently lost more than ONE stone (14 lb) in a 3-mo period?

- Do you believe yourself to be FAT when others say you are too thin?

- Would you say that FOOD dominates your life?

Yes = 1 pt

Score > 2 suggests eating disorder

23

What are some non-SCOFF (additional) screening questions?

Perception of weight:

- "Do you fell you are too thin, too heavy, or just right?"

- "Do you have a fear of gaining weight?"

Efforts to control weight (diet, exercise, vomiting, laxatives...)

24

Physical findings with eating disorders?

- Neurological

- Psychiatric

- Fluid and Electrolytes

- Cardiovascular

- Endocrine

- Gastrointestinal

- Dermatological

- HEENT

25

Physical findings: Neurologic?

Neurological

- Cortical atrophy

- Syncope

- Cognitive impairment

26

Physical findings: Psychiatric?

Psychiatric

- Anxiety

- Obsessive-compulsive symptoms

- Depression

27

Physical findings: Fluid and electrolytes?

Fluid and Electrolytes

- Dehydration

- Electrolyte abnormalities (decreased Ca, Na, PO4, K, Mg)

28

Physical findings: Cardiovascular?

Cardiovascular

- Bradycardia

- Hypotension (especially orthostasis)

- Prolonged QTc

29

Physical findings: Dermatological?

Dermatological

- Lanugo (fine hair)

- Russell's sign (knuckles that may be impacted by teeth during vomiting)

30

Physical findings: HEENT?

HEENT

- Enamel erosion

- Parotid hypertrophy

31

DDx for eating disorder?

- Feeding disorder

- Inflammatory bowel disease

- Primary endocrine disorder

- Diabetes mellitus

- Addison's disease

- Depression or other psychiatric disease

- Malignancy including CNS tumor

- Other GI illness (achalasia, cystic fibrosis)

32

Laboratory evaluations to look at?

- CBC, CMP including Ca, Mg, Phos-

- Thyroid stimulating hormone (may have decreased levels of T3/T4 secondary to malnutrition?)

- Urine POC dipstick, pregnancy test if sexually active

- ESR, CRP, (amylase, lipase)

- Baseline EKG when HR < 50 or moderate malnutrition

- FSH, LH, Prolactin, estradiol (amenorrhea)

33

Indications for hospitalization?

- Sever malnutrition (under 75% ideal body weight)

- Physiologic instability (severe bradycardia < 50, hypotension, hypothermia, severe orthostatic changes)

- Dehydration or electrolyte imbalance

- Cardiac arrhythmias

- Hematemesis

- Suicidal or acute mental status changes

- Others: intractable vomiting, hematemesis, esophageal tears

34

T/F: People with eating disorders have a higher lifetime suicidality?

True

35

General approach to treatment for eating disorder?

- < 30% seek care related to weight or eating

- Medical care provided by clinicians trained in eating disorders

- Interdisciplinary team is ideal (nutritional support, psychological component for individual and family, psychiatric evaluation as needed for diagnosis and medication)

- Tried SSRis (prob to increase appetite) and anti-psychotics, but not great results

36

Recommendations to PCP?

- PCP visits weekly until care is established with specialists

- Food supplements helpful when introduce as "prescribed medication"

- Treatment- empathic and not punitive

37

Natural history of eating disorder?

Recovery

- 72% achieve partial or full recovery

- 28% persistent illness

- 22%-35% relapse

Long-term

- Decrease in fertility

- Alterations in cognitive and social functioning

High mortality rates

- 5.9% AN

- 1.9% BN

 

38

What is Binge Eating Disorder?

- Eating in a discrete period of time within any 2 hours period, an amount of food that is definitely larger than what most people would eat in a similar period under similar circumstances

- Sense of lack of control over eating during the episode , a feeling that one cannot stop eating or control what or how much is eaten, and marked distress associated with the binge-eating episodes;

--- The episodes occur on average at least once a week for at least 3 months, are not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa, and do not occur exclusively during the course of bulimia nervosa or anorexia nervosa

--- Three or more of the following factors are also present:

+ Eating much more rapidly than normal

+ Eating until feeling uncomfortably full

+ Eating large amts of food when not feeling physically hungry

+ Eating alone b/c of feeling embarrassed by how much is being eaten

+ Feeling disgusted with oneself, depressed, or very guilty afterward

39

What is the most common eating disorder?

Binge Eating disorder

40

What is the prevalence of binge eating disorder?

- 1 in 35 adults

- 3.5% female

- 2% male

41

Up to __ of people with binge eating disorder are obese

Up to 2/3 of people with binge eating disorder are obese

42

Treatment for Binge Eating Disorder?

- Cognitive behavioral therapy (CBT)

- Mindfulness training

- One FDA approved drug in adults; Lisdexamfetamine dimesylate (Vyvanse)

43

Summary:

- Eating disorders affect many adolescents and adults (chronic illness with high morbidity and mortality rate)

- Physicians should recognize the early signs

- Multidisciplinary care with experienced providers improves outcomes

- Urgent medical and/or psychiatric hospitalization may be needed

Merp