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3: Psych Y3 - Mental Health [10] > [18] Bulimia Nervosa > Flashcards

[18] Bulimia Nervosa Flashcards

1
Q

What is bulimia nervosa characterised by?

A

Repeated episodes of uncontrolled binge eating followed by compensatory weight loss behaviours and overvalued ideas regarding ‘ideal body shape/weight’

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2
Q

How does the aetiology of bulimia nervosa compare to anorexia nervosa?

A

The aetiology of bulimia nervosa is very similar to anorexia nervosa, but whereas the genetic component of anorexia is very clear, the role of genetics in bulimia is unclear

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3
Q

How is a viscous cycle set up in bulimia nervosa?

A

When patients with BN binge due to strong cravings, they tend to feel guilty, and as a result undergo compensaty behaviours such as vomiting, using laxatives, exercising excessively, and alternating with periods of starvation. This may result in large fluctuations in weight, which reinforce the compensatory weight loss behaviour, setting up a viscous cycle

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4
Q

Who does bulimia nervosa typically occur in?

A

Young women age 15-40

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5
Q

How does bulimia nervosa compare to anorexia nervosa in terms of social class distribution?

A

Whereas anorexia is thought to be more prevalent in higher socioeconomic classes, bulimia has equal socioecoomic class distribution

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6
Q

What are the biological predisposing factors for bulimia nervosa?

A
  • Female sex
  • Family history of eating disorder, mood disorder, substance misuse, or alcohol misuse
  • Early onset of puberty
  • Type 1 diabetes
  • Childhood obesity
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7
Q

What are the biological precipitating risk factors for bulimia nervosa?

A

Early onset of puberty/menarche

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8
Q

What are the biological perpetuating factors for bulimia nervosa?

A

Co-morbid mental health problems

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9
Q

What are the psychological predisposing factors for bulimia nervosa?

A
  • Physical or sexual abuse as a child
  • Childhood bullying
  • Parental obesity
  • Pre-morbid mental health disorder
  • Preoccupation with slimnesss
  • Parents with high expectations
  • Low self-esteem
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10
Q

What are the psychological precipitating factors for bulimia nervosa?

A
  • Perceived pressure to be thin may come from culture, e.g. Western society, media, and profession
  • Criticism regarding body shape
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11
Q

What are the psychological perpetuating factors for bulimia nervosa?

A
  • Low self,esttem, perfectionism
  • Obsessional personality
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12
Q

What are the social predisposing factors for bulimia nervosa?

A
  • Living in a developed country
  • Professionm e.g. actors, dancers, models, athletes
  • Difficulty resolving conflicts
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13
Q

What are the social precipitating factors for bulimia nervosa?

A
  • Environmental stessors
  • Family dieting
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14
Q

What are the social perpetuating risk factors for bulimia nervosa?

A

Environmental stressors

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15
Q

What psychiatric disorders commonly co-exist with bulimia nervosa?

A
  • Depression
  • Anxiety
  • DSH
  • Substance misuse
  • Emotionally unstable personality disorder
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16
Q

What are the components of the ICD-10 diagnostic criteria for bulimia nervosa?

A
  • Behaviours that prevent weight gain (compensatory)
  • Preoccupation with eating
  • Fear of fatness
  • Overeating
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17
Q

What compensatory weight loss behaviours are included in the ICD-10 diagnostic criteria for bulimia nervosa?

A
  • Self-induced vomiting
  • Alternating periods of starvation
  • Drugs, including laxatives, diuetics, appetite suppressants, amphetamines, and thyroxine
  • Excessive exericse
  • Omission or reduction in insulin dose in diabetics
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18
Q

What is meant by preoccupation with eating in the ICD-10 diagnostic criteria for bulimia nervosa?

A

A sense of compulsion (craving) to eat, which leads to bingeing. There is typically regret or shame after an episode

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19
Q

What does the fear of fatness include in the ICD-10 diagnostic criteria for bulimia nervosa?

A

A self-perception of being too fat

20
Q

What does the ICD-10 diagnostic criteria for bulimia nervosa specify about overeating?

A

There must be at least 2 episodes per week over a period of 3 months

21
Q

Other than those mentioned in the ICD-10, what are the features of bulimia nervosa?

A
  • Depression and low self esteem
  • Irregular periods
  • Signs of dehydration
  • Consequences of repeated vomiting and hypokalaemia
22
Q

What signs of dehydration may be present in bulimia nervosa?

A
  • Decreased blood pressure
  • Dry mucous membranes
  • Increased capillary refill time
  • Decreased skin turgor
  • Sunken eyes
23
Q

What are the cardiovascular complications of repeated vomiting?

A
  • Arrhythmias
  • Mitral valve prolapse
  • Peripheral oedema
24
Q

What is hypokalaemia?

A

A potentially life threatening complication of excessive vomiting, where low potassium (<3,5mmol/L) can result in muscle weakness, cardiac arrhythmias, and renal damage

25
Q

What are the gastrointestinal complications of repeated vomiting?

A
  • Mallory-Weiss tear
  • Increased size of salivary glands, especially parotid
26
Q

What are the endocrine complications of repeated vomiting?

A
  • Amenorrhoea
  • Irregular menses
  • Hypoglycaemia
  • Osteopenia
27
Q

What are the metabolic/renal complications of repeated vomiting?

A
  • Dehydration
  • Hypokalaemia
  • Renal stones
  • Renal failure
28
Q

What are the dermatological signs of repeated vomiting?

A

Russell’s sign (calluses on the back of the hand due to abrasion against teeth)

29
Q

What are the neurological complications of repeated vomiting?

A
  • Cognitive impairment
  • Peripheral neuropathy
  • Seizures
30
Q

What are the pulmonary complications of repeated vomiting?

A

Aspiration pneumonitis

31
Q

How is mild hypokalaemia managed?

A

Oral replacement with potassium rich foods, e.g. bananas, or oral supplements (Sando-K)

32
Q

What are the dental complications of repeated vomiting?

A

Pernament erosion of dental enamel seconWdary to vomiting of gastric acid

33
Q

How is severe hypokalaemia managed?

A

Requires hospitalisation and intravenous potassium replacement

34
Q

What weight are people with bulimia nervosa?

A

The patient is usually normal weight because the potential for weight gain from bingeing is counteracted by the weight loss/purging behaviours

35
Q

What investigations are done into bulimia nervosa?

A
  • History
  • MSE
  • Blood tests
  • VBG
  • ECG
36
Q

What blood tests need to be done in bulimia nervosa?

A
  • FBC
  • U&Es
  • Amylase
  • Lipids
  • Glucose
  • TFTs
  • Magnesium
  • Calcium
  • Phosphate
37
Q

Why is an ECG done in bulimia nervosa?

A
  • To look for arrhythmias resulting from hypokalamia, which can be life threatening
  • Look for classic ECG changes, such as prolongation of the PR interval, flattened or inverted T waves, prominent U waves after T waves
38
Q

What are the differential diagnoses of bulimia nervosa?

A
  • Anorexia nervosa with bulimic symptoms
  • EDNOS
  • Kleine-Levin syndrome
  • Depression
  • OCD
  • Organic causes of vomiting, e.g. gastric outlet obstruction
39
Q

What is Kleine-Levin syndrome?

A

A sleep disorder in adolescent males characterised by recurrent episodes of binge eating and hypersomnia

40
Q

What is included in the biological management of bulimia nervosa?

A
  • A trial of antidepressants should be offered, and can reduce the frequency of bind eating/purging
  • Treat medical complications of repeated vomiting, e.g. potassium replacement
  • Treat co-morbid conditions
41
Q

What is the antidepressant of choice in bulimia nervosa?

A

Fluoxetine, usually at high dose (60mg)

42
Q

What is involved in the psychological management of anorexia nervosa?

A
  • Psychoeducation about nutrition
  • CBT for bulimia nervosa (CBT-BN is a specially adapted form of CBT)
  • Interpersonal psychotherapy
43
Q

What is involved in the social management of bulimia nervosa?

A
  • Food diary to monitor eating/purging patterns
  • Techniques to avoid bingeing, e.g. eating in company, distractions
  • Small, regular meals
  • Self-help programmes
44
Q

When is inpatient treatment required in bulimia nervosa?

A

For cases of suicide risk and severe electrolye imbalances

45
Q

Is the Mental Health Act often required in bulimia nervosa?

A

No, as patients usually have good insight and are motivated to change

46
Q

How does recovery from bulimia nervosa compare to anorexia nervosa?

A

Approximately 50% of bulimia patients make a full recovery, compared to 20% anorexia patients

3: Psych Y3 - Mental Health [10] (21 decks)

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