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NMSP Exam 3 > Clinical Approach to Eating Disorder and Refeeding Syndrome > Flashcards

Clinical Approach to Eating Disorder and Refeeding Syndrome Flashcards

1
Q

what are the three eating disorder types?

A
  1. Anorexia Nervosa
  2. Bulimia Nervosa
  3. Binge Eating Disorder
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2
Q

Anorexia Nervosa is more common in what sex?

A

females: 3 times greater than males

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3
Q

Do adults or adolescents have a higher percentage of anorexia nervosa?

A

Adults- 0.6%
adolescents- 0.3%

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4
Q

bulimia nervosa lifetime prevalence

A

varies from 1-3 percent

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5
Q

Bulimia and Anorexia Nervosa are often accompanied by?

A

suicidality

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6
Q

what is an indication for hospitalization regarding suicide?

A

specific suicide plan or intent

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7
Q

for bulimia nervosa suicide rate is _ times higher than the general population

A

7

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8
Q

for anorexia nervosa suicide rate is _ times higher than the general population

A

5

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9
Q

DSM 5 diagnostic criteria for Anorexia Nervosa

A

restriction in energy/caloric intake far below their requirement leading to significantly reduced body weight

intense fear of gaining weight or becoming fat (even through they are obviously underweight)

Distorted perception of body weight and shape

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10
Q

what are the two types of Anorexia Nervosa

A

Restricting type and Binge-eating/purging type

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11
Q

what is the DSM5 criteria for Anorexia Nervosa - restrictive type

A

3 months of no binging or purging (vomiting), excessive exercising, fasting, and dieting

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12
Q

what is the DSM5 criteria for Anoerxia Nervosa- Binge-eating/purging type?

A

3 months of binging and purging behaviors

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13
Q

what is purging

A

self induced vomiting or tissues of laxatives, diuretics or enemas

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14
Q

DSM subtypes Anorexia Nervosa into restricting and binge-eating/purging based on weight loss strategies. However _ is common

A

cross over

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15
Q

Severity of Anorexia Nervosa is based on current _

A

Body Mass Index (BMI)

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16
Q

Mild Anorexia BMI

A

greater than 17 kg/m2

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17
Q

moderate anorexia BMI

A

16-16.99 kg/m2

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18
Q

Severe Anorexia BMI

A

15-15.99 kg/m2

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19
Q

extreme Anorexia BMI

A

<15 kg/m2

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20
Q

rituals associated with eating disorders share characteristics with _ which is especially common in anorexia nervosa

A

OCD

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21
Q

what other disorders arise in childhood and predate the development of eating disorders in most cases

A

OCD and anxiety disorders

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22
Q

in someone with anorexia nervosa_ is often viewed as a form of control

A

weight loss

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23
Q

in someone with anorexia nervosa self esteem may largely revolve around _ and _ image

A

weight and body image

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24
Q

excessive viewing in the mirror and weight measurements are common in what eating disorder

A

anorexia nervosa

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25
Q

fear of weight gain and other psychological comorbidities tend to _ (get better/worsen) as patient lose more weight

A

worsen

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26
Q

in what eating disorder will patients deny starvation despite acknowledgement of emaciated appearance

A

anorexia nervosa

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27
Q

why is screening for eating disorders important

A

eating disorders are often undetected and untreated

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28
Q

give a few examples of when you would do an eating disorder primary screen in a patient

A

-if there was adversity during childhood
-young adult
-female
-transgender ppl
-athletes
-signs of eating disorder
-anxiety/depression
-perfectionism

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29
Q

Eating disorder screen for primary care:

A

Are you satisfied with your eating patterns (no is abnormal)

Do you ever eat in secret (yes is abnormal)

does your weight affect the way you feel about yourself ( yes is abnormal)

have any members of your family suffered with an eating disorder ( yes it abnormal)

do you currently suffer with , or have you ever suffered in the past with an eating disorder (yes is abnormal)

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30
Q

What questionnaire is the most commonly used instrument and is recommended by the United States preventive services task force (screening for eating disorders)

A

SCOFF

31
Q

what is the scoff questionnaire

A

do you ever make yourself SICK because you feel uncomfortably full?

do you worry you have lost CONTROL over how much you eat?

have you recently lost more than ONE stone (14 pounds) in a three month period?

do you believe yourself to be FAT when others say you are too thin ?

would you say that FOOD dominates your life ?

the most commonly used instrument and is recommended by the United States preventive services task force (screening for eating disorders)

**yes to the two or more questions is generally regarded as a positive screen and should prompt further assessment to establish or rule out a diagnosis

32
Q

what are some psychosocial factors that contribute to eating disorders?

A

americas obsession with weight loss

magazines/models

computer programs/photoshop

preoccupation to lose weight and bring self esteem to a thin body extends into maturing adolescents

33
Q

pathogenesis and neurobiology of eating disorders

A

aggregation of anorexia and nervosa in families suggests there are genetic factors

locus on chromosome 12

34
Q

medical complications of Anorexia Nervosa

A

Cardiac: bradycardia, hypotension, QT dispersion, cardiac atrophy, and MVP

gynecology: amenorrhea and decreased sex drive

endocrine: osteoporosis, hypothermia, euthyroid, HYPOglycemia

electrolyte:dehydration, HYPOkalemia, HYPOphophatemia, HYPOmagnesemia

pulmonary: respiratory muscle atrophy and dyspnea

hematologic: anemia, leukopenia, thrombocytopenia

dermatologic: Xerosis, carotenoderma, acrocyanosis, seborrheic dermatitis

35
Q

why should we not rehydrate or feed patients behind their current capacity in people with Anorexia Nervosa

A

due to Refeeding Syndrome complication

36
Q

what is refeeding syndrome?

A

A clinical complication that occurs as a result of fluid and electrolyte shifts during aggressive nutritional rehabilitation of malnourished patients

-complications are potentially fatal when not detected or treated early

37
Q

what are some of the complications of referring syndrome ?

A

HYPOphosphatemia, HYPOkalemia, congestive heart failure , peripheral edema, rhabdomyolysis, seizures, hemolysis

38
Q

How can we avoid Refeeding syndrome?

A

judiciously limit the amount of calories and fluid provided in the early stages of refeeding

avoid rapid increase in the amount of calories ingested

closely monitor labs during the first few weeks

39
Q

in anorexia nervosa: failure to recognize and treat comorbidities can have catastrophic repercussions. What are some other disorders that can present with anorexia nervosa

A

anxiety, OCD, PTSD, body dysmorphic disorder, depressive disorder, substance use, personality disorders

40
Q

treatment of anorexia nervosa requires a _ team that usually includes a health services clinical psychologist, a registered dietitian, and PCP

A

interdisciplinary

41
Q

what treatment options are needed at minimum first like care in a person with AN

A

nutritional rehabilitation and psychotherapy

42
Q

hospitalization of a person with AN should last how long?

A

until normal weight is achieved to reduce relapse and re-hospitalization

43
Q

AN is resistant to pharmacotherapy and medications are only used for what?

A

to reduce depression or anxiety if they are a barrier to treatment

44
Q

what is the primary treatment in AN

A

nutritional rehabilitation

45
Q

what is nutritional rehabilitation?

A

this is treatment in AN supervised by a registered dietitian with a focus on proper weight gain and practices

-can include supervised meals

46
Q

what is the average weight gain in nutritional rehabilitation inpatient vs outpatient

A

inpatient 2-3 pounds/week

outpatient 0.1-1 pounds/ week

47
Q

usual initial intake in nutritional rehabilitation is?

-this is progressively increased to match tolerance and weight gain goals

A

30-40 kcal

48
Q

how is psychotherapy helpful in AN

A

it focuses on helping patient confront their disorder and change their eating habits and/or thoughts about weight gain

49
Q

what are the different psychotherapy options?

A

cognitive behavioral therapy (CBT), specialist supportive clinical management, motivational interviewing, family therapy

50
Q

what medication should you avoid in AN due to a risk of seizure in the binding and purging type

A

Bupropion (used as antidepressant)

51
Q

what medications should you avoid in AN due to cardio toxicity?

A

tricyclic antidepressants

52
Q

what medications should you exercise cation with in AN due to risk of QT prolongation

A

antipsychotics

53
Q

what adjunctive medication in AN is used to help with weight gain?

A

Olanzapine

54
Q

what medication in AN is associated with confronting meals

A

Lorazepam

55
Q

what medications can you use in AN if anxiety or depression becomes severe enough to create barriers to care

A

SSRI

and if unresponsive

second generation antipsychotics

56
Q

DSM5 Diagnostic Criteria for Bulimia Nervosa

A

recurrent episodes of binge eating; large amount during a given time period

patients cannot feel like they are in control of their eating during that episode

recurrent compensatory behavior to prevent weight gain such as vomiting and misuse of laxatives/diruetics, fasting or excessive exercise

the patients sense of self worth is influences by body shape and weight

disturbances does not occur exclusively during an episode of AN

57
Q

In Bulimia Nervosa patients can vary between _ and can use the same weight loss tactics to those with _

patients often feel _ after binging

patients often excessively fearful of _ gain, _. behaviors are used to counteract the weight gain from binge eating. Patients dont necessarily want to become _ they just dont want to become _

A

weights

ANorexia Nervosa

dysphoric

weight

purging

thin

fat

58
Q

medical complications of BN

A

electrolyte: dehydration, hypokalemia, hypochloremia, metabolic alkalosis

cardiac: hypotension, orthostasis, sinus tachycardia*, arrythmias

GI: MALLORY-WEISS syndrome, esophageal rupture, parotid and submandibular gland hypertrophy, abdominal pain

dental: tooth enamel erosions and dental caries, scar and callus on dorm of hand (RUSSEL’S sign)

59
Q

BN treatment best standard

A

combination of nutritional rehabilitation, CBT psychotherapy, and pharmacotherapy

60
Q

what treatment for BN is alone the most appropriate treatment if the other options are no available

A

pharmacotherapy or psychotherapy

61
Q

what is the most critical assessment in BN patient

A

monitor them for suicidal ideation (7 times higher suicide rate)

62
Q

what is the most critical assessment in BN patient

A

monitor them for suicidal ideation (7 times higher suicide rate)

63
Q

first line treatment pharmacotherapy for BN

A

fluoxetine 60 mg per day; may start at full dose or 20mg per day with 20mg increases each week until 60mg is reached

64
Q

second line treatment in BN

A

other SSRis ar higher doses than that is used to treat major depression ( sertraline or fluvoxamine)

65
Q

Third line treatment in BN

A

tricyclis, topiramate, trazado, MAOIs

66
Q

avoid what medication in BN due to increased seizure risk with binging and purging

A

bupropion

67
Q

Episodes of binge eating, defined as consuming a large amount of food in a discrete period of time (about 2 hrs)

A

Binge Eating Disorder (BED)

68
Q

Binge Eating Disorder DSM 5 diagnostic criteria

A

binge eating large amounts of food within 2 hours

lack control over their eating behavior during the episode

episodes occur on average once a week for at least 3 months

no regular use of inappropriate compensatory behavior (purging fasting) etc.

69
Q

binge eating episodes are marked by at least 3 of the following

A

eating large amounts of food when not hungry

eating rapidly

feeling uncomfortable after eating

eating alone due to embarrassment over amount consumed

feeling of guilt, depression, disgust after binging

70
Q

treatment of binge eating disorder should focus on helping to reduce the patients…. (4)

A

binge eating, excessive weight gain ( if present), psychiatric comorbidities, excessive body image concerns

71
Q

what is the first line treatment in binge eating disorder

A

psychotherapy (CBT) and interpersonal therapy (IPT)

72
Q

what is the first and only medication approved to treat Binge Eating Disorder

A

Vyvanse (lisedexamfetamine dimesylate)

73
Q

Binge eating disorder pharmacotherapy

A

less effective than psychotherapy but less expense and time

-combination with CBT, only topiramate may be exeception

SSRIs: CItalopram, escitalopram, fluoxetine (chosed over topiramate)

74
Q

what drug is not recommended in binge eating disorder due to poor efficacy and serious adverse outcomes

A

anti-obesity drugs

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