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AIP: Self-harm > Anorexia nervosa > Flashcards

Anorexia nervosa Flashcards

1
Q

What is the definition of anorexia nervosa?

A

an eating disorder characterised by deliberate weight loss, an intense fear of fatness, distorted body image, and endocrine disturbances

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2
Q

What are 3 groups into which the factors for anorexia nervosa can be divided?

A

predisposing, precipitating and perpetuating factors (or biological, psychological, social)

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3
Q

What are 4 biological factors that predispose to anorexia nervosa?

A
  1. Genetics: monozygotic twin studies
  2. Family history: first degree relatives
  3. Female
  4. Early menarche
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4
Q

What is 1 biological factor that precipitates anorexia nervosa?

A

adolescence and puberty

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5
Q

What is 1 biological factor that perpetuates anorexia nervosa?

A

starvation leads to neuroendocrine changes that perpetuate anorexia

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6
Q

What are 6 pscyhological factors that predispose to anorexia nervosa?

A
  1. Sexual abuse
  2. Preoccupation with slimness
  3. Dieting behaviours starting in adolescence
  4. Low self-esteem
  5. Premorbid anxiety or depressive disorder
  6. Perfectionism, obsessional/anankastic personality
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7
Q

What is a precipitating psychological factor to anorexia nervosa?

A

criticism regarding eating, body shape or weight

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8
Q

What is a pscyhological factor that can perpetuate AN?

A

perfectionism, obsessional/anankastic personality

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9
Q

What are 3 social factors that can predispose to anorexia nervosa?

A
  1. Western society: pressure to diet in a society that emphasises being thin is beauty
  2. Bullying at school revolving around weight
  3. Stressful life events
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10
Q

What is a social factor that can precipitate AN?

A

occupational or recreational pressure ot be slim e.g. ballet dancers, models

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11
Q

What are 2 social factors that can perpetuate AN?

A
  1. Occupation
  2. Western society
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12
Q

What is the gender ratio affected by anorexia nervosa?

A

10:1 F:M

9 in 1000 women will experience at some point in lives vs 0.4 in 1000 men

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13
Q

What is the typical age on onset of anorexia nervosa?

A

mid-adolescence

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14
Q

What are the ICD-10 criteria for anorexia nervosa?

A

FEEDD

  • F: fear of weight gain
  • E: endocrine disturbance resulting in amenorrhoea in females and loss of sexual interest and potency in males
  • E: emaciated (abnormally low body weight, >15% below expected weight or BMI <17.5)
  • D: Deliberate weight loss with reduced food intake or increased exercise
  • D: distorted body image
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15
Q

What body weight criteria are suggestive of a diagnosis of anorexia nervosa?

A
  • >15% below expected weight
  • BMI < 17.5
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16
Q

What are additional physical features of anorexia nervosa, in addition to the ICD-10 criteria?

A
  • physical:
    • fatigue
    • hypothermia
    • bradycardia
    • arrhythmias
    • peripheral oedema (due to hypoalbuminaemia)
    • headaches
    • lanugo hair
  • Preoccupation with food:
    • dieting
    • preparing elaborate meals for others
  • Socially isolated
  • Sexuality feared
  • Symptoms of depression and obsessions
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17
Q

What are 7 examples of the physical features of anorexia nervosa?

A
  1. fatigue
  2. hypothermia
  3. bradycardia
  4. arrhythmias
  5. peripheral oedema (due to hypoalbuminaemia)
  6. headaches
  7. lanugo hair
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18
Q

What BMI is considered underweight?

A

<18.5

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19
Q

What is the normal BMI range?

A

18.5-25

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20
Q

What are 5 differences between anorexia nervosa and bulimia nervosa?

A
  1. Bulimia - usually noral weight/overweight
  2. Less likely to have endocrine abnormalities in bulimia
  3. Bulimia - strong cravings for food, not present in anorexia
  4. Recurrent binge eating in bulimia, not anorexia
  5. Ma have compensatory weight loss behaviours in bulimia but not anorexia (excluding purging)
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21
Q

What are 5 key things to ask about in the anorexia nervosa history?

A
  1. Fear of weight gain
  2. Overvalued ideas about weight
  3. Deliberate weight loss
  4. Amenorrhoea
  5. Physical symptoms e.g. fatigue and headaches
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22
Q

How can you ascertain fear of weight gain in the history for anorexia? (i.e. what question would you ask)

A

“Some people find body shape and weight to be very important to their identity. Do you ever find yourself feeling concerned about your weight?”

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23
Q

How can you ask a question to determined overvalued ideas about weight in an anorexia history?

A

“What would be your ideal target weight?”

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24
Q

How can you ask a question to determine deliberate weight loss in an anorexia history?

A

The obvious methods people use to lose weight are to eat less and exercise more. Are these things that you personally do? (deliberate weight loss)

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25
Q

What will the 8 parts of a mental state examination show in anorexia nervosa?

A
  • Appearance: thin, weak, slow, anxious. May try to disguise emaciation with makeup. Baggy clothes. Dry skin. Lanugo hair
  • Behaviour: slow, anxious
  • Speech: may be slow, slurred or normal
  • Mood: can be low with co-morbid depression, or euthymic
  • Thought: preoccupation with food, overvalued ideas about weight and appearance
  • Perception: no hallucinations
  • Cognition: either normal or poor if physically unwell with complications
  • Insight: often poor
26
Q

What type of examination should be performed for patients with anorexia and why?

A

full systems examination to find out degree of emaciation, exclude differentials and look for complications

27
Q

What are 5 investigations to perform in the workup for anorexia nervosa?

A
  1. Blood tests: FBC, U+Es, TFTs, LFTs, lipids, cortisol, sex hormones, glucose, amylase
  2. Venosu blood gas
  3. DEXA scan
  4. ECG
  5. Questionnaires e.g. Eating Attitudes Test (EAT)
28
Q

What are 9 blood tests to perform in the workup for anorexia nervosa and why for each?

A
  1. FBC: anaemia, thrombocyttonpenia, leucopenia
  2. TFTs: reduced T3 and T4
  3. U+Es: increased urea and creatinine if dehydrated, low potassium, magnesium and chloride
  4. LFTs: low albumin
  5. Lipids: raised cholesterol
  6. Cortisol: raised
  7. Sex hormones: low LH, FSH, oestrogens and progestogens
  8. Glucose: low
  9. Amylase: pancreatitis is a complication
29
Q

What are 6 possible findings on U+Es in anorexia?

A
  1. Raised urea - if dehydrated
  2. Raised creatinine - if dehydrated
  3. Low magnesium
  4. Low phosphate
  5. Low potassium
  6. Low chloride
30
Q

What are 2 possible findings on VBG in anorexia and what could be the cause for each?

A
  1. Metabolic alkalosis (vomiting)
  2. Metabolic acidosis (laxatives)
31
Q

Why is a DEXA scan sometimes perform in patients with anorexia?

A

to rule out osteoporosis, if suspected

32
Q

Why should an ECG be performed in anorexia?

A

arrhythmias such as sinus bradycardia and prolonged QT are associated with AN patients

33
Q

What are 2 key ECG features seen in anorexia?

A
  1. Sinus bradycardia
  2. Prolonged QT
34
Q

What is an example of a questionnaire which can be used in anorexia?

A

Eating Attitudes Test (EAT)

35
Q

What are 9 groups that the complications of anorexia can be split into?

A
  1. Metabolic
  2. Endocrine
  3. Gastrointestinal
  4. Cardiovascular
  5. Renal
  6. Neurological
  7. Haematological
  8. Musculoskeletal
  9. Others
36
Q

What are 10 possible metabolic complications of anorexia nervosa?

A
  1. Hypokalaemia
  2. Hypercholesterolaemia
  3. Hypoglycaemia
  4. Impaired glucose tolerance
  5. Deranged LFTs
  6. Increased urea and creatinine (if dehydrated)
  7. Low phosphate
  8. Low magnesium
  9. Low albumin
  10. Low chloride
37
Q

What are 5 possbile endocrine complications seen in AN?

A
  1. Increased cortisol
  2. Increased growth hormone
  3. Low T3 and T4
  4. Low LH, FSH, oestrogens and progestogens leading to amenorrhoea
  5. Low testosterone in men
38
Q

What are 5 gastrointestinal complications of anorexia?

A
  1. Enlarged salivary glands
  2. Pancreatitis
  3. Constipation
  4. Peptic ulcers
  5. Hepatitis
39
Q

What are 6 cardiovascular complications of AN?

A
  1. Cardiac failure
  2. ECG abnormalities
  3. Arrhythmias
  4. Low BP
  5. Bradycardia
  6. Peripheral oedema
40
Q

What are 2 renal complications of anorexia?

A
  1. Renal failure
  2. Renal stones
41
Q

What are 3 neurological complications of anorexia?

A
  1. Seizures
  2. Peripheral neuropathy
  3. Autonomic dysfunction
42
Q

What are 3 haematological complications of anorexia?

A
  1. Iron deficiency anaemia
  2. Thrombocytopenia
  3. Leucopenia
43
Q

What are 2 musculoskeletal complications of anorexia nervosa?

A

Proximal myopathy

Osteoporosis

44
Q

What are 6 other complications of anorexia nervosa?

A
  1. Hypothermia
  2. Dry skin
  3. Brittle nails
  4. Lanugo hair
  5. Infections
  6. Suicide
45
Q

What are 3 other types of eating disorders in addition to AN?

A
  1. bulimia nervosa
  2. binge eating diorder
  3. EDNOS (eating disorders not otherwise specified) or atypical eating disorder
46
Q

What is binge eating disorder?

A

recurrent episodes of binge eating without compensatory behaviour such as vomiting, fasting, or excessive exercise

47
Q

What is EDNOS (Eating Disorder Not Otherwise Specified)?

A

closely resembles anorexia nervosa, bulimia nervosa, and/or binge eating, but does not meet the precise diagnostic criteria

48
Q

What is the model used for maangement approach of AN?

A

biopsychosocial

  • biological: treating med complications, SSRIs
  • psychological: psycho-education about nutrition, CBT, Cognitive Analytic Therapy, IPT, Family therapy
  • social: voluntary organisations, self-help groups
49
Q

What type of assessment is absolutely vital for anorexia nervosa?

A

risk assessment for suicide and medical complications

50
Q

What are 5 examples of psychological treatments for anoreia?

A
  1. Psycho-education about nutrition
  2. Cognitive behavioural therapy
  3. Cognitive analytic therapy
  4. Interpersonal psychotherapy
  5. Family therapy
51
Q

What is the minimum length of time that psychologicla treatments should be for in AN?

A

6 months

52
Q

What is the aim of treatment as an inpatient with AN in regard to weight gain?

A

0.5-1kg / week

53
Q

What is the aim of treatment as an outpatinet with AN in regard to weight gain?

A

0.5 kg / week

54
Q

What particular complication of AN are patients at risk of during treatment?

A

refeeding syndrome

55
Q

What are 3 reasons why hospitalisation may be necessary for the treatment of AN?

A
  1. Severe anorexia with BMI <14
  2. Severe electrolyte abnormalities
  3. Psychiatric (suicidal) reasons
56
Q

What may be necessary in cases where insight is clouded in anorexia nervosa for treatment?

A

mental health act, OR children act

for life-saving traetment

57
Q

What are 2 aspects of the biological management of anorexia nervosa?

A
  1. treatment of medical complications e.g. electrolyte disturbance
  2. SSRIs for comorbid depression or OCD
58
Q

What is the cause of refeeding syndrome?

A

insulin surgey following increased food intake

59
Q

What are 5 key biochemical abnormalities in refeeding syndrome?

A
  1. Fluid balance abnormalities
  2. Hypokalaemia
  3. Hypomagnesaemia
  4. Hypophosphataemia
  5. Abnormal glucose metabolism
60
Q

What can hypophosphataemia lead to in refeeding syndrome?

A

reduction in cardiac muscle activity which can lead to cardiac failure

61
Q

What are 4 aspects of the prevention of refeeding syndrome?

A
  1. Measure serum electrolytes prior to feeding
  2. Monitor refeeding bloods daily
  3. Start at 1200 kcal/day and gradually incerase every 5 days
  4. Monitor for signs such as tachycardia and oedema
62
Q

What is the management in refeeding syndrome if electrolyte levels are low?

A

replace either orally or IV (depending on severity)

AIP: Self-harm (15 decks)

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