Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AIP: Self-harm > Bulimia nervosa > Flashcards

Bulimia nervosa Flashcards

1
Q

What is the definition of bulimia nervosa?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does the aetiology of BM compare to AN?

A

very similar, but whereas there is a clear genetic component in AN, the role of genetics in BN is unclear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens when patients with BN binge due to strong cravings?

A

they feel guilty and as a result undergo compensatory behaviours such as vomiting, using laxatives, exercising excessively and alternating with periods of starvation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What often happens with a patient’s weight with BN?

A

can result in large fluctuations in weight, which reinforce the compensatory weight loss behaviour, setting up a vicious cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What patient group is typically affected by bulimia nervosa?

A

young women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the estimated prevalence of BN in women aged 15-40 years?

A

1-2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the difference in socioeconomic class distribution between BN and AN?

A

AN thought to be more prevalent in higher socioeconomic classes, BN has equal socioeconomic class distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 5 biological factors which predispose to bulimia nervosa?

A
  1. Female sex
  2. Family history of eating disorder, mood disorder, substnace misuse or alcohol abuse
  3. Early onset of puberty
  4. Type 1 diabetes
  5. Childhood obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a biological factor which can precipitate BN?

A

early onset of puberty/menarce

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a biological factor which can perpetuate BN?

A

co-morbid mental health problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are 7 psychological factors which can predispose to BN?

A
  1. Physical or sexual abuse as a child
  2. Childhood bullying
  3. Parental obesity
  4. Pre-morbid mental health disorder
  5. Preoccupation with slimness
  6. Parents with high expectations
  7. Low self-esteem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are 2 psychological factors which can precipitate BN?

A
  1. Perceived pressure to be thin may come from culture e.g. Western society, media and profession
  2. Criticism regarding body weight or shape
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are 2 pscychological factors which can perpetuate BN?

A
  1. Low self-esteem, perfectionism
  2. Obsessional personality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are 3 social factors that can predispose to BN?

A
  1. Living in a developed country
  2. Profession e.g. actors, dancers, models, athletes
  3. Difficulty resolving conflicts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are 2 social factors whcih can precipitate BN?

A
  1. Environmental stressors
  2. Family dieting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a social factor which can perpetuate BN?

A

environmental stressors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are 5 conditions that BN commonly co-exists with and therefore it is important to screen for?

A
  1. Depression
  2. Anxiety
  3. Deliberate self-harm
  4. Substance misuse
  5. Emotionally unstable (borderline) personality disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 4 ICD-10 key criteria for a diagnoiss of BN and how can they be remembered?

A

Bulimia Patients Fear Obesity

  1. B: behaviours ot prevent weight gain (compensatory)
  2. P: preoccupation with eating
  3. F: fear of fatness
  4. O: overeating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 5 examples of compensatory behaviours to prevent weight gain seen in BN?

A
  1. Self-induced vomiting
  2. Alternating periods of starvation
  3. Drugs: laxatives, diuretics, appetite suppressants, amphetamines, thyroxine
  4. Excessive exercise
  5. Diabetics may omit or reduce insulin dose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is meant by a preoccupation with eating when diagnosing BN?

A

sense of compulsion (craving) to eat which leads to bingeing. Typically regret or shame after an episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the definition of overeating when diagnosing BN from the ICD-10 criteria?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are 5 additional features of BN in addition to the ICD-10 criteria?

A
  1. Normal weight
  2. Depression and low self-esteem
  3. Irregular periods
  4. Signs of dehydration
  5. Consequences of repeated vomiting and hypokalaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the 2 subtypes of BN?

A
  1. Purging type
  2. Non-purging type
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the purging type of BN?

A

patient uses self-induced vomiting and other ways of expelling food from the body e.g. laxatives, diuretics and enemas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the non-purging type of BN?

A

patients use excessive exercise or fasting after a binge. purging-type may also exercise and fast but this is not the main form of weight control for them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the more common subtype of BN?

A

purging-type

27
Q

Does the ICD-10 differentiate between purging and non-purging?

A

no

28
Q

What causes hypokalaemia in BN?

A

potentially life-threatening complication of excessive vomiting

29
Q

What are 3 possible adverse effects of hypokalaemia in BN?

A
  1. Muscle weakness
  2. Cardiac arrhythmias
  3. Renal damage
30
Q

What is the maangement of mild hypokalaemia in BN?

A

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

31
Q

What is the management of severe hypokalaemia?

A

requires hospitalisation and IV potassium replacement

32
Q

What are 7 parts of the history in bulimia nervosa to remember?

A
  1. Ask abotu binge eating
  2. Compensatory self-induced vomiting
  3. Self-induced purging
  4. Preoccupation with food
  5. Complications of hypokalaemia
  6. Ask about complications of repeated vomiting
  7. Screen for other co-morbid psychiatric conditions
33
Q

How can you ask about binge-eating in the bulimia history?

A

‘Do you ever feel that your eating is getting out of control?’

34
Q

How can you ask about compensatory self-induced vomiting in the bulimia history?

A

‘After an episode of eating what you later feel is too much, do you ever make yourself sick so that you feel better?’

35
Q

How can you ask about self-induced purging (other than vomiting) in the bulimia history?

A

‘Have you ever used medication to help you control your weight?’

36
Q

How can you ask about preoccupation with food in the bulimia history?

A

‘Do you ever feel a strong craving to eat?’

37
Q

How can you ask about complications of hypokalaemia in the bulimia history?

A

‘Do you ever get muscle aches? Do you ever have the sensation that your heart is beating abnormally fast?’

38
Q

What will the 8 aspects of the mental state examination show in bulimia?

A
  • Appearance: may be consistent with depression or anxiety, likely normal weight. Parotid swelling. Russell’s sign, sunken eyes (dehydration)
  • Behaviour: may be consistent with depression/anxiety
  • Speech: slow or normal
  • Mood: low
  • Thoughts: preoccupation with body size and shape. Preoccupation with eating. Guilt
  • Perception: normal
  • Cognition: either normal or poor
  • Insight: usually good insight
39
Q

What are 3 investigations to perform in bulimia?

A
  1. Bloods: FBC, U+Es, amylase, lipids, TFTs, glucose, magnesium, calcium, phosphate
  2. VBG
  3. ECG
40
Q

What are 9 blood tests to perform in bulimia?

A
  1. FBC
  2. U+Es
  3. Amylase
  4. Lipids
  5. Glucose
  6. TFTs
  7. Magnesium
  8. Calcium
  9. Phosphate
41
Q

What will a VBG show in bulimia?

A

may show metabolic alkalosis

42
Q

What will ECG show in bulimia?

A

can show arrhythmias as a consequence of hypokalaemia

hypokalaemia changes (flattened or inverted T waves, prolonged PR, prominent U waves after T wave)

43
Q

What are 3 classic ECG changes seen in hypokalaemia?

A
  1. Prolongation of the PR interval
  2. Flattened or inverted T waves
  3. Prominent U waves after T wave
44
Q

What are 6 differentials for bulimia nervosa?

A
  1. Anorexia nervosa
  2. EDNOS
  3. Kleine-Levin syndrome
  4. Depression
  5. OCD
  6. Organic causes of vomiting e.g. gastric outlet obstruction
45
Q

What are 8 groups of phsyical complications of repeated vomiting?

A
  1. Cardiovascular
  2. Gastrointestinal
  3. Metabolic/renal
  4. Dental
  5. Endocrine
  6. Dermatological
  7. Pulmonary
  8. Neurological
46
Q

What are 3 cardiovascular complications of BN?

A
  1. Arrhythmias
  2. Mitral valve prolapse
  3. Peripheral oedema
47
Q

What are 2 gastrointestinal complications of bulimia?

A
  1. Mallory-Weiss tears
  2. Increased size of salivary glands, especially parotid
48
Q

What are 4 metabolic/renal complications of BN?

A
  1. Dehydration
  2. Hypokalaemia
  3. Renal stones
  4. Renal failure
49
Q

What is a key dental effect of BN?

A

permanent erosion of dental enamel secondary to vomiting of gastric acid

50
Q

What are 4 endocrine complications of BN?

A
  1. Amenorrhoea
  2. Irregular menses
  3. Hypoglycaemia
  4. Osteopenia
51
Q

What is a dermatological complication of BN?

A

Russell’s sign: calluses on back of hand due to abrasion against teeth when making self vomit

52
Q

What is a key pulmonary complication of BN?

A

aspiration pneumonitis

53
Q

What are 3 neurological complications of BN?

A
  1. Cognitive impairment
  2. Peripheral neuropathy
  3. Seizures
54
Q

What approach is taken with the management of BN?

A

Biopsychosocial

55
Q

What are 3 aspects of the biological management of BN?

A
  1. Trial of antidepressant should be offered and can reduce frequency of bine eating/ purging
  2. Treat medication complications of repeated vomiting e.g. potassium replacement
  3. Treat co-morbid conditions
56
Q

What is usually the first dose antidepressant offered as a trial to reduce frequency of binge eating and purging in BN?

A

Fluoxetine, 60mg, SSRI of choice

57
Q

What are 3 options for the psychological management of BN?

A
  1. Psychoeducation about nutrition
  2. CBT for BN (CBT-BN - a specifically adapted form)
  3. Interpersonal psychotherapy (alternative)
58
Q

What are 4 aspects of the social management of BN?

A
  1. Food diary to monitor eating/purging patterns
  2. Techniques to avoid bingeing (eating in company, distractions)
  3. Small, regular meals
  4. Self-help programmes
59
Q

What biological monitoring must be performed in BN?

A

eletrolyte monitoring - for any potential disturbances, shoudl be replaced accordingly where appropriate

60
Q

What are 2 indications for inpatients treatment of BN?

A
  1. Suicide risk
  2. Severe electrolyte imbalances
61
Q

How commonly is the MHA (Mental Health Act) required as part of the management of BN and why?

A

not usually required as BN patients have good insight and are motivated to change

62
Q

What is important to assess for in BN?

A

Risk assess - co-morbid depression and substance misuse common

63
Q

What is the recovery rate of BN compared with AN?

A

50% of patients make a complete recovery, in AN 20% make a full recovery

AIP: Self-harm (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions