Eating Disorders Flashcards

Question

Relevant investigations in ?bulimia nervosa

Answer 1

Bedside: Height and weight: to calculate BMI Basic observations: including blood pressure and heart rate Urinalysis: may show ketones if the patient has co-morbid diabetes mellitus. Some patients may skip insulin to control their weight. This is often referred to as ‘diabulimia’. ECG: important to perform if there is a severe deficiency in potassium or magnesium. Features of hypokalaemia include increased P wave amplitude, prolonged PR interval, ST depression and T wave flattening/inversion and prominent U waves. Relevant laboratory investigations include: Urea & electrolytes: these may show hypokalaemia and/or increased creatinine. Elevated bicarbonate usually indicates alkalosis due to loss of gastric acid. Magnesium: may be low Full blood count: may show anaemia Liver function tests: may be abnormal as excess exercise can elevate aminotransferases

Answer 2

Preoccupation with controlling body weight Repeated bouts of overeating Compensatory behaviours after overeating, including self-induced vomiting, using laxatives and excessive exercise These binge eating and compensatory behaviours usually occur at least once weekly for three months

Answer 3

Selective serotonin-reuptake inhibitors (SSRIs) are used for the pharmacological management of bulimia. Fluoxetine is typically used first-line, followed by sertraline if this is poorly tolerated. These may be used when cognitive behaviour therapy (CBT) isn’t available or when it has been tried and the patient hasn’t seen any improvement. The medications should be given at a time of day when they are unlikely to be purged.2 SSRIs are also useful in the case of comorbid disorders (e.g. depression and anxiety).

Answer 4

Irregular menstrual cycles and fertility issues Mental health conditions such as depression and anxiety Gastric ulcers Osteoporosis Heart issues including arrhythmias, heart attacks or failure and cardiomyopathy

Answer 5

Eating disorders are mental health conditions in which the person uses the control of food to cope with feelings and/or other situations. This usually involves eating too little or too much, purging behaviours or worrying excessively about body weight or shape. The three most common eating disorders are: Anorexia nervosa: an eating disorder characterised by weight loss, inability to maintain appropriate body weight for age/height and often associated with distorted body image. It generally involves the restricting of calories and sometimes also involves excessive (and compulsive) exercise and purging. Bulimia: often involves bingeing and then purging. People with bulimia often make themselves sick or take medications such as laxatives or diuretics to help them get rid of calories. Binge eating disorder: involves eating excessive amounts of food in a short period and then having feelings of guilt and upset.

Answer 6

Weight history Eating behaviour Adaptive behaviours Physical symptoms including red flags Psychological symptoms

Answer 7

SLIM S: stages - weight during childhood/adult/teenage years, any time of drastic change L: loss - any periods of excessive or rapid weight-loss, triggers for any weight loss/gain I: ideal - what do they think is a health weight, how do they feel currently about their weight M: Maximum and minimum - heaviest and lightest weights

Answer 8

Establish what would be a normal day for them and what their beliefs around eating are. It is also helpful to understand if they believe they have a problem: “What would a typical day’s food intake look like for you?” “Do you think that your eating habits are similar to your friends and families?” “Has anyone expressed they are concerned about the amount you are eating?”

Answer 9

Exercise - how much, what type Purging - vommiting or medication including insulin Binge eating - what triggers this?

Answer 10

Rapid weight loss Heart rate <40 Significant orthostatic changes in systolic BP (>20 mmHg) History of recurrent syncope ECG abnormalities (prolonged QTc, arrhythmias, signs of electrolyte abnormalities) Fluid refusal or signs of severe dehydration (reduced urine output, tachypnoea, tachycardia, reduced skin turgor, sunken eyes) Low temperature (hypothermia) Signs of electrolyte disturbance Unable to stand up from squatting or sit up from laying (SUSS test)

Answer 11

Current mood Periods of high or low moods symtpoms of anxiety or panic attack Obsessive or compulsive thoughts Thoughts of self harm/plans/obstructive factors

Answer 12

Neurological: memory, concentration, numbness or weakness in limbs, dizziness on sitting to standing Respiratory: shortness of breath particularly on exercise Cardiovascular: palpitations or chest pain Gastrointestinal: changes to bowel habits, abdominal pain, reflux, bloating Genitourinary: changes to urinary frequency, changes to or absence of menstruation Miscellaneous: hair loss or growth, dry skin, lethargy

Answer 13

Ask the patient if there is any family history of psychiatric disease in first-degree relatives: Ask about a family history of gastrointestinal disease (e.g. inflammatory bowel disease, coeliac disease) when considering other causes of weight loss. It may be useful to draw a genogram displaying this information.

Answer 14

“Are you feeling particularly stressed at the moment in any area of your life?” (school, work, home) “How are your eating habits impacting your family/relationship/friends?” “Has anyone else commented on your mood or behaviours recently?” “Have you spoken about your concerns to any friends/family/partner?”

Answer 15

Stress Alcohol Smoking Drugs Caffeine use Support networks

Answer 16

In addition to malnutrition secondary to the eating disorder, long-standing alcohol dependency can lead to malnourishment. Folate and B12 deficiency may consequently develop Can help understand triggers and coping mechanisms

Answer 17

The sit-up–squat–stand (SUSS) test is a method used to assess muscle wasting in patients with anorexia nervosa. In the sit-up test, the patient lies flat on a firm surface such as the floor and attempts to sit up without using their hands. In the squat test, the patient is asked to rise from a squatting position without using their hands. An inability to stand up from a chair without using their hands indicates failure of the squat test, which is a red-flag sign indicating severe muscle wasting.

Answer 18

A prolonged QT interval (>450ms) is often seen in those with Anorexia Nervosa, secondary to weight loss or electrolyte disturbance. It is important to detect this, as it can predispose to potentially fatal arrhythmias

Answer 19

Excessive potassium loss occurs as a result of repeated self-induced vomiting and laxative use. Excessive vomiting can cause metabolic alkalosis due to loss of hydrochloric acid, which in turn increases renal potassium excretion. Generalised muscle weakness and cramps, fatigue and constipation

Answer 20

most things low G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

Answer 21

A syndrome characterized by repeated bouts of overeating and an excessive preoccupation with the control of body weight, leading to a pattern of overeating followed by vomiting or use of purgatives. This disorder shares many psychological features with anorexia nervosa, including an overconcern with body shape and weight. Repeated vomiting is likely to give rise to disturbances of body electrolytes and physical complications. There is often, but not always, a history of an earlier episode of anorexia nervosa, the interval ranging from a few months to several years.

Answer 22

Anorexia nervosa is complicated by hypothalamic-pituitary dysregulation, including hypothalamic amenorrhea

Answer 23

pharmacological treatments have a limited role - a trial of high-dose fluoxetine is currently licensed for bulimia but long-term data is lacking

Answer 24

Adults - NICE recommend: individual eating-disorder-focused cognitive behavioural therapy (CBT-ED) Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) specialist supportive clinical management (SSCM). Children and young people - NICE recommend: first-line treatment: anorexia focused family therapy second-line treatment: cognitive behavioural therapy (IPT, Psychodynamic therapy)

Answer 25

For safety, tricyclic antidepressants and monoamine oxidase inhibitors are not recommended, and bupropion is contraindicated.

Answer 26

patients with anorexia nervosa have an increased risk of suicide, TCAS have high toxicity in overdose Increased risk of fatal arrhythmia (both TCAs and AN can cause QT prolongation) ADEs such as prolonged QT and cardiac dysrhythmias are more likely in people with electrolyte abnormalities or who are malnourished

Answer 27

Cerebral dystrophy/atrophy Cognitive decline/impairment Desphoria/depression Anxiety Sleep disorders

Answer 28

Amenorrhea Infertility Osteopenia/osteoporosis Thyroid abnormalities Hypercortisolemia Low serum albumin Hypoqlycemia Neurogenic diabetes insipidus Secondary hyperaldosteronism

Answer 29

Dehydration/hypovolemia Increased BUN Increased SCr Decreased GFR Electrolyte dysbalance" (eg, hypokalemia, hyponatremia, hypomaqnesemia, hypophosphatemia) Hypochloremic metabolic alkalosisd Refeeding syndrome

Answer 30

Bradycardia Hypotension Orthostatic hypotension Prolonged QT interval Arrhythmias Mitral valve prolapse

Answer 31

Gastroparesis Constipation Esophagitis" Dysphagia Postprandial discomfort Postprandial bloating Elevated liver enzymes Severe acute pancreatitis

Answer 32

Anemia Neutropenia Thrombocvtopenia Decreased ESR

Answer 33

Aspiration Pneumonia Emphysema

Answer 34

Hypokalemia

Answer 35

Anorexia nervosa Bulimia nervosa Other specified feeding or eating disorder (OSFED) Avoidant Restrictive Food Intake Disorder (ARFID)

Answer 36

Adult: BMI of less than 18.5 Child BMI<5 percentile Rapid weight loss (more than 20% total body weight within 6 months)

Answer 37

Persistent pattern of restrictive eating or other behaviours aimed at establishing or maintaining abnormally low body weight Significantly low body weight: Adults: BMI of less than 18.5 Children: BMI-for-age <5th percentile or failure to gain weight as expected Rapid weight loss (more than 20% total body weight within 6 months) Low body weight is not better explained by another medical condition or unavailability of food Excessive preoccupation with body, weight and shape Low weight is overvalued and central to a person’s self evaluation Body weight or shape is inaccurately perceived to be normal or excessive Repeatedly checking body weight using scales Repeatedly checking body weight using tape measures Body checking in the mirror Constantly monitoring the calorie content of food or searching for information on how to lose weight Extreme avoidant behaviours – refusing to have mirrors at home, avoidance of tight fitting clothes, refusal to know one’s weight, purchasing clothes in specific size

Answer 38

Restrictive sub type: Weight loss an maintenance of low body weight attributed to restricted intaking/fasting Binge-Purge pattern: Sufferers have episodes of binge eating and purging behaviours

Answer 39

Frequent, recurrent episodes of binge eating: Once a week or more over a period of at least 1 month Repeated inappropriate compensatory behaviours to prevent weight gain: Once a week or more over a period of at least 1 month Usually self induced vomiting Fasting, diuretics, laxatives, enemas (to reduce absorption of food) Omission of insulin, excessive exercise (to increase energy expenditure) Excessive preoccupation with body weight or shape Similar behaviours to AN – weighing, body checking etc Marked distress about the pattern of binge eating and inappropriate compensatory behaviours Or significant impairment in personal, family, social, educational, occupational or other important areas of functioning Symptoms do not meet the diagnostic criteria for Anorexia Nervosa Binges may be objective or subjective The core feature is the loss of control over eating Binge eating is typically experienced as very distressing Associated emotions: guilt, shame, disgust Negatively affect the individual’s self evaluation May be associated with weight gain over time Individuals may be normal weight or low weight (not enough to meet criteria for AN)

Answer 40

Eating a larger than usual amount of food in a discrete period of time Usually highly calorific (“bad foods”) Lack of control during the episode Eat rapidly and until uncomfortably full Eating when not hungry Usually very secretive

Answer 41

Binge eating episodes are not regularly accompanied by compensatory behaviours aimed at preventing weight gain.

Answer 42

Avoidance or restriction of food intake that results in either or both of: -The intake of an insufficient quantity or variety of food to meet adequate energy or nutritional requirements that has resulted in significant: Weight loss Nutritional deficiencies Dependence on oral supplements or tube feeding Has otherwise negatively affected the health of the individual -Significant impairment in personal, family, social, educational, occupational or other important areas of functioning (e.g. due to avoidance or distress related to participating in social experiences involving eating) The pattern of eating is not motivated by preoccupation with body weight or shape Restriction of food may be variable and affected by emotional or psychological factors May be associated with high levels of distractibility May be associated with high levels of emotional arousal and extreme resistance at mealtimes – often require lots of prompting and encouragement to eat Individuals generally do not have difficulty eating foods within their preferred range May be underweight or normal weight Can negatively impact family functioning Mealtimes can be associated with distress (particularly in children) Variety of reasons for restriction of food intake: Lack of interest in eating, chronically low appetite or poor ability to recognise hunger Avoidance of foods with certain sensory characteristics (smell, taste, texture, colour, temperature) Concern about the perceived consequences of eating (choking, vomiting, health problems) – may be subsequent to a history of an aversive food related experience such as choking or vomiting after eating a particular type of food May be no identifiable event that has preceded the onset of the disorder Restricted food intake and consequent weight loss (or failure to gain weight) or other impact on physical health or related functional impairment, are not due to: Unavailability of food Are not related to another medical condition (e.g. food allergies, hyperthyroidism) or mental disorder Are not due to the effects of a substance or medication (including withdrawal effects)

Answer 43

Variety of reasons for restriction of food intake: Lack of interest in eating, chronically low appetite or poor ability to recognise hunger Avoidance of foods with certain sensory characteristics (smell, taste, texture, colour, temperature) Concern about the perceived consequences of eating (choking, vomiting, health problems) – may be subsequent to a history of an aversive food related experience such as choking or vomiting after eating a particular type of food May be no identifiable event that has preceded the onset of the disorder

Answer 44

Depression OCD Social anxiety ASD (AN) Substance abuse EUPD

Answer 45

Genetics Social/cultural Biological vulenerability Biological stress Psychological vulnerability (e.g. perfectionism) Psychological stress

Answer 46

Genetics Social/cultural Biological vulnerability Biological stress Psychological vulnerability (e.g. perfectionism) Psychological stress

Answer 47

Genes Neurotransmitters Hormones Physical illness or allergies Family history of depression, anxiety or addiction

Answer 48

Low self esteem Feelings of ineffectiveness or lack of control Self-identity History of depression/anxiety/mood intolerance Personality traits: perfectionism, obsessional Interpersonal styles: struggle to recognise cues and emotional state of others Emotional processing: difficulty recognising own emotional state expressing emotions, difficulty handling stress Thinking styles – cognitively rigid, all or nothing thinking, can't see bigger picture

Answer 49

History of bullying, especially about weight Trauma – all forms of abuse Stressful life events – grief, loss Difficult interpersonal relationships Conflict within the family - High expectations - Stressful family circumstances - Overprotection Taking part in competitive sports – dancing, gymnastics Growing up in a household that places value on appearance and dieting

Answer 50

Biological: puberty, physical illness/trauma, dieting and weight loss Psychological: mood/anxiety, sense of lack of control in other areas of life Social/environmental: interpersonal problems - conflict, lonlieness, transitions - taking on a new role with expectations and responsibilities Grief/loss Social media/diet culture

Answer 51

Brain structure and self regulatory system (in the forebrain) changes Anxiety and intense negative emotions increase Both negative and positive emotions are numbed Coping ability reduces Thinking becomes more rigid and routine

Answer 52

Effects of starvation – energy, euphoria Reduced sex drive – can be positive in terms of avoidance

Answer 53

Reinforcement from others – positive comments Eliciting care from others Ability to avoid transitions, events, responsibilities Social media/the media/diet culture

Answer 54

Decreased effect Thinking about social situations Emotional regulation Decision making Flexibility Ability to plan Increased effect Compulsive behaviours Avoidance Anxiety Sensitivity

Answer 55

When first became concerned about weight/food? Any food fads, dieting, physical illness that have affected weight in the past? Have they restrained their eating? If so when, to what extent and why? History of weight change since onset of eating disorder Highest & lowest ever adult weight Stable weight as an adult? Were they restricting at that time? Ideal weight

Answer 56

Hx of eating disorder Current pattern of eating Mechanisms of weight control Attitudes to weight and shape/body image Current mood or anxiety symptoms Physical symptoms: feeling tired/week/faint, feeling cold, palpitations, chest pain, SOB, abdominal symptoms, lanugo hair, oedema in feet hands/face, period and bone changes General mental health assesment

Answer 57

Red <13 or recent rapid weight loss of >1kg/week in an undernourished patient -highest risk of decompensation Amber: 13-14.9 or recent weight loss of 0.5-1kg/week in an undernourished patient Green: >15 or recent weight loss of <0.5kg/week or fluctuating weight - lower risk of decompensation

Answer 58

Cachexia, signs of dehydration, lanugo hair, salviary gland enlargement

Answer 59

Lower body temperature Lower blood pressure Lower HR

Answer 60

0: Unable to sit up from lying flat 1: Able only using hands to help 2: Able with notable difficulty 3: Able without difficulty

Answer 61

Bloods: FBC, U&E, LFTs, bone profile, magnesium, glucose ECG DEXA Scan

Answer 62

Sodium retention + ECF with thiamine deficiency can lead to congestive cardiac failure Deficiencies of K+ PO4-, Mg2+ associated with life threating cardiac arrythmias Neurological problems such as delirium, neuropathy, or seizures can develop in some patients Poor ventilatory function due to respiratory muscles weakness can result in respiratory failure Rhabdomyolysis due to hypophosphataemia not only causes muscle weakness and myalgia but can also be complicated by renal failure due to myoglobinuria Infrequently, thrombocytopaenia and impaired blood clotting can also be a consequence of phosphate deficiency

Answer 63

Carbohydrate

Answer 64

Egodystonic nature

Answer 65

50-60% Prognosis worse if no recovery in first 3-5 years (physiological and psychological changes)

Answer 66

1:4 (1 in 5 suicide, 4 in 5 physical causes)

Answer 67

• ECG – potential for conduction defects, prolongation of QTc, consequences of electrolye abnormalities. • Bloods: • Hormone: low LH, FSH & oestradiol TFT – low T3, normal T4, normal TSH (low T3 syndrome) Mild increase cortisol • FBC: normocytic, normochromic anaemia. Potential low WCC and low platelets • U&E’s:hypokalaemic (if vomiting) Potential hyponatraemia and hypokalaemia (if using laxatives) Hypophosphataemia Hypomagnesemia • Other:Hypercholesterolaemia Potentially DEXA scan (usually organised by Eating Disorders team if necessary)

Answer 68

• Monitoring of weight & dietary counselling • Vitamin and mineral supplementation • Psychological treatment: CBT-ED (Cognitive behavioural therapy for eating disorders). MANTRA (Maudsley Anorexia Nervosa Treatment for Adults). Specialist Supportive Clinical Management. • Admission to hospital if physical health severely compromised.

Answer 69

solitary, abnormal belief that is neither delusional nor obsessional in nature, but which is preoccupying to the extent of dominating the sufferer's life

Answer 70

solitary, abnormal belief that is neither delusional nor obsessional in nature, but which is preoccupying to the extent of dominating the sufferer's life

Eating Disorders Flashcards

(97 cards)