Eating Disorders Flashcards

(71 cards)

1
Q

What are the two sub-types of anorexia nervosa?

A

Restrictive

Binge eating/purging type

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2
Q

According to the ICD10 what are the diagnostic criteria of anorexia nervosa?

A

Refusal to maintain or achieve healthy body weight

BMI <17.5

Intense fear of gaining weight

Undue influence of weight/shape on self-evaluation

Amenorrhoea

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3
Q

What different strategies are used by patients with anorexia nervosa in order to lose/avoid gaining weight?

A

Ignore hunger

Eat very little

Develop rules about what they can eat

Compensate for what’s eaten

Diabetics may omit or reduce insulin

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4
Q

What rules may a patient with anorexia nervosa set for themselves?

A

Calorie limits

Foods/food groups to be avoided

Have to eat less than others, or not eat if others aren’t

Have to eat at exact times or not at all

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5
Q

How might a patient with anorexia nervosa compensate for what they eat?

A

Use purging behaviours

Use slimming aids and fat blockers

Take amphetamine like drugs

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6
Q

What are some examples of purging behaviours used in anorexia nervosa?

A

Self-induced vomiting

Taking laxatives

Taking diuretics

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7
Q

When may a person with anorexia nervosa feel the need to induce vomiting?

A

After binges

After small amounts of food

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8
Q

What fuels anorexia nervosa?

A

Distorted body image

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9
Q

What is meant by a distorted body image in the context of anorexia nervosa?

A

Know that they are thin but feel fat

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10
Q

What is meant by ‘feeling fat’ in the context of anorexia nervosa?

A

Many emotions and psychological states

Often due to comparing to others and body checking

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11
Q

What can anorexia nervosa lead to socially?

A

Avoidance of others to avoid comparing

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12
Q

What are the two sub-types of bulimia nervosa?

A

Purging

Non-purging

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13
Q

Define a ‘binge’

A

A subjective loss of control where large amounts of typically calorie laden or ‘forbidden’ foods are eaten

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14
Q

What typically follows binge eating in a patient with bulimia nervosa?

A

Guilt

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15
Q

How is binge eating conducted by patients with bulimia nervosa?

A

In secret with the evidence hidden

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16
Q

What is the diagnostic criteria for bulimia nervosa as described by the ICD 10?

A

Recurrent episodes of overeating

Persistent preoccupation with eating

Strong desire to eat

Patient attempts to counteract fattening affects of binge eating

Self-perception of being too fat

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17
Q

What types of compensatory measures are used by people with bulimia nervosa?

A

Purging

Non-purging

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18
Q

What purging behaviours are used by people with bulimia nervosa to compensate for binge eating?

A

Self-induced vomiting

Laxative abuse

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19
Q

What non-purging behaviours are used by patients with bulimia nervosa to compensate for binge eating?

A

Exercise

Fasting

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20
Q

Do all patients referred to eating disorder clinics have bulimia nervosa or anorexia nervosa?

A

No, 1/3 have more atypical eating disorders

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21
Q

What are some examples of atypical eating disorders?

A

Atypical BN or AN

Binge eating disorders

Other disorders that defy classification

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22
Q

What factors can make people more prone to eating disorders?

A

Genetics

Biological vulnerability

Biological stress

Psychological vulnerability

Psychological stress

Social factors

Cultural factors

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23
Q

Differences in what can lead to differing psychological vulnerability to eating disorders?

A

Certain thinking styles

Interpersonal styles

Emotional processing

Personality traits

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24
Q

What thinking styles can lead to increased psychological vulnerability to eating disorders?

A

Cognitive rigidity

All or nothing thinking

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25
What interpersonal styles can lead to increased psychological vulnerability to eating disorders?
Struggling to recognise cues and emotional states of others Control issues Managing/avoiding emotions
26
How can differences in emotional processing lead to increased psychological vulnerability to eating disorders?
Some will have difficulty recognising their own emotional state and expressing emotions
27
What personality traits can lead to increased psychological vulnerability to eating disorders?
Perfectionistic Obsessional
28
What social factors can lead to increased psychological vulnerability to eating disorders?
How relationships are managed Separation/individualisation
29
Where is the prevalence of eating disorders currently increasing?
Asia and Africa
30
What does the increasing prevalence of eating disorders in developing countries suggest?
A link to media images and globalisation
31
What biological effects can starvation have on the body?
Increased preoccupation with food Agitation and restlessness Tired, distress, and lacking in motivation Low mood and irritability Social withdrawal Focus on body Worrying about weight gain Binging
32
What effects can eating disorders have on the endocrine system?
Body adjusts its free T4 levels to reduce metabolic requirement Amenorrhoea
33
What term is given to the adjustment of free T4 levels as a result of eating disorders?
Sick euthyroid syndrome
34
What are the effects of sick euthyroid syndrome?
Reduced metabolic rate Reduced body temperature Bradycardia
35
What effects can eating disorders have on the cardiovascular system?
Myocardial thinning Bradycardia Hypotension Arrhythmias Cardiomyopathy Mitral prolapse Heart failure
36
What effects can eating disorders have on the skeletal system?
Osteopenia/osteoporosis Fractures
37
Eating disorders can lead to deficiencies in what?
Electrolytes and nutrients
38
What effects can eating disorders have on the blood?
Bone marrow suppression Abnormal WCC, Hb and platelets
39
What effects can eating disorders have on the GI system?
Delayed gut motility/delayed gastric emptying Constipation Mallory-Weiss tears Hepatitis Pancreatitis
40
Do people with anorexia typically appear unwell immediately?
No, can look well until their body decompensates
41
What is the most dangerous time for patients with anorexia?
Rapid refeeding
42
What effects does starvation have on blood glucose?
Decreased blood glucose
43
What effect does decreased blood glucose have on insulin levels?
Decreased insulin
44
On refeeding what happens to serum glucose and insulin levels?
Increase
45
What does increased insulin levels do to tissues?
Causes regeneration
46
What is required for regeneration of tissues?
Phosphate for cell division
47
What happens to serum phosphate transport during rapid refeeding?
Increased co-transport into cells
48
What effect does rapid refeeding have on serum phosphate?
Abrupt decrease
49
Why is there a rapid increase in co-transport of serum phosphate into cells upon refeeding?
Starvation causes decreased intracellular phosphate levels due to decreased oral intake When refeeding occurs, serum phosphate levels rise and phosphate is rapidly taken up from the serum
50
Why do serum phosphate levels not fall during starvation?
They are maintained by homeostatic levels
51
Which patients are most at risk of refeeding syndrome?
Very low weight, malnourished patients
52
What kind of rapid refeeding carries the biggest risk?
Refeeding with food with high carbohydrate content
53
What effect does rapid tissue regeneration occurring as a result of refeeding have on the body?
Deficiency in trace elements
54
Deficiencies in which trace elements can occur as a result of rapid tissue regeneration?
Phosphate Potassium Magnesium (These are the most dangerous and potentially fatal)
55
What can low serum phosphate result on?
Heart failure/multi-organ failure
56
What guidelines can be used to prevent refeeding syndrome?
MARSIPAN guidelines
57
What does MARSIPAN stand for?
MAnagement of Really SIck Patients with Anorexia Nervosa
58
What suggestions do the MARSIPAN guidelines make?
Refeeding requires specialist management Close blood monitoring is required with daily blood tests Oral supplements and maybe IV
59
What can make treatment of anorexia difficult?
Patients may not want to get better
60
What treatment methods does NICE recommend for anorexia nervosa?
CBT MANTS SSCM
61
What are the aims of therapy for anorexia?
Shift motivational position Restore healthy weight Help patients cope with life, and express themselves without resorting to dietary restrictions Get life back on track
62
How does NICE recommend bulimia should be treated?
Guided self-help for milder cases CBT Regular eating Binge analysis Mood management Improving self-esteem and resolving interpersonal issues
63
When may a patient with bulimia nervosa be admitted to a specialist unit?
Patient wants to change but not progressing with out patient treatment Patient is in immediate danger
64
What percentage of anorexia nervosa sufferers recover completely?
30-75%
65
When is complete recovery most likely in sufferers of anorexia nervosa?
Within the first 3 years
66
When does outcome of anorexia nervosa treatment become poor?
After 10 years
67
What is the average yearly mortality rate of anorexia nervosa patients?
0.5%
68
What percentage of deaths in anorexia nervosa patients are due to suicide?
50%
69
What percentage of bulimia nervosa sufferers recover completely?
50-70%
70
What kind of course does bulimia nervosa recovery typically follow?
Relpasing and remitting
71
What are some predictors of good outcomes of eating disorder treatment?
Motivation to change Short duration of illness Low level of severity Onset during adolescence Good family function Lack of co-morbid conditions