anorexia & bulimia

Question 1

What factors can lead to a person developing bulimia?

Answer 1

• genetic factors- twin studies
• other psych disorders - OCd, anxiety, mood, personality disorders
• psychological factors - trauma, difficulty in feeling in control, high pressure sports/careers
• unrealistic standards of beauty

Question 2

What are the main features of Anorexia?

Answer 2

• BMI <17.5 significant reduction in body mass - done deliberately through purging, restrictive eating and excessive dieting
• fear of weight gain
• can delay puberty
• lack of insight into seriousness of condition
• Sx last greater than 3 months

Question 3

What affects can anorexia have on the body?

Answer 3

• CNS - hypothermia, seizures
• endo - increase stress hormones, hypothyroid disorders
• heart - bradycardia, arrhythmias,mitral valve prolapse
• bones - osteo
• skin - lanugo hair, russel signs (vommy callus fingers)
• Teeth - caries from vomiting lots

Question 4

Treatment of anorexia?

Answer 4

• CBT/Psychodynamic/family therapy
• Anti-Ds
• onlanzapine
• nutritional support - education, goal setting, monitor weight gain
• feeding against will (last resort)

Question 5

What are the indications for admitting a person with anorexia to hospital?

Answer 5

-those who are at moderate to high physical risk 
moderate = BMI 17-13
High = BMI <13
-Or with abnormal worrying bloods 
-unstable obs
-losing 1kg a week

Question 6

What are anorexia patients most at risk of when starting treatment?

Answer 6

Refeeding syndrome

• rapid increase of food intake in severely malnourished people
• causes massive insulin release
• causes shifts in electrolytes
• decrease K+, Decrease PO4+, decrease in Mg2+

Question 7

What are the clinical features of refeeding syndrome?

Answer 7

• oedema
• tachycardia (torsades de pointes)
• seizures
• ataxia
• rhabdomyolysis

Question 8

what is the treatment for refeeding syndrome?

Answer 8

• electrolyte substitution

- ideally prevent it by starting with small increase in diet 1000-1500 Kals/day

Question 9

What are the features of bulimia?

Answer 9

• self induced vomiting after binging
• laxative abuse
• transient starvation
• occurs at least once a week for 3/12

body image issues

Question 10

What are other physical manifestations of bulimia?

Answer 10

• teeth - caries from vomming
• GI - GORD, gastritis, Mallory-weiss tares, bilateral parotid swelling
• skin - calluses on knuckles, dry/brittle nails
• cardiac - arrhythmias, hypotension
• CNS - seizures

Question 11

How does the diagnostics for bulimia differ from anorexia?

Answer 11

-BMI normal or slightly raised in bulimia

Question 12

What is the treatment for bulimia?

Answer 12

• CBT
• nutritional support
• meds - fluoxetine