Class 1 Flashcards
(40 cards)
ARFID criteria
Avoidance or restriction of food intake characterized by eating a quantity or variety of foods insufficient to respond to energy or nutritional needs leading to one or more of the following:
–Loss of weight (or inability to gain expected weight);
–Significant nutritional deficits;
–Dependence upon nutritional supplements
–Marked interference with psychosocial functioning.
ARFID m=W?
a little more common than anorexia in males
Sub-types ARFID
Fear of negative consequences (orthorexia)
Loss of interest
Sensory Sensitivity
RESTRICTER comorbid
anx, dep (50%), compulsivity, preference for order. Overregulation.
BINGER/PURGER comorbid
substance abuse (50%), impulsivity, parasuicidality, lability, anxiety, dep. Dysregulation
Perinatal Factors
•Sex hormone exposure in utero: brain makes serotonin out of tryptophan which it gets only
with eating so if you diet you lose serotonin. even 2-3 weeks women are more sensitive to that due to estrogen. ring finger longer than index = more estrogen = more at risk of ED
•Obstetric complications
•Combined obstetric complications and childhood stress
•Season of birth: developing a more serotonergic environment
•In utero exposure to viral infection
Risk factors Development
- No necessity of adversity
- Inconsistent association with anxious or unstable attachments
- Association with childhood trauma and adult victimization experiences (in binge-purge variants)
Risk factors Family
- No ED-prone family
- No special meal-related problems
- No excessive parental body-image concerns
- No pre-requisite family dysfunction
Are there genetic factors involved?
50% explained by genetic factors alone
The genetic architecture of AN implicates
psychiatric disorders, metabolic factors and anthropometric traits
Is there a link between AN and immune function?
Significant relationships between previous celiac, Crohn’s, ulcerative colitis, psoriasis, type-1 diabetes and later EDs.
Significant relationships between previous AN, BN, AED or OED and Any Autoimmune disease.
Transactional model
Genes (•Brain function and psychiatric disorders, Metabolism, set point, Immune function) X Environments (Perinatal, Developmental, Current)
genetic factors need to be turned on by the enviro
DNA Methylation
if methyl binds to promoter = no gene expression.
Nutrients contribute to methylation. If you don’t eat = mess your methylation and the way your DNA produces proteins
The ED Trajectory
genetic susceptibility + obstetric/ perinatal insults + developmental stress + life stress + dieting
Hospitalise or not?
- Hospitalization not associated with favorable outcome
* no difference really between short or long hospit on long term outcome
Main Practice Principles
- Not coercive
- Ensure safety
- Encourage re-evaluation of beliefs and values
- Encourage experimentation with behaviors that put mistaken beliefs to the test: Did you pat the dog today?
- Go for personal engagement (« Is this really in your best interest? »)
Risk Evaluation: The Big 7
Precipitous or extreme weight loss Hypokalemia- Hyponatremia –Hypoglycemia Pulse (< 50 bpm); EKG; Orthostatic hypotension (BP decreases by ≥20 (≥10 if adolescent) /Pulse increases by ≥20) Elevated liver enzymes Hypothermia ( ≤ 35.0°) Weakness; Fainting Total fasting; Refusing to drink
Examens de Laboratoire for all pts
•Formule sanguine complète avec différentiel •Biochimie –Électrolytes –Fonctions rénales •Fonctions thyroïdiennes •ECG
Examens de Laboratoire
Dénutrition marquée ou patient très symptomatique
•Biochimie –Calcium, magnésium, phosphores –Fonctions hépatiques –Amylase –B12, folate •Ostéodensitométrie (Aménorrhée > 6 mois)
Evidence-supported ED treatments- Adolescent AN or BN
- FBT
- CBT
Evidence-supported ED treatments-Adult BN or BED
- CBT
- IPT
- DBT
Evidence-supported ED treatments-Adult AN
- CBT
- IPT
- Specialist Supportive Clinical Management
x% can be helped short term but y% need something more
50%
Can we predict who will have a good prognosis?
No
