Behavioral Science - eating disorders

Question 1

T/F obesity is a diagnosable condition marked by being more than 20% over ideal weight with BMI > 30

Answer 1

True

Question 2

What two receptor mutations are associated with obesity?

Answer 2

Leptin receptor mutation

Melanocortin 4 receptor mutation

Question 3

Blocking which histamine receptor can cause weight gain?

Answer 3

Blocking histamine 1 receptor - makes you tired and groggy but also turns off satiety center (fat because you don’t feel full and keep eating)

Question 4

Blockade of muscarinic receptors (Achm) results in weight gain or weight loss?

Answer 4

Weight gain

Question 5

Blockade of 5HT2c receptors cause weight gain or weight loss?

Answer 5

Blockade or serotonin 2c receptor raises NE and DA in cortex (good for depression) but also removes inhibitory control on fat cell growth causing weight gain

Question 6

Increased prolactin levels correspond to weight gain - blockade of which receptors can indirectly trigger this?

Answer 6

D2 receptor blockade

Question 7

What are the two types of drugs that contribute the most to “iatrogenic” obesity?

Answer 7

Anti-psychotics and anti-depressants

Question 8

What are 3 lifestyle factors that contribute to obesity?

Answer 8

sedentary lifestyle
dependence on automobiles
Large portion sizes with high fat/carb content

Question 9

When would you consider bariatric surgery or gastric banding for treatment of obesity?

Answer 9

When lifestyle modification therapy (e.g. attempts to lose weight with diet, exercise) fails

Question 10

Why are amphetamines an effective weight loss medications?

Answer 10

decrease appetite

Question 11

T/F research data has shown that exercise rather than diet is the better target for obesity treatments

Answer 11

False - exercise alone isn’t enough to curb obesity - diet has the largest impact on weight gain/loss

Question 12

Pharmacological treatments can be very effective for weight loss. Why are they not considered a long term solution?

Answer 12

Rebound appetite increase after medication is stopped. Long term solutions are lifestyle and behavioral modifications (portion control etc.)

Question 13

What is orlistat?

What are major side effects?

Answer 13

weight loss medication that inhibits gastric lipase so fats don’t get absorbed/metabolized

profuse diarrhea and fecal accidents

Question 14

What are topiramate and zonisamide?

Answer 14

anti-convulsant medications used for weight loss

Question 15

How do the anti-convulsant medications (topiramate and zonisamide) facilitate weight loss?

Answer 15

lower gluconeogenisis and improve carb metabolism (results in less conversion to fat)

Question 16

What is phentermine?

Answer 16

psychostimulant that is used primarily to cause appetite suppression and weight loss

Question 17

topiramate/phentermine are used in conjunction for weight loss medications due to which properties?

Answer 17

improved carb metabolism and appetite suppression

Question 18

Why is naltrexone effective for weight loss?

Answer 18

opiate receptor blocker prevents reward sensation from after eating (interrupts positive re-enforcement)

Question 19

Why is bupropion effective for weight loss?

Answer 19

appetite suppressant

Question 20

What is lorcaserin?

Answer 20

5HT2c receptor agonist - used as weight loss medication because it increases metabolism (by inhibiting adipocyte growth)

Question 21

What are the 3 required diagnostic criteria for DSM-5 diagnosis of anorexia nervosa?

Answer 21

1) Persistent restriction of energy intake leading to low body weight
2) Intense fear of gaining weight or of becoming fat
3) Body image disturbance (dysmorphism)

Question 22

T/F Missed menstrual cycles (x3) and refusal to maintain 85% typical weight can substitute for other diagnostic criteria for anorexia nervosa.

Answer 22

False - these criteria were from DSM4; no longer in DSM 5

Question 23

What are the two subtypes of anorexia nervosa?

Answer 23

Restricting type = does not eat, does not purge

Binge/Purge Type=does binge or purge

Question 24

How is anorexia nervosa scaled for severity?

Answer 24

Severity based upon BMI and classified as mild, moderate, severe, or extreme

Question 25

What constitutes mild, moderate, severe, extreme anorexia nervosa?

Answer 25

Severity based upon BMI (so depends on weight and height) Mild >17 kg/m2 Mod 16-16.99 Severe 15-15.99 Extreme

Question 26

What age range is the typical start of anorexia nervosa?

Answer 26

Starts mid-teens to 20s

Question 27

T/F Individual socioeconomic status is an associated risk factor for development of anorexia nervosa

Answer 27

False - Individual Socioeconomics are not related

Question 28

T/F prevalence of anorexia nervosa is 10x females>males

Answer 28

False - 20x females>males Though increasing in males possibly due to increased adonis complex prevalence -- body dysmorphia in men (body builder vs barbie complex)

Question 29

What is the personality profile of a patient with anorexia?

Answer 29

more rigid and controlling, perfectionistic, and high achieving (may encounter this description in vignettes - if there is a rigid of personality type described, associated with weight loss suggestive of eating disorder and choices include bulimia or anorexia - answer is anorexia)

Question 30

T/F addition rates are higher in patients with anorexia

Answer 30

False - lower!

Question 31

T/F depression/suicide/anorexia/OCD are more common in patients with anorexia

Answer 31

true

Question 32

T/F patients with anorexia exhibit delayed pschyosexual development

Answer 32

true

Question 33

T/F patients with anorexia often exhibit these associated medical issues: ``` Poor dentition, enamel loss, cavities Abraided knuckles (Russell’s Sign) Normal/overweight Sexually active Salivary enlargement Esophagitis/tears/chronic esophageal reflux Lab changes: (low PO4, low Mg, high amylase) ```

Answer 33

False - those are for bulimia! Common medical issues in anorexia include: ``` Weight loss Hypothermia Edema Bradycardia, hypotension, syncope Amenorrhea Electrolyte imbalance, low K+ ST, T, QT cardiac changes Lanugo hair Osteoporosis Delayed gastric emptying Metabolic acidosis Organ failure ```

Question 34

Pt presents with anorexia what are some associated medical concerns?

Answer 34

amenorrhea, osteoporosis, hair loss, muscle loss/weakness, dehydration, abnormal heart rate, bradycardia, edema, hypotension, syncope, soft downy hair growth all over body including the face (lanugo hair), depression, hypothermia, delayed gastric emptying, metabolic acidosis, organ failure

Question 35

Pt presents with: constipation, depression, electrolyte imbalance (low PO4, low Mg, high amylase), facial/neck swelling, dehydration, GERD, tooth decay, peptic ulcers/Esophagitis/tears , abraided knuckles (Russell’s Sign), and is sexually active with normal or increased body weight. What do they have?

Answer 35

Bulimia

Question 36

Pt presents with: ``` Weight loss Hypothermia Edema Bradycardia, hypotension, syncope Amenorrhea Electrolyte imbalance, low K+ ST, T, QT cardiac changes Lanugo hair Osteoporosis Delayed gastric emptying Metabolic acidosis Organ failure ``` What diagnostic criteria must they meet to be diagnosed according to DSM-5?

Answer 36

Dx Anorexia nervosa must have: 1) Persistent restriction of energy intake leading to low body weight 2) Intense fear of gaining weight or of becoming fat 3) Body image disturbance (dysmorphism)

Question 37

T/F if 20% of typical weight is lost, anorexic patients should be hospitalized to restore nutritional state

Answer 37

true

Question 38

T/F 2-6 month hospitalization is sometimes indicated if 30% or more typical weight is lost

Answer 38

true

Question 39

T/F forced tube feeding is appropriate if severe anorexia with end organ damage, electrolyte or cardiac findings or if patient unwilling to comply

Answer 39

true - if severe enough can be committed because not competent decision maker/delusional

Question 40

Does psychotherapy help for treatment of anorexia?

Answer 40

Yes - there is controlled clinical data supporting efficacy

Question 41

Which FDA drugs are approved to treat anorexia?

Answer 41

none approved - non-compliance due to fear of weight gain is a major barrier to drug treatment

Question 42

What are the DSM 5 criteria for diagnosis of bulimia nervosa?

Answer 42

Recurrent binge eating (eating an atypically large amount in discrete period of time disproportionate to typical eating) No anorexia present Loss of self control over eating behavior Must exhibit compensatory behaviors for Dx (vomiting, laxative use, enemas, diuretics, exercise) must have binges 1x/wk for 3 months

Question 43

According to DSM 5 how frequent must binging behavior be to qualify for Dx of bulimia nervosa? Persistent for how long?

Answer 43

must have binges 1x/wk for 3 months

Question 44

vomiting, laxative use, enemas, diuretics, exercise are common among patients with bulimia nervosa. What are these symptoms called?

Answer 44

compensatory behaviors - required for DSM5 Dx!

Question 45

According to DSM 5, can a Dx for bulimia be made if there is no purging?

Answer 45

Yes 2 subtypes Purging VS non-purging if no purging must have other compensatory behaviors

Question 46

What is the "personality type" for bulimia?

Answer 46

erratic, emotional, chaotic personality - Outgoing, angry, impulsive traits, borderline personality, less rigid and more conflicted in contrast to anorexic with rigid, perfectionist, obsessive compulsive, high achieving

Question 47

T/F bulimia is 10x female>male

Answer 47

true

Question 48

T/F bulimia is most common in high school aged females

Answer 48

false - college aged females later onset than anorexia (40% of all cases in college aged women)

Question 49

T/F normal to overweight is common presentation of patients with bulimia

Answer 49

true

Question 50

What is Russell's sign?

Answer 50

abraided knuckles - from contact with teeth during purging

Question 51

What are the expected lab findings for bulimia?

Answer 51

Low PO4, Low Mg, high amylase

Question 52

What are the approved drugs for treatment of bulimia?

Answer 52

SSRI's - regulation of serotonin is beneficial for treatment

Question 53

T/F psychotherapy has demonstrated efficacy for treatment of bulimia in controlled clinical trials

Answer 53

true

Question 54

What is avoidant/restrictive food intake disorder?

Answer 54

Failure to meet diet/energy needs Weight loss, nutritional deficiency, supplementation needed, psychosocial distress Doesn’t meet full anorexia criteria

Question 55

What criteria for anorexia is lacking in avoidant/restrictive food intake disorder?

Answer 55

no evidence of a disturbance in the way one’s body weight or shape is experienced

Question 56

What criteria define binge eating disorder?

Answer 56

Binges Lack of control Ego Dystonic (self perception unduly influenced by body weight/shape) 1X/wk for 3 months

Question 57

What criteria of bulimia is absent in binge eating disorder?

Answer 57

No purging or compensations (required for bulimia Dx)

Question 58

What is Pica?

Answer 58

persistent eating of non-nutritive substance x 1mos Not developmentally or culturally appropriate Not medical or from intellectual disability or autism

Question 59

What time period of persistent symptoms is required for Dx of Pica

Answer 59

1 month

Question 60

What is Rumination Disorder?

Answer 60

repeated regurgitation and re-chewing of food no weight gain Not medical or from intellectual disability or autism

Question 61

When does rumination disorder commonly present?

Answer 61

Before age 6

Question 62

What time period of persistent symptoms is required for Dx of Rumination Disorder

Answer 62

1 month

Question 63

What differentiates over-eating from bing eating disorder?

Answer 63

significant subjective distress regarding the eating behavior