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Flashcards in Eating disorders Deck (19):
1

three eating disorders

ANOREXIA NERVOSA

BULIMIA NERVOSA

BINGE-EATING DISORDER

OTHER SPECIFIED EATING DISORDER

2

Anorexia

Criteria

EPI

Mortality rate

causes of deaht

Restriction of intake leading to significantly low body weight

Intense fear of gaining weight or becoming fat

Disturbances in self perception based on body image ("if im not thin i'm a bad person)




No longer require impaired menstruation

Anorexia = 0.3-1% of women, 0.1% of men
F > M


Mortality rate 5-18%, or 5.6% per decade of illness (death due to suicide vs. cardiac failure)

3

changes in hormones in weight loss

what is the clinical manifestation in women

Increased CRH
Decreased LH, FSH
Impaired regulation of GH

4

Other characteristics of anorexia

***

5

Types of anorexia:
Restricting type

the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior

weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise


6

Types of anorexia:Binge-Eating/Purging Subtype

uring the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior

may have had a heavier body weight before AN onset

More likely to be associated with substance abuse

higher suicide rate

7

Other physical/medical findings of anorexia:

related to purging


Purging: Metabolic – ↓ K, ↓ Mg, hypochloremic alkalosis

Dental with purging: Erosion of dental enamel & corresponding decay
Elevated salivary amylase
Seizures



8

Other physical/medical findings of anorexia:

Related to weight loss:
Cachexia

Cardiac: Hypotension, loss of heart muscle, arythmias, prolonged QT, ST depression, bradycardia, Vtach

Delayed gastric emptying;

Amenorrhea -- low LH, FSH

Lanugo -- fine hair

Leukopenia

Osteoporosis (not reversible

9

Evaluation for anorexia

what labs and tests/

CBC: Leukopenia
BMP
Elevated salivary amylase
Elevated serum cholesterol
Vitamin D levels, Ca levels
EKG changes, hypotension, bradycardia

10

Treatment for anorexia

Hospitalization frequently necessary after pt weighs less than 20% of minimum body weight, often for 2-6 months at a time

Behavioral management + group therapy + individual therapy + family education and therapy + nutritional consultants + medications

Total caloric intake 500 calories above what is required;

Gradual transition to outpatient care; overnight stays at hotels; weekend passes to families

Medications:
SSRIs --
some TCA -- cardiac side effects
Some naltrexone -- block endorphins



11

common causes of death for anorexia patients

common comorbidity

heart conditions


depression, OCD

12

Bulimia Nervosa
- general characteristics
- primary symptom?
- definition of this

Epi

Cormorbidities

Binge-eating is the primary symptom (Eating more food than most persons in similar circumstances and in a similar period of time)

Purging, laxatives, excessive exercise

1%-1.5% of young women
F > M, ratio 10:1

Mood disorders, substance abuse, personality disorders

13

biological pathophys

psychological pathophys

Dysregulation of 5-HT and NE
Abnormal endorphin response? Patients feel a sense of well-being after vomiting.

Dysregulation of 5-HT and NE
Abnormal endorphin response? Patients feel a sense of well-being after vomiting.


14

who is more likely to seek treatment beteween AN and BN

which has a better prognosis?

BN

BN

15

BN Criteria

Recurrent episodes of binge eating (eating a shit ton in a discrete amount of time -- 2hours, feeling of lack of control)

Recurrent inappropriate compensatory behavior

binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.


Self-evaluation is unduly influenced by body shape and weight.

16

BN DDX

Anorexia

Klüver-Bucy syndrome

Kleine-Levin syndrome

Borderline PD

CNS tumor

17

Treatment for BN


what is the first line?


Hospitalization is less often required

Hospitalize if: co-occuring subs abuse, suicidality, or electrolyte abnormalities

Outpatient is more successful


Psychotherapy: CBT (first line)


Medications: high dose fluoextine

18

Binge Eating D/o

EPI

who?

more prevalent than anorexia; same as bulemia

Occurs in normal/overweight and obese individuals of industrilzed countries

19

Dx of Binge eating d/o

characteristics?
Duration?

Recurrent episodes of binge eating.

NO PURGING

Three or more of the following:
eating a lot of food quickly, eating until uncomfortably full, large amounts of food when not hungry, eating alone, feeling guilty after

Marked distress
1x/week x 3 months at least