Bullimia Nervoisa Flashcards
Define Bulimia Nervosa
ICD criteria (must have all 3)
1) Binging/persistant preoccipation with eating/irrestitble craving for food (BUT a non pruging subtype exist)
2) Purging Behaviours (laxatives, exercise, insulin, vomit)
3) psychopathology (feeling loss of control, dread of fatness, hx of AN)
AN-thin
BN -normal/fat
Binge eating disorder - like BN but no purging behaviours
Signs and Sx of Bulimia Nervosa
Similar to AN -mainyl malnutritions (lentigo, mallory weiss, squat test, etc)
Ammenorrhea despite normal weigth Electrolyte imbalance (hypokalemic alkalosis)
Ddx - Upper GI causing vomit, personality disorder, depression, obesity
Mx of Bulimia Nervosa
Screen for immediate admission -
if BMI too low,
signs of sepsis, suicude risk, bradycardia, WL<1kg/week
Refer imemdiatly to–
severe -> immediate to CEDS (daily purging, significant electolyte imbalance, co-morbidity
Moderate -> guided self help, BEAT charity, monitor 8w ( frequent binding purgin (>2/week), some medical signs (refer to CEDS after)
Mild - guided self help, BEAT charity, monitor 12w ( frequent pruging/biging, no physical sx)
Mx at the gp (ontop of previous 3 points)
Treat medical complications (dental-acid wears down teeth)
treat comorbid psych
Moderate/Severe - SSRI at high dose (60mg fluoxetine)- help impulse
then therapy
adults - guided self help program
2nd line - CBT-ED
children _fam therapy
2nd line CBT-ED
Prognosis of bulimia nervosa
much better than AN
70% fully recover, 1% die
bad prog-
very low ewight, severe binge/purge
Co-morbidd depression
