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Flashcards in Eating Disorders Deck (25)
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1

What are the risk factors for developing an eating disorder ?

White females
16-22 years
High achieving perfectionists with low self esteem
Assoc with depression and substance misuse
10% of cases are male

2

Is there a genetic component to eating disorders ?

Monozygotic twin concordance 65% in AN

Unlikely to be a genetic link in BN

3

What is the psychological theory regarding the aetiology of anorexia nervosa?

Successful weight loss gives patient sense of autonomy and achievement during times when life feels uncontrollable.
Avoiding separation from family

4

What is the sociocultural theory of the aetiology of anorexia nervosa?

Social pressures to be thin
Promotion of dieting
High risk groups:
Models, athletes, dancers

5

What elements of family life might contribute to development of anorexia nervosa?

Parental overprotection
Family enmeshment: over involved, poor boundaries

6

What factors may contribute to development of bulimia nervosa ?

Perfectionism and low self esteem
Promotion of dieting, pressure to be thin
History of obesity
Previous AN
Disturbed family dynamics
Parental weight concern
High parental expectation
Fhx: obesity, depression, substance misuse

7

What is the clinical presentation of anorexia nervosa?

BMI

8

What are physical complications of anorexia nervosa?

Lethargy and cold intolerance
Anaemia/ leukopenia/ thrombocytopenia
If severe = pancytopenia
Bradycardia, hypotension, arrhythmia
Constipation, abdo pain, ulcers, oesophageal tears, gastric rupture, delayed gastric emptying, nutritional hepatitis
Amenorrhoea, infertility, loss of libido
Osteoporosis, proximal myopathy
Peripheral neuropathy
Lanugo hair

9

What might swollen submandibular a parotid glands indicate?

Anorexia or bulimia
Bingeing

10

What investigations would you undertake in suspected anorexia nervosa?

Height, weight, BMI
Squat test
Bloods: ESR, TFTs to rule out organic causes
FBC, U+Es, phosphate, albumin, LFT, creative kinase, glucose to evaluate nutritional state and risk
ECG: bradycardia, Arrhythmias, long QT
Possible DEXA

11

What organic causes might you want to rule out in apparent anorexia nervosa?

Hyperthyroidism
Malignancy
GI disease
Addison's
Chronic infection
Inflammatory conditions
AIDS

12

What is EDNOS

An eating disorder not otherwise specified

Atypical presentation

13

What is body dysmorphic disorder?

BDD
Distorted body image
Deliberate weight loss unusual

14

What is Russell's sign?

Calluses or cuts on knuckles from self induced vomiting

15

What is melanosis coli?

Pigmentation of colonic mucosa
Seen with laxative abuse

16

How are patients with anorexia managed?

Engagement: with early family involvement
Psycho-education: advice on nutrition and health
Treat comorbid psychiatric illness: depression, OCD, substance misuse
Nutritional management and weight restoration: negotiate realistic weekly weight gain target 0.5-1kg target weight and eating plan
Psychotherapy: motivational interviewing, family therapy, interpersonal therapy, CBT
Medical treatment: physical complications, rapid weight loss or BMI

17

When might you consider inpatient treatment for anorexia nervosa?

BMI

18

What clinical presentation is seen in bulimia nervosa?

Binge eating: irresistible cravings, loss of control, sense of desperate urgency + compulsion, triggered by distress
Purging: shame + guilt, vomiting, laxatives, episodes of fasting, excessive exercise
Body image distortion
BMI> 17.5

19

What complications are associated with purges in bulimia nervosa?

Arrhythmias: hypokalaemia
Convulsions: hyponatraemia

20

How are patients with bulimia nervosa managed?

Community based
Treat medical complications
SSRIS can reduce bingeing and purging by enhancing impulse control
Treat comorbid psych illness: depression, self harm, substance misuse
CBT

21

What are the hallmarks of nutritional decompensation?

BMI1kg/wk
Purpuric rash
Cold peripheries
Core body temperature

22

Why is establishing adequate food intake hazardous?

Refeeding syndrome: cause of mortality
Electrolyte imbalance:
Low PO4 Low K Low Mg
Due switch from fat to carbohydrate metabolism and secretion of insulin causing sudden intracellular electrolyte movement

23

What is the prognosis with anorexia nervosa?

After 10 years:
50% no eating disorder
40% ongoing problems
10% have died (1/3 due to suicide)

Features of poor prognosis:
V low weight, bulimic features, later onset, longer illness duration.

24

What is the prognosis with bulimia nervosa?

After 10 years:
70% recovered completely
29% ongoing problems
1% have dies

Poorer prognosis associated with: severe bingeing or purging, low body weight, comorbid depression

25

What is the lifetime risk of eating disorders?

Anorexia nervosa: 0.6%
Bulimia nervosa: 1%
Binge eating disorder/ 2.8%