Eating disorders

Question 1

What is the core psychopathology of an ED?

Answer 1

Not psychotic - overvalued idea.

Fear of fatness
Pursuit of thinness
Body dissatisfaction
Body image distortion

Question 2

What is ‘water loading’?

Answer 2

Drinking excessive amounts of water. A method of manipulating weight used by AN patients: falsely increase BMI, suppresses appetite.

Question 3

What is the general psychopathology of EDs?

Answer 3

Depression, anxiety, social phobia, suicidal ideation, OCD symptoms (co-morbid Dx - all diagnsoed with these).

Question 4

What are lanugo hairs?

Answer 4

Downy hairs seen in anorexia patients, as a result of poor temperature control.

Question 5

What are the questions in the SCOFF questionnaire?

Answer 5

S: Do you make yourself SICK because you’re uncomfortably full?
C: Do you worry you have lost CONTROL over how much you eat?
O: Have you recently lost more than ONE stone in a 3 month period?
F: Do you believe yourself to be FAT when others say you are too thin?
F: Would you say FOOD dominates your life?

Question 6

What are the 5 steps involved in a physical risk assessment for EDs?

Answer 6

1. Clinical Hx
2. Physical Ex
3. BMI (weight/height^2)
4. ECG
5. Bloods

Question 7

What are the CVS effects of starvation?

Answer 7

Bradycardia
Hypotension
Sudden death

Question 8

What are the CVS effects of bingeing/purging?

Answer 8

Arrhythmias
Cardiac failure
Sudden death

Question 9

Why is an ECG so important for AN patients, and what signs should you be looking for?

Answer 9

Up to 86% of AN patients have cardiac abnormalities, and most AN deaths are due to cardiac arrest.

T wave changes (hypokalaemia)
Bradycardia (40bpm or less is very concerning - this resolves with strict bed rest and nutrition)
QTc prolongation (>450ms)

Question 10

What are the ways to check for proximal myopathy during physical examination? (ED)

Answer 10

(wastage of the proximal muscles)

1. Stand up from squatting
2. Perform a sit up

If have to use arms for either, PM is present.

Question 11

What are the most dangerous CVS effects involved in AN?

Answer 11

Bradycardia
Hypotension
Arrhythmias
Cardiac failure

Question 12

What are the 5 areas of management useful for AN?

Answer 12

Education of family and sufferers (firm but supportive)
Alter perceptions of body (supportive psychotherapy, CBT, support groups, family therapy)
Encourage refeeding (balanced diet, ~3000kcal/day)
Monitor physical condition
Treat associated psych conditions

(Consider hospitalisation if severe / no social support)

Question 13

What is the F:M ratio for EDs?

Answer 13

10:1

Question 14

What are the compensatory behaviours classical of BN?

Answer 14

Exercise
Prolonged fasting
Self induced vomiting
Laxative/diuretic/enema use
Stimulant drug misuse

Question 15

In which eating disorder is depressive symptoms more prominent?

Answer 15

Bulimia nervosa

Question 16

What are the complications of self-induced vomiting, and purging behaviour generally? (BN)

Answer 16

Dental erosion
Enlarged parotid glands (chipmunk face)
Oesophagitis and oesophageal tears
Aspiration pneumonia
Russel sign (on hands)

Purging behaviour in general can cause: dehydration, malnutrition
oedema
electrolyte disturbances, cardiac arrhythmias, renal failure
muscle paralysis, tetany, seizures
UTIs

Question 17

What is Russell’s sign? (ED)

Answer 17

Callosities, scarring/abrasions on the dorsal surface of the index and middle finger as a result of self induced vomiting

Question 18

What is the biopsychosocial model for BN Rx?

Answer 18

Biological:
Treat Medical Complications
Treat Psychiatric Disorders
SSRIs – help with depressive symptoms

Psychological:
CBT, Supportive Psychotherapy, Interpersonal therapy, Alter Body Perception, Patient Education

Social:
Support Groups, Family education

Question 19

Average age of onset for Anorexia Nervosa?

Answer 19

15-16 y/o

Question 20

What drugs can be used to treat BN?

Answer 20

SSRIs - fluoxetine, sertraline

Demonstrated to have a specific antibulimic effect at higher doses. ?due to depressive px common in BN

Question 21

What are the 6 areas of Mx most useful for Bulimia nervosa?

Answer 21

Education: patient and family
Alter disturbed perceptions (support pt)
Therapy: Supportive psychotherapy, Support groups, CBT, Interpersonal therapy, Family therapy
SSRIs (fluoxetine, sertraline) - can have antibulimic effect (possibly due to symptoms concurrent with bulimia)
Monitor patients physical condition, treat complications
Treat associated psychiatric disorders

(Consider hospitalisation if severe / no social support)