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Eating disorders Flashcards

Anorexia Nervosa Bulimia Nervosa OSFED (93 cards)

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1
Q

Anorexia diagnosis

A

BMI < 18.5
Persistent pattern of behaviours to prevent restoration of normal weight
Body image distortion
Low body weight/shape central to self evaluation
Intense fear of gaining weight

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2
Q

Subtypes anorexia

A

Significantly low body weight < 14-18.5
Dangerously low body weight < 14
Restricting pattern
Bu he purging pattern
In recovery with normal body weight - healthy body eight, cessation of behaviours over a year

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3
Q

What is a dangerously low body weight

A

<14

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4
Q

BMI in anorexia

A

<18.5

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5
Q

Persistent weight pattern of behaviours to prevent restoration normal weight in anorexia

A

Dietary restriction
Excessive exercise
Purging - self induced vomitting, diuretics/laxatives/appetite supressants/enemas

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6
Q

Comorbidities anorexia

A

Depression
Anxiety
OCD
Personality disorders - avoidant, anankastic

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7
Q

Symptoms of starvation

A

Low mood
Labour mood
Irritability
Anxiety
Extreme distress
Rigidity
Loss libido
Social withdrawal
Poor concentration
Rituals
Compulsive behaviour
Personality changes

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8
Q

Medication for anorexia?

A

Often ineffective
Increased risk side effects

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9
Q

Is there a family history in eating disorders?

A

Yes

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10
Q

Risk factors eating disorders

A

Gender
Early puberty
Type 1 diabetes

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11
Q

Genetic factors

A

Anorexia - genetics affecting hunger hormones eg ghrelin - tolerate hunger better

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12
Q

Psychological risk anorexia

A

Temperament traits - perfectionism
Early experience or attachment
Early feeding behaviours
Life events
Low self esteem
Weight shape concerns

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13
Q

Risk social anorexia

A

Dieting industry
Professions
Upbringing
Acculturation - struggling in new culture
Social media

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14
Q

Which eating disorder has highest mortality of any psychiatric condition?

A

Anorexia

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15
Q

Physical risks of anorexia

A

Starvation
Compensatory behaviours
Falsifying weight
Related to re-feeding syndrome
More chronic problems - osteoporosis
Complications from mismanagement of diabetes

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16
Q

Lagopthalmos

A

Tape eyes to sleep as eye muscles to weak from hydration

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17
Q

Vomiting physical affects

A

Enamel erosion
Swollen parotid glands
Gastric and oesophageal trauma

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18
Q

Bloods when vomiting

A

Low chloride
Low potassium
Metabolic alkalosis
Amylase and bicarbonate increase
Treat hypokalemia

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19
Q

Hypokalemai sumtpksm

A

Muscle cramps
Tingling
Fatugue
Paliptiations
U wave on ECG

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20
Q

Laxatives effects

A

Increased water and electrolyte loss
Dehydration
Electrolyte imbalance - u Musial
Rectal bleeding
Abdominal bleeding
Rebound constipation - pseudo obstruction - reduce by 10% per week

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21
Q

Over exercise signs and symptoms

A

Physical exhaustion
Muscle damage injuries
Elevated Creatinine kinase
Rhabdomyolysis
Cardiac or ECG abnormalities
Bradycardia, heart block

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22
Q

Falsifying weight

A

Weights in shoes/hair/arm purse
Attempts tamper with scales
Excessive fluid

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23
Q

Reason for excess fluid intake

A

Hunger suppress
Anxiety manage
Deliberate weight falsify

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24
Q

What can over hydration cause

A

Hyponatremia

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25
Re feeding syndrome physiology
Glucose increases, Insulin secreted Potassium taken into cells with glucose Phosphate, magnesium, potassium and thiamine all rapidly depleted Leads to arrhythmia
26
What does re feeding syndrome cause
Low potassium/phosphate/magnesium B12 deficiency - wernickes/korsakoffs Sodium balance - oedema, cardiac failure
27
Who is re feeding syndrome Particularly high risk for
Very low BMI Complete restriction/ rapid weight loss Co-morbid alcohol dependence Co-morbid physical health problems e.g. sepsis, cancer Parenteral feeding > NG feeding > Oral diet
28
Risk to self
Low mood and hopelessness v common Suicide - chronic anorexia Self harm - binge and purge
29
Other risks eating disorders
Driving - difficult concentration, preoccupation with food, mood instability - impulsive Duties at work Child care Activities Universities - attendance guidance
30
What BMI shouldn’t drive at
<16
31
Assess physical risk
Weight height BMI, rate of weight loss BP incl postural, pulse, temp ECG Sit up/squat test - SUSS FBC, U+Es, KFY, glucose, bone, Mg
32
What happens to LFTs in starvation
Apoptosis in liver - go up
33
Sit up test + scoring
Patient lies down on floor and sitsup without using hands 0: Unable 1: Able only using hands to help 2: Able with noticeable difficulty 3: Able with no difficulty
34
Squat test
squats down and rises without using hands
35
Kings college guidelines
36
Symptoms of anorexia/ bulimia
Lenugo hair - fine hair all over body (anorexia) Swollen parotid glands Russells sign - nodules on knuckles from purging Globe haemorrhages of eye Erythema ab igne - laxatives + hot water bottle
37
Russell’s sign
Calluses on hands from vomiting
38
Erythema ab igne
Mottling of skin when use hot water bottle - excess use of laxatives
39
Anorexia recovery
50% full recovery 30% improve 20% remain chronically I’ll Early intervention model - 60% full recovery
40
Why early intervention important
Different illness stages 1 brain plasticity and thought compulsion hardwiring
41
Management nutrition
Dieticians and OT Regular eating and snacks Food prep, soho, cook Eating in different situations and environments Psychoeducation
42
Aim weight gain per week
0.5-1kg per week
43
Food restrictions to do with eating disorders
Vegetarianism’s and veganism No vegan NG feeding - moral?
44
Set point concept
Work towards a threshold that is genetically predisposed Can go up but can go down Psychoedycation - teach patient to trust body
45
Management of ED
Nutritional Psychoeducation
46
Medical management anarexia
Reseeding syndrome Monitor physical parameters Olanzapine - antipsychotic (weight gain is side effect! No mer for anorexia itself NG feeding Bed rest be chair rest Frequency monitoring bloods/investigations/IBD
47
Important bone investigations
DEXA scans, calcium supplements
48
Treatment setting
GP, community, day service Medical ward
49
When admit to ward
Medically unstable High risk re-feeding syndrome Specialist eating disorders unit
50
Psychological management EDs
MANTRA/SSCM CBT Psychodynamic therapy
51
MANTRA
Maudsley Anorecia Nervosa Treatment
52
Bulimia psychological help
Self help CBT if severe
53
Ego syntonic condition
Feel like illness is part of you - ingrained into personality and identity, difficult to challenge
54
Ego dystonic condition
Recognised as intrusive/excessive Don’t want but have it
55
Motivation to chan her
Ambivalence - universal Stages of change - prochaska +
56
Low risk and ready to change
Standard treatment
57
High risk and ready to change
Intensive treatment
58
Low risk not ready to change
Motivational work Discharge
59
MHA - anorexia detain what need
2 doctors and an AMP (mental health social worker) Risk of self neglect
60
When can medical treatments be given against will
Symptom or manifestation treatment - NG feeding Blood tests Fluids
61
Anorexia capacity
Difficult to assess Severe anorexia normally don’t have capacity but coherent and articulate Fluctuates hourly Irrespective of capacity can be detained and treated under MHA if stay criteria are met
62
MEED
Medical emergency eating disorders BMI of 13 Admit to hospital
63
I’d have eating dirsoder what can sepsis look like
V slightly raised WCC and neutrophils and temp - baseline is much lowe than normal so increase
64
What is bulimia Nervosa?
Not significantly underweight Preoccupation with body shape/weight which strongly influences self evaluation Episodes of binge eating Recurrent compensatory behaviours
65
How often does a binge have to be to be a disorder
Once a week for a month
66
Binge eatind disorder diagnosis
Frequent binges Distressing and accompanied by negative emoitons - guilt/disgust Not ass with compensatory behaviours Discrete period of time Subjective loss of control More food than ususal
67
Bone density
DEXA scan Osteopenia vs osteoporosis Calcium supplement Alendornic acid Restore bone density need weight restoration
68
Stages of anorexia
Beliefs - body image distortion, fear of weight gain Behaviour - dietary restriction, exercise, purging Physical consequences - starvation, medical complications
69
What models for stages of change are there?
Prochaska and Diclemente
70
Prochaska and diclemente
Pre-contemplation - no intention on changing behaviour Contemplation - aware a problem exists but with no commitment to action Preparation - intent on taking action to adress problem Action - active modification of behaviour Maintenance - sustained change new behaviour replaces old Relapse - fall back into old patterns of beahviour
70
Prochaska and diclemente
Pre-contemplation - no intention on changing behaviour Contemplation - aware a problem exists but with no commitment to action Preparation - intent on taking action to adress problem Action - active modification of behaviour Maintenance - sustained change new behaviour replaces old Relapse - fall back into old patterns of beahviour
71
High risk not ready to change
Consider use of mental health act
72
What do low WCC, neutrophils, glucose and high ALT, Alkaline Phosphate and normal, U+Es normal, 45 BPM show?
Starvation
73
What does low WCC, glucose, potassium and chloride and high bicarb, Creatinine Kinase mean?
Vomitting
74
Low WCC, neutrophils, glucose and sodium with normal ECG signal what?
75
What do slightly raised WCC, neutrophils, temp 37.8 degrees and 110BPM signal in an anorexic patient?
Sepsis - lower baseline to start with
76
Recurrent compensatory behaviours
Purging Restricting Exercise Neglect insulin treatment
77
What is ARFID defined as?
Abnormal eating/feeding resulting in insufficient quantity/variety of food Significant weight loss/failure to gain weight Negatively affective the health of the person/impaired functioning Not due to concerns about body weight or shape It isn’t about lack of food availability/effects of meds/substance use/underlying physical health condition
78
What is the criteria for childhood anorexia?
BMI for age under fifth percentile in children and adolescents Prepubertal onset – pubertal events delayed/arrested
79
Men signs of anorexia
Loss of sexual interest or potency Differences in idealised body shape – muscular strength, definition, physical fitness
80
Pscyhological risk factors for eating disorders
Temperament traits - Perfectionism Early experiences/Attachment Early feeding behaviours Life events Low self-esteem Weight shape concerns
80
Pscyhological risk factors for eating disorders
Temperament traits - Perfectionism Early experiences/Attachment Early feeding behaviours Life events Low self-esteem Weight shape concerns
81
Social influences on eating disorders
Dieting industry Professions – models, gymnasts, ballet, fashion, acting Upringing Acculturation Social Media – which is worst platform? Instagram
82
How to nutritionally manage anorexia?
Dietiicians and OTs Regular eating and snacks 0.5-1kg restoration per week aim for Food prep, cookking, shopping Psychoeducation
83
Medical management of eating disorders
Treatment setting: GP monitoring / Community / Day Service Medical Ward (medically unstable, or high risk refeeding syndrome) Specialist Eating Disorders Unit Nasogastric feeding Bed Rest vs Chair Rest Frequency of monitoring bloods/investigations/obs Observations Leave
84
Bone density in eating disorders what do?
DEXA scan Osteopenia/porosis Calcium supplement Alendronic acid -ONLY WAY to restore density is weight restoration
85
What can be used off license for anorexia?
Low dose olanzapine
86
Refeeding syndrome - whats importatn
Gradual calories but dont underfeed Potassium, phosphate, magnesium, thiamine, vitamin B
87
How decide if motivation to change?
Ambivalence universal - dont preclude treatment Stages of change - prochaska and diclemente Motivational enhancement Externalissation (egosyntric disorder)
88
MANTRA stages treatment anorexia
. Getting started and finding motivation for recovery 2. Working with support, including families and others 3. Improving nutritional health and dietetics 4. Understanding anorexia, guided by the vicious flower 5. Developing treatment goals (SMART) 6. Understanding and relating to emotions helpfully 7. Exploring thinking styles, and challenging styles that are rigid, perfectionist, attention to detail 8. Developing identity outside of the eating disorder 9. Relapse prevention
89
Phases of SSCM
an initial orientation phase, which focuses on identifying target symptoms and agreeing goals for weight gain and normal eating a middle phase in which target symptoms are monitored, and support is focused on encouraging weight gain via normal eating and reduction of other eating-disordered behaviours a final phase, which focuses on ending the intervention and planning the future
90
What does specialist supportice clinical management of anorexia look like
Knowledge about therapy and purpose Engagement Assessment Pscyhoeducation Establish and review target symptoms Monitor weight Encourage normal eating Supportive therapy Maintenance
91
What is rhabdomyolysis and how treat
Myocyte destruction Causes raised CK - 5 x is diagnositc level Fluid rehydration is treatment

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