Eating Disorders Flashcards

Question

What can severe cases of eating disorders require?

Answer 1

Compulsory admission for observed refeeding and monitoring for refeeding syndrome

Answer 2

- Coping mechanism for difficult emotions, distraction and numbing - Help individual feel protected, confident and less anxious - Sense of being special - May present a barrier to engaging with treatment

Answer 3

* 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 * History of bulling and trauma * Stressful life events * Difficult interpersonal relationships * Competitive sports e.g. gymnastics

Answer 4

Effects of starvation – energy, euphoria Reduced sex drive – can be positive in terms of avoidance Feelings of control, protection and safety Sense of identity Numbing of emotions Sense of achievement Reinforcement from others, positive comments Social media

Answer 5

- Brain structure and self-regulatory system changes - Anxiety and intense negative emotions increase - Negative and positive emotions are numbed - Coping ability reduces - Thinking becomes more rigid- habits and routines more rigid

Answer 6

- Psychiatric assessment - Medical assessment - Risk assessment

Answer 7

**BMI** **RED** < 13 or rapid weight loss > 1kg in undernourished patient **Amber**- 13-14.9 or rapid weight loss > 0.5kg in undernourished patient **Green**- >15 or recent weight loss < 0.5kg/week **Heart rate** **RED**- < 40 **Amber** 40-50 **Green** > 50 **BP** **RED**- Standing < 90, postural drop over 20mmHg or increase in HR over 30bpm **Amber**- Standing BP > 90, associated with occasional syncope, postural drop over 15mmHg or increase in HR up to 30bpm **Green**- Normal standing BP, no changes **Temperature** **RED**- < 35.5 **Amber**- < 36.0 **Green**- > 36 **Hydration** **RED**- Fluid refusal, severe dehydration (10%) **Amber**- severe fluid restriction, moderate dehydration (5%) **Green**- Minimal restriction, mild dehydration < 5% **Muscle power** **RED**- unable to sit up from lying flat, or get up from squat (score 0 or 1) **Amber**- Unable to sit up or stand from squat without noticeable difficulty (score 2) **Green**- Able to sit up from lying flat and stand from squat with no difficulty

Answer 8

FBC U&Es LFT Bone profile TFT **Magnesium** **Glucose** ECG DEXA scan

Answer 9

**RED**- QTc >450ms females and >430 males + another significant ECG finding **Amber**- QTc > 450ms females and > 430 male, taking medication known to prolong QTc **Green**- Normal

Answer 10

Adjusted free T4 to reduce metabolic requirements (sick euthyroid syndrome) - Reduced resting metabolic rate - Reduced body temperature - Bradycardia

Answer 11

In patients with extended severe nutritional deficits that start eating again

Answer 12

In prolonged starvation intracellular potassium, phosphate and magnesium are depleted Electrolytes move from cells to blood to maintain normal serum levels in absence of dietary intake Cell metabolism reduces to conserve energy, resulting in a loss of intracellular electrolytes e.g. slowed NaKATPase During refeeding magnesium, potassium and phosphate are shifted out of the blood and sodium shifted into the blood Carbohydrate intake causes increase in insulin, driving glucose, potassium and phosphate into cells NaKATPase actively pumps potassium into cells and sodium out of cells Insulin causes extra sodium reabsorption in the kidneys

Answer 13

Hypomagnesaemia Hypokalaemia Hypophosphatemia Fluid overload (water following extra sodium into extracellular space)

Answer 14

Risk of arrhythmia and heart failure

Answer 15

Slow reintroduction of food with limited calories Close monitoring of magnesium, phosphate, potassium and glucose Fluid balance monitoring ECG monitoring Supplementation with electrolytes, particularly B vitamins and thiamine

Answer 16

- Psychoeducation - Weight monitoring, mental and physical health and risk factors - Involve family or carers - Aim to help people reach healthy body weight or BMI - Dietary advice, meal planning

Answer 17

**Adults** - Individual CBT-ED - Individual Maudsley anorexia nervosa treatment - Individual specialist supportive clinical management - Individual focal psychodenamyic therapy (second line) **Children and young people** - Anorexia focused family therapy (first line) - Individual CBT-ED (second line) - Individual adolescent focused psychotherapy for anorexia nervosa (second line)

Answer 18

- Guided self-help in milder cases - Up to 20 session of individual CBT-ED **Children and young people** - Bulimia-nervosa focused family therapy - Individual CBT-ED (second line)

Answer 19

- Treatment not about losing weight, but stabilise eating and stop bingeing - Offered guided self-help programme If no effect after 4 weeks, group CBT-ED Last line- individual therapy

Answer 20

Use treatment for eating disorder it most closely resembles

Answer 21

Managing emotions Controlling relationships Self-esteem Communication

Answer 22

- Patients want to change but not progressing - Patient in immediate danger - No adequate treatment locally

Eating Disorders Flashcards

(46 cards)