Eating Disorders

Question 1

Who is anorexia most commonly seen in? What is the female: male ratio?

Answer 1

Young females aged 15-34 / 1: 10

Question 2

What are some social factors which increase risk of the development of anorexia?

Answer 2

Higher social class, Westernised family, certain occupational groups (dancers/nurses) and in societies where cultural value is placed on thinness

Question 3

Patients with anorexia often see the condition as what?

Answer 3

A way to escape from the problems of adolescence and regress back to childhood

Question 4

What are some antecedents of anorexia?

Answer 4

Childhood abuse, dietary problems earlier in life, low self-esteem, perfectionism

Question 5

How can people with type 1 diabetes also develop anorexia?

Answer 5

By running their blood sugars very low

Question 6

The onset of anorexia is usually when?

Answer 6

In adolesence

Question 7

What will be the background of a patient presenting with anorexia?

Answer 7

They will eat very little, but be obsessed with food. There will be excessive exercise and weighing.

Question 8

What are some physical consequences of anorexia?

Answer 8

Increased sensitivity to the cold, constipation, hypotension and bradycardia

Question 9

In people with anorexia who binge and vomit, or abuse purgatives, what others features may be present?

Answer 9

Hypokalaemia and alkalosis

Question 10

What is the body weight definition of anorexia in ICD-10?

Answer 10

A body weight > 15% below the standard weight, or a BMI < 17.5

Question 11

Apart from the actual definition of weight, what are the other key parts of ICD-10 criteria for anorexia?

Answer 11

Self-induced weight loss, distortion of body image, morbid fear of fatness, amenorrhoea in females

Question 12

What causes amenorrhoea in anorexia? Is it reversible?

Answer 12

Malnutrition / usually it is reversed by refeeding

Question 13

What investigations should be done for anorexia?

Answer 13

FBCs, biochemistry, LFTs, ECG, DEXA

Question 14

What may an FBC of someone with anorexia show?

Answer 14

Low WCC

Question 15

Why is it important to do a DEXA scan in someone who you suspect has anorexia?

Answer 15

The disease can quickly cause osteopenia which can become osteoporosis which is irreversible

Question 16

What would LFTs show in someone with anorexia?

Answer 16

Raised liver enzymes since the liver is being broken down and used for energy

Question 17

Treatment for anorexia can be conducted on an outpatient basis unless there is what?

Answer 17

Severe weight loss accompanied by marked CV signs and/or electrolyte and vitamin disturbances

Question 18

If a patient with anorexia refuses to go to hospital for treatment what can you do?

Answer 18

Compulsory admission

Question 19

Explain what happens in compulsory admission for anorexia?

Answer 19

In an emergency, artificial feeding can be started but only for 2-3 days. After this, a 2nd opinion from an independent doctor is required.

Question 20

In treatment for anorexia, you should aim for a weight gain of what?

Answer 20

0.5-1kg per week

Question 21

What is the outpatient treatment for anorexia?

Answer 21

CBT and interpersonal therapy / family therapy is best if they still live at home

Question 22

Drugs which do what should be avoided in the treatment of anorexia?

Answer 22

Prolong the QT interval

Question 23

How should a patient hospitalised for anorexia be fed?

Answer 23

NG tube

Question 24

What happens in refeeding syndrome?

Answer 24

Already inadequate stores of nutrients are used up as the body starts to repair itself

Question 25

What are the outcomes of anorexia?

Answer 25

2/3rds of patients maintain a normal weight, while 1/3rd will remain moderately-severely underweight

Question 26

More than 1/3rd of anorexia patients have what other psychiatric illness?

Answer 26

An affective disorder

Question 27

What is the lifetime prevalence of bulimia in women? It can sometimes be associated with what?

Answer 27

3-7% / anorexia

Question 28

A premorbid history of what is common in people with bulimia?

Answer 28

Dieting

Question 29

Which of the main eating disorders has a better prognosis?

Answer 29

Bulimia

Question 30

What happens in bulimia?

Answer 30

Episodes of uncontrolled and excessive eating followed by attempts to lose weight

Question 31

What are some of the attempts to lose weight which may be seen in bulimia?

Answer 31

Vomiting, starvation, laxatives, drug misuse

Question 32

What other psychiatric conditions are most commonly seen alongside bulimia?

Answer 32

Depression and substance misuse

Question 33

What happens to the body weight in bulimia?

Answer 33

It fluctuates within normal limits

Question 34

What happens to periods in bulimia?

Answer 34

They are irregular (but amenorrhoea is rare)

Question 35

What are some physical signs of bulimia?

Answer 35

Russell’s sign (calluses on knuckles), parotid hypertrophy, dental caries, hypokalaemia

Question 36

What assessments do people with suspected bulimia undergo?

Answer 36

Psychological assessment to screen for other psychiatric conditions / screen for medical complications

Question 37

What are the management options for bulimia?

Answer 37

Guided self-help, CBT (individual or group), high dose SSRIs

Question 38

What is the most effective treatment for bulimia?

Answer 38

CBT

Question 39

What SSRI should be used for bulimia?

Answer 39

Fluoxetine