1
Q
3 major types of ED in ICD10
A
- Anorexia
- Bulimia nervosa
- EDNOS- eating disorder not otherwise specified
2
Q
Binge eating disorder
A
-currently falls under EDNOS
3
Q
Diagnosis stability
A
- patients migrate from one to other very often
- 1/4-1/3 of those with bulimia have a past history of anorexia
4
Q
Amenorrhoea
A
- DSM-5 have eliminated the requirement for amenorrhoea
- most people with BMI of 17.5 are amenorrhoeic with body image disturbance. Those with periods still have the same clinical features and outcome
5
Q
Bulimia binges
A
- DSM5 criteria is for once weekly frequency of binge eating and inappropriate compensatory behaviour
- amount of food intake during a binge is 1000 to 2000 kcals
- patients with bulimia engage in treatment better as they feel they have lost control
6
Q
Epidemiology of anorexia
A
- onset mostly in adolescents
- excess in higher social class
- 0.5-1% prevalence in teenage girls
- 19/100000 females per year
7
Q
Epidemiology of bulimia
A
- onset mostly in young adults- later onset than anorexia
- even class distribution
- 1-2% prevalence I n16-35 age group
- 29/100,000 females a year
8
Q
Comorbidity
A
- 65% patients with anorexia have depression
- 34% have social phobia
- 26% have OCD
9
Q
Aetiology
A
- shared family liability
- personality traits
- substance missuse is increased in the families in bulimic patients
- obsessive and perfectionist traits are increased in families of anorexic probands
10
Q
Anorexia heritability
A
- MZ twins 55%
- DZ twins 5%
11
Q
Bulimia heritability
A
- MZ 35%
- DZ 30%
12
Q
Risk factors for ED
A
- female sex, adolescence and early adulthood
- western cultural adaptation
- family history of ED, depression, substance missuse, alcohol and obesity
- adverse parenting
- childhood sexual abuse
- critical comments about eating, shape or weight from family
- occupational and recreational pressure to be slim
- low self-esteem and perfectionism
- past history of obesity (BN)
- early menarche (BN)
13
Q
Binge eating disorder
A
- recurrent episodes of binge eating in the absence of extreme weight control behaviour
- associated with obesity- 5-10% of obese patients
- present in 40s ,more males than in other EDs (25%)
- high degree of spontaneous remission is seen
- stress associated overeating is common
- CBT and self help can help
14
Q
Physical symptoms of EDs
A
- increased sensitivity to cold
- GI symptoms
- dizziness and syncope
- amenorrhoea, low sexual appetite, infertility
- poor sleep with early morning wakening
15
Q
Physical signs of EDs
A
- emaciation: stunted growth and failure of breast development (if prepubertal onset)
- dry skin, lanugo hair, hypercarotenaemia
- Russel’s sign- calluses on knuckles due to vomit
- swelling of parotid and submandibular glands (BN)
- erosion of inner surface of front teeth (perimylolysis)
- cold hands and feet; hypothermia
- bradycardia (HR of40 is common)
- orthostatic hypotension, cardiac arrhythmias
- hypotension
- dependent oedema
- weak proximal muscles- difficulty rising from squatting position
16
Q
Endocrine abnormalities
A
- low concentrations of LH, FSH and oestradiol
- low T3, normal T4, normal TSH
- mild increase in cortisol
- raised GH
- severe hypoglycaemia
- low leptin
17
Q
Cardiovascular abnormalities
A
- ECG abnormalities
- conduction defects
- prolonged QT
- Ipecac (emetic substance) contains emetine an alkaloid that can cause myopathy and fatal cardiomyopathy which may be reversible in early stages
18
Q
GI abnormalities
A
- delayed gastric emptying
- decreased colonic motility (secondary to chronic laxative missuse)
- acute gastric dilatation (rare, secondary to refeeding or binge eating)
19
Q
Haematological abnormalities
A
- moderate normocytic normochromic anaemia
- mild leucopenia with relative lymphocytosis
- thrombocytopenia
20
Q
Other metabolic abnormalities
A
- hypercholesterolaemia
- raised serum carotene
- hypophosphataemia (exaggerated during refeeding)
- dehydration
- electrolyte disturbance
- metabolic alkalosis and hypokalaemia due to vomiting
- metabolic acidosis, hyponatraemia and hypokalaemia in laxative missuse
21
Q
Other abnormalities in ED
A
- osteopenia and osteoporosis
- enlarged cerebral ventricles with external cerebrospinal fluid spaces (pseudoatrophy)
22
Q
Effect of ED on pregnancy
A
- decreased fertility- can be regained
- may have more abortions
- higher rates of hyperemesis gravidarum, anaemia and impaired weight gain
- compromised intrauterine foetal growth
- premature delivery is more likely
- rates of caesarians are higher
- post-natal complications and post-partum depression are higher
- associated with low birth weigh, microcephaly and low APGAR scores
- in actively anorexic mother, the neonate may have hypoglycemia
23
Q
Managing bulimia
A
- most effective treatment is CBT (needs 20 sessions over 5 months)
- 33-50% make complete recovery
- antidepressant drugs have an antibulimic effect, improve mood and decrease binge eating, but effect is often not sustained
24
Q
Managing anorexia
A
- cognitive analytic or CBT, interpersonal psychotherapy, focal dynamic therapy or family interventions
- requires engagemen
- weight restoration
25
Chance of recovery in AN
- best chance of recovery if
1. illness is present for less than 6 months
2. no bingeing or vomiting
3. have parents who cooperate and are willing to participate in family therapy
