Eating disorders Flashcards by Bethan Williams

Three major types of eating disorders seen in ICD 10

Anorexia nervosa
Bulimia nervosa
Eating disorder not otherwise specified

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Percentage of patients with bulimia who have a history of anorexia

25-33%

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Eating disorders seen in ICD 11

Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Avoidant-restrictive food intake disorder
Pica
Rumination-regurgitation disorder
Other specified feeding or eating disorders

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Criteria for anorexia nervosa in ICD 11

Significantly low body weight (e.g. BMI <18.5) or rapid weight loss (e.g. 20% of body weight in 6 months)
Persistent pattern of restrictive eating or other behaviours aimed at reducing body weight/maintaining low body weight
Excessive preoccupation with body weight or shape

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BMI required for adults with ‘anorexia with significantly low body weight’ in ICD 11

14-18.5

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Percentile BMI required for children and adolescents with ‘anorexia with significantly low body weight’ in ICD 11

0.3-5th percentile for BMI for age

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BMI required for adults with ‘anorexia with dangerously low body weight’ in ICD 11

<14

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Percentile BMI required for children and adolescents with ‘anorexia with dangerously low body weight’ in ICD 11

<0.3rd percentile for BMI for age

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Behaviour patterns specified for anorexia nervosa in ICD 11

Restricting pattern
Binge-purge pattern
Unspecified

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Definition of binge eating

A discrete period of time during which the individual loses control of their eating and eats notably more or differently than usual

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Criteria for bulimia nervosa in ICD 11

Frequent recurrent episodes of binge eating
Repeated inappropriate measures to prevent weight gain
Excessive preoccupation with body weight or shape
Distress about the pattern of eating
Does not meet criteria for anorexia nervosa

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Most common compensatory behaviour to prevent weight gain in bulimia nervosa

Vomiting

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Frequency of binges and compensatory behaviours required for a diagnosis of bulimia nervosa in DSM V

Once weekly

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Class distribution of anorexia nervosa

Excess in higher social classes

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Class distribution of bulimia nervosa

Even class distribution

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Usual age of onset of anorexia nervosa

15-19

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Usual age of onset of bulimia nervosa

Young adulthood

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Prevalence of anorexia nervosa among teenage girls

0.5-1%

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Percentage of patients with anorexia nervosa who also have depression

65%

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Eating disorder with the highest heritability

Anorexia nervosa

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MZ concordance for anorexia nervosa

55%

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MZ concordance for bulimia nervosa

35%

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DZ concordance for anorexia nervosa

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DZ concordance for bulimia nervosa

30%

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Criteria for binge eating disorder in ICD 11

Frequent, recurrent episodes of binge eating Not regularly accompanied by inappropriate compensatory behaviours aimed at reducing weight gain Marked distress or impairment in functioning Not better accounted for by another medical condition

Usual length of time symptoms should be present for a diagnosis of binge eating disorder

3 months

Criteria for ARFID in ICD 11

Avoidance or restriction of food that leads to inability to meet nutritional requirements, or impairment in functioning or distress Behaviour not motivated by preoccupation with weight or body shape Not a result of lack of food, medical condition, other mental disorder, or medication

Male:female ratio for binge eating disorder

1:3

Definition of fine downy hair seen on the body of patients with EDs

Lanugo

Sign seen in patients with EDs where the knuckles are calloused due to repeated induced vomiting

Russel's sign

Medical complications of repeatedly induced vomiting

Russel's sign Parotid and submandibular gland swelling (sialadenosis) Erosion of inner surface of front teeth QTc prolongation Slowed GI motility Oesophagitis or Mallory-Weiss syndrome Epistaxis Subconjunctival haemorrhage

Endocrine abnormalities seen in patients with EDs

Low LH, FSH, and oestradiol Low T3, normal T4 High plasma cortisol High growth hormone Low glucose Low leptin (but may be higher than expected for weight)

Thyroid abnormalities seen in patients with EDs

Low T3 Normal T4

Sex hormone abnormalities seen in patients with EDs

Low LH Low FSH Low oestradiol

Cortisol abnormality seen in patients with EDs

High cortisol

Growth hormone abnormality seen in patients with EDs

High growth hormone

FBC abnormalities seen in patients with EDs

Normocytic normochromic anaemia Leucopaenia Relative lymphocytosis Thrombocytopaenia

Cholesterol abnormality seen in patients with EDs

High cholesterol

Serum carotene abnormality seen in patients with EDs

High serum carotene

Most effective treatment for bulimia nervosa

CBT

Percentage of patients with bulimia nervosa who make a complete and lasting recovery

33-50%

First choice antidepressant for patients with bulimia nervosa

Fluoxetine

Number of treatments of CBT usually used for patients with bulimia nervosa

16-20

Psychosocial treatments with evidence for anorexia nervosa

CBT Maudsley anorexia nervosa treatments for adults (MANTRA) Specialist supportive clinical management Focussed psychodynamic therapy

Poor prognostic features of anorexia nervosa

Male sex Late onset Long duration of symptoms Low BMI Purging Psychiatric comorbidities Anxiety when eating in front of others

Good prognostic features of anorexia nervosa

Shorter duration of symptoms Good premorbid functioning Good parental relationships Stable life situation Good family acceptance

Most common cardiac abnormalities in anorexia nervosa

Bradycardia QT prolongation

Male:female ratio for anorexia

1:10

Eating disorder with the highest rate of spontaneous remission

Binge eating disorder

Core feature of a binge episode

Experience of a loss of control while eating

Sex less likely to seek treatment for bulimia nervosa

Males

Compensatory behaviours more often used by females in bulimia nervosa

Vomiting Laxative use

Compensatory behaviours more often used by males in bulimia nervosa

Exercise Steroids

Features of rumination regurgitation disorder

Intentional bringing up of previously swallowed food to the mouth Either re-swallowing the food or spitting it out Regurgitation occurs several times a week

Sex with an earlier age of onset of anorexia nervosa

Females

Medical complications of food restriction and very low weight

Renal failure Peripheral oedema Bradycardia QTc prolongation Pericardial effusion Valve prolapse Slowed GI motility and constipation Hair loss Dry skin and lanugo hair Muscular weakness Hypothermia Osteoporosis

Reason why patients with anorexia nervosa are at higher risk of hepatotoxicity following a paracetamol overdose

They are likely to lack glutathione Glutathione conjugates benzoquinonimine, which is the hepatotoxic metabolite of paracetamol

Percentage of patients with anorexia nervosa who would be expected to have recovered fully in 30 years

50%

Percentage of patients with anorexia nervosa who would be expected to have recovered partially in 30 years

33%

Percentage of patients with anorexia nervosa who would be expected to have a continuing ED in 30 years

20%

Percentage of patients with anorexia nervosa who would be expected to have died in 30 years

Nutrient deficiency associated with eating clay in pica

Zinc

Features that suggest hospital admission should be considered in anorexia nervosa

BMI <13 Pulse <40 SUSS test score <2 Sodium <130 Potassium <3 Serum glucose <3 QTc >450

Maximum score in the sit up squat stand test where the patient is able to rise without difficulty and without the use of their hands

Hours of bed rest per day recommended for a patient with BMI <13 with anorexia nervosa

Cause of Takotsubo cardiomyopathy seen in anorexia nervosa

Coronary vasospasm

Features of Takotsubo cardiomyopathy

Rarely seen in anorexia nervosa Similar presentation to MI Cardiac enzymes usually raised Usually mild and self limiting but can cause cardiogenic shock

Substance ingested in the amylophagia form of pica

Starch

First line treatment options for anorexia nervosa

CBT Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) Specialist supportive clinical management (SSCM)

First line treatment for anorexia nervosa in patients <18

Anorexia nervosa focused family therapy

Recommendations on medication treatment as the only treatment for anorexia nervosa

Should not be offered

First line treatment for bulimia nervosa

Evidence-based self-help programme

Second line treatment for bulimia nervosa

CBT

First line treatment for bulimia nervosa in paitents <18

Bulimia nervosa focused family therapy

First line treatment for binge eating disorder

Guided self-help programme

Second line treatment for binge eating disorder

Group CBT

Advice for oral hygiene after vomiting

Avoid brushing teeth Rinse with a non-acid mouthwash

Effect of laxatives and diuretics on calorie consumption

Little to none

Eating disorders Flashcards

(78 cards)