Eating Disorders Flashcards

Question

What are the complications of repeated volume?

Answer 1

Russell's sign - calluses on knuckles due to knuckles making contact with incisor teeth when inducing gag Bilateral parotid swelling Dental erosion

Answer 2

CV - arrhythmias, mitral prolapse, oedema GI - M-W tears Dehydration, hypokalaemia Dental - erosion Endocrine - amenorrhea, irregular menses, osteopenia Aspiration pneumonitis Cognitive impairment

Answer 3

Biological Trial of antidepressant should be offered, can decrease freq of binge eating/purging. Fluoxetine high dose 60mg Treat medical complications Psychological Psychoeducatio CBT-BN Interpersonal therapy ``` Social Food diary to monitor eating and purging Techniques to avoid binging e.g. eating in company, distractions Small regular meals Self-help programmes ``` BN patients usually have good insight, hospital treatment if suicide risk or severe electrolyte imbalances

Answer 4

``` Subjective loss of control Large amounts, typically calories laden, 'forbidden foods' Associated guilt afterwards Secretive Alone Hiding the evidence ```

Answer 5

``` Motivation to change Short duration of illness Level of severity Onset during adolescence Good family function Lack of comorbid conditions ```

Answer 6

Up to 40 sessions over 40 weeks; twice-weekly sessions in first 2/3 weeks Reduce risk to physical health Encourage healthy eating Cover nutrition, mood regulation, body image concern Personalised treatment plan Explain risks of malnutrition Self monitoring of dietary intake and associated thoughts and feelings

Answer 7

7 core modules conducted over 20-40 sessions Use of MANTRA workbook non-anorexic identity

Answer 8

16-20 sessions Determine how dietary and emotional factors contribute to their binge eating Weekly monitoring of binge eating behaviours, dietary intake and weight Share weight record Address any body image issues

Answer 9

Gradual increase in amount of carbs in diet if medically safe so insulin can be started at a lower dose Gradual increase in insulin doses Adjusted glycaemic load and carb distribution, prevents rapid weight gain Psychoeducation Diabetes education interventions Test glucose before all supervised meals

Answer 10

Have regular dental and medical reviews Avoid brushing teeth immediately after vomiting Rinse with non-acid mouthwash after vomiting Avoid highly acidic foods and drinks

Answer 11

``` Weight or BMI Blood pressure Relevant blood tests Any problems with daily functioning Assessment of risk - related to both physical and mental health ECG, for those with purging behaviours and/or significant weight changes Discussion of treatment options Consider bisphosphonates if osteoporosis ```

Answer 12

``` Height, weight, BMI Core temperature Peripheral examination - circulation, oedema CV exam - pulse, BP Test muscle power ``` Could find bradycardia, hypotension, peripheral oedema, gaunt face, lanugo hair, scanty pubic hair, acrocyanosis (hands, feet red or purple)

Answer 13

BMI 13-15 medium risk, <13 high risk Rate of weight loss more than 0.5kg per week Pulse below 40 BP: systolic below 90, diastolic below 70, postural drop greater than 10 Unable to get up from squatting or lying down without using arms for balance or leverage Core temp below 35 Low K, Na, Mg, PO4, raised urea, cr, transaminases Prolonged QT on ECG

Answer 14

BMI: medium risk is 70-80% of median BMI (0.4th to 2nd centile) and high risk is <70% (below the 0.2nd centile). Rate of weight loss: medium risk is suggested by recent loss of weight of 500-999 g per week for two consecutive weeks; high risk is 1 kg or more over the same time frame. Pulse rate: medium risk if the pulse rate whilst awake is below 50 beats per minute; high risk below 40 beats per minute. Blood pressures: figures are dependent on age and gender but below the 2nd centile confers medium risk and below the 0.4th centile high risk. Cardiovascular symptoms: a history of syncope and/or postural drops in blood pressure suggests higher risk. ECG: an increase in the QT interval of 460 ms for girls or 400 ms for boys suggests medium or high risk, particularly in the presence of other rate or rhythm change. Core temperature: <36°C suggests medium risk; <35.5°C high risk. Blood tests: low potassium, sodium, calcium, phosphate, albumin or glucose. Behaviour: severe restriction of calorie intake, moderate to high levels of excessive exercise, fluid restriction, vomiting, purging, poor insight, violent rebellion against parental input, suicidal behaviour and self-harm. Squat test: unable to get up from a lying down position or from squatting without using arms for balance or leverage.

Answer 15

Monitor U&Es, regular ECGs Oral supplementation for any abnormal electrolytes, IV if severe Regular assessment by dentist DEXA scan - do not give oestrogen treatment, bisphosphonates may be useful in adults

Answer 16

Electrolyte imbalance or hypoglycaemia. Severe malnutrition. Severe dehydration. Evidence of incipient organ failure. Bradycardia (below 40 beats per minute) or a prolonged QT interval on the ECG. Very low BMI. Levels of risk are detailed above. BMI alone is not usually enough as a measure of high risk and other factors should be taken into consideration. Rapid weight loss (eg, more than 1 kg per week for more than two consecutive weeks). Need for medical stabilisation and refeeding. Inability or incapacity of parents or carers to provide the support needed. Significant suicide risk.

Answer 17

``` Hypokalaemia Hypotension Cardiac problems Anaemia Hypoglycaemia Osteoporosis Constipation Lack of growth in teens Infertility Infections Renal calculi, AKI, CKD Alcohol dependency Anxiety ```

Answer 18

Bulimia nervosa focused family therapy as a first line - 18-20 sessions involving family support, monitoring, regular eating, reducing compensatory behaviours Or individual CBT-ED

Answer 19

``` If vomiting freq or taking large quantities of laxatives have fluids and electrolytes balance freq assessed. Regular dental reviews and hygiene. Reduce laxatives slowly Screen for osteoporosis Check no insulin misuse ```

Answer 20

Haematemesis Metabolic complications Dental erosions Painless enlargement of salivary glands, tetany, seizures.

Answer 21

People lose control of eating, have reoccurring episodes of eating unusually large amounts of food Recurrent binge eating, no purging behaviour

Answer 22

Binge eating and no purging Feeling of lack of control over the amount of food consumed Three of - eating faster, eating until uncomfortably full, eating large amounts when not hungry, eating alone due to embarrassment, feeling of disgust after

Answer 23

Psychotherapy - self guided CBT, psychotherapy | If CBT ineffective alone, SSRIs to reduce impulse, methylphenidate to reduce binge eating episodes

Answer 24

Selective eating disorder Do not have fear of gaining weight, does not eat enough calories Dramatic restriction of types or amount of food eaten Lack of appetite or interest in food Dramatic weight loss Upset stomach, abdo pain, GI issues with no other cause Limited range of preferred foods, picky eating getting worse

Answer 25

Appetite for and ingestion of nonnutritive substances e.g. hair, clay, soil, ice, paint Persistent ingestion for >1 month, inappropriate for developmental age

Answer 26

Lead poisoning from paint Bowel obstruction, perforation Bacterial or parasite infections

Answer 27

Behavioural interventions and nutritional rehabilitation | Pharmacotherapy - SSRI second line

Eating Disorders Flashcards

(51 cards)