Eating disorders Flashcards
(51 cards)
1
Q
ICD-10 diagnostic criteria for anorexia nervosa
A
- Low weight: BMI<17.5 (weight loss or lack of weight gain in children, <5thcentile)
- Weight loss is self-induced by avoidance of “fattening foods”
- Self-perception of being “too fat” leading to low weight threshold, even when thin
- Irrational fear of fatness
- Amennorhoea
2
Q
Definition of atypical anorexia nervosa
A
Fulfills some but not all features of AN (e.g. may have weight loss behaviours in absence of endocrine changes/dread of being fat)
3
Q
ICD-10 criteria for bulimia nervosa
A
- Recurrent episodes of overeating: 1000-4000 kcal, loss of control
- Compensatory behaviours e.g. purging, starvation, exercise, drugs
- Preoccupation with eating
- Perception of being too fat/dread of fatness
4
Q
Time criterion for bulimia nervosa
A
>=2 episodes of overeating per week, for 3 months
5
Q
Criteria for binge-eating disorder (DSM-V)
A
- Recurrent episodes of binge-eating: characterised by lack of control
- Distress: regarding binge-eating (depression frequently co-morbid)
- No compensatory behaviour: BMI >25
6
Q
Time criteria for binge-eating disorder
A
>=1 per week for 3 months
7
Q
Features of binge eating episodes in binge-eating disorder
A
>=3 of:
- Eating until uncomfortably full
- Eating when not physically hungry
- Eating alone due to shame/embarrasment
- Eating more rapidly than normal
- Feelings of disgust, guilt, depression afterwards
8
Q
Biological predisposing factors for eating disorder
A
- Female
- Genetics (56% AN, up to 80% BN)
- Early menarche (BN)
- Obesity (BN)
- +ve FHx (?biological)
9
Q
Psychological predisposing factors for ED
A
- Perfectionism (AN)
- Low self-esteem
- Sexual abuse (less common in ED, little evidence)
- Anxiety
- Impulsivity (BN)
- FHx of obesity (BN)
- PPH of eating disorder (AN –> BN)
10
Q
Social predisposing factors for ED
A
- Adverse parenting (arguments, expectations, contact)
- Western society
- Specific groups (e.g. models)
11
Q
Biological precipitating factors for ED
A
- Dieting/lent
- Illness/infection
- Puberty
12
Q
Psychological precipitating factors for ED
A
- Emotional stress
- Bullying/critical comments
13
Q
Social precipitating factors for ED
A
- Family dieting
- Peer group/lifecycle transition
14
Q
Biological perpetuating factors for ED
A
Neuroendocrine dysregulation
e.g. 5-HT disturbance makes psychopathology worse
15
Q
Psychological perpetuating factors for ED
A
- Over-valued intrusive ideas re: weight
- Abnormal weight perception
- Co-morbid mood disorder (esp depression)
16
Q
Social perpetuating factors for ED
A
+ve reinforcement from friends/family
17
Q
Average age of onset for EDs
A
AN: 15-16 years old
BN:20
BED: 23
18
Q
F:M prevalence ratio for eating disorders
A
6:1 in community, 10:1 in clinical samples
19
Q
Prevalence of ED
A
AN: 1%
BN: 1%
BED: 1-2%
20
Q
Physical symptoms in anorexia nervosa
A
- Sensitivity to cold
- Amennorhoea/delayed onset of puberty
- Reduced sex drive
- Dizziness, fatigue
- Poor concentration
- Poor sleep
- GI symptoms: constipation, bloating
21
Q
Physical signs of anorexia nervosa
A
- Cold extremities
- Sarcopenia
- Bradycardia, postural hypotension, arrhythmia
- Dry skin, sometimes orange (hypercarotinaemia)
- Brittle hair/nails
- Lanugo on back, forearms, cheeks
- Peripheral oedema
- Proximal myopathy
- Osteoporosis/osteopaenia
- Poorly developed 2ry sexual characteristics
22
Q
Endocrine abnormalities in anorexia nervosa
A
Low: LH, FSH, T3, estradiol
High: Cortisol, GH
23
Q
Metabolic abnormalities in anorexia nervosa
A
Hypoglycaemia
Hypercholesterolaemia
24
Q
Electrolyte abnormalities in anorexia nervosa
A
Hyponatraemia, hypokalaemia, metabolic alkalosis
MAY PRESENT AS ASYMPTOMATIC HYPOGLYCAEMIA DUE TO RESERVE
25
ECG abnormality in anorexia nervosa
Prolonged Q-T interval, arrhythmias, bradycardia
26
Physical signs in bulmia nervosa
1. Pitted teeth
2. Calluses on knuckles (Russell's sign)
3. Enlarged salivary glands
4. Hoarse voice
27
Blood abnormalities in bulimia nervosa
Renal dysfunction, electrolyte abnormalities from diuretics
Metabolic alkalosis from vomiting
Colonic hypomotolity from laxatives
28
Psychiatric differential for anorexia
1. Depressive disorder
2. OCD
3. Body-dysmorphic disorder
4. Substance misuse
29
Physical differential for anorexia
1. IBD, IBS
2. Diabetes insipidus/mellitus
3. Hypopituitarism
4. Pituitary brain tumour (headache + non-induced vomiting)
5. Cancer
6. Malabsorption syndromes
7. Amphetamine use
30
Differential for bulimia
1. Binge-eating disorder
2. Atypical depression (psychogenic overeating)
3. Anorexia nervosa
4. Medical causes of vomiting
31
Short-term management of anorexia nervosa
1. Physical + psychosocial assessment --\> assess immediate risk to consider admission to hospital
2. If moderate anorexia --\> secondary care referral
3. Slowly begin refeeding --\> monitor electrolytes prior to refeeding and regularly to avoid refeeding syndrome
1. Use Pabrinex, multivitamin supplements
4. Agree on goals/need for treatment to work towards
1. aim for 0.5-1kg weight gain per week
5. Psychoeducation + self-help resources
32
Long-term management of eating disorders
CBT
Family therapy (esp in adolescents)
Regular physical monitoring (electrolytes, height, weight, dental review)
Use of nutritional supplements (e.g. multivitamins)
Monitor drugs (esp for prolonged Q-T)
Weight gain 0.5-1kg per week) --\> improves psychopathology
Consider SSRI (for BN/BED, or comorbidity)
33
Risk factors for refeeding syndrome
Low initial electrolytes
BMI \<13
Significant comorbidity (intercurrent infection, alcoholism, uncontrolled diabetes, cardiac failure)
34
Criteria for considering admission to hospital for AN
1. Risk of suicide/severe self-harm
2. Home environment impedes recovery
3. Rapid weight loss, BMI \<15
4. Bradycardia, hypoglycaemia, severe intercurrent infeciton, pronounced oedema, electrolyte abnormalities
35
Components of hospital management of severe eating disorder
1. Medical: life-saving treatment, refeeding + avoid refeeding syndrome, manage complications
2. Psychological: intensive individual, family, and group therapy
36
Treatment of bulimia nervosa
1. Self-help programmes
2. CBT: Break vicious cycle between bingeing, purging + preoccupation with weight + shape
3. interpersonal therapy (emphasises the role of relationships, takes longer)
4. Trial of fluoxetine (high doses needed, 60mg)
37
Success rate of CBT in bulimia
60-70% disease-free at 5 years
38
Prognosis for BN
30% residual symptoms at 10y
Evidence unclear
39
Poor prognostic factors for bulimia
Low self-esteem
premorbid hildhood obesity
Co-morbid personality disturbance
long duration prior to prersentation
40
Poor prognostic factors in anorexia
Long duration prior to presentation
Adult onset (20-29)
Severe weight loss (ost prognostic)
Vomiting/purging subtype
41
10-year mortality of anorexia nervosa
10-20%
60% due to starvation (mainly cardiac failure due to dilation/thin walls, reversible with weight gain)
27% due to suicide
42
Anorexia red flags that raise risk
1. BMI \<13
2. ECG: Long Q-T or flattened T-waves
3. Skin: purpura
4. Vascular: BP \<80/50, pulse \<40, Sats \<92%
5. Temperature \<34.5
6. Wt loss \>1kg/week
7. Electrolyte abnormalities
8. Proximal myopathy (not using arms for leverage unable to get up
43
Signs of refeeding syndrome
1. Falling PO4, K+, Mg2+
2. Falling BP
3. Rhabdomyolysis
4. Cardiac/respiratory failure
5. Arrhythmias
6. Seizures
44
Prognosis for anorexia nervosa
1/3 complete recovery
1/3 partial recovery
1/3 chronic illness
0.5% mortality per year
45
Psychosocial assessment in suspected eating disorder
1. Motivation to change eating habits
2. Causes of eating habits
3. Views on consequences of eating habits
4. Suicide risk
5. Psychiatric comorbidities: Depression, OCD, anxiety
46
Physical assessment in suspected eating disorder
1. Height + weight
2. Core body temperature
3. Cardiovascular incl. postural drop
4. Muscle power
5. Skin signs
47
Questions to ask about weight control behaviours
1. Typical day's dietary intake
2. Exercise: type and frequency
3. Induced vomiting
4. Laxatives, diuretics (incl. coffee), amphetamines
5. Binges: loss of control + feelings afterwards
48
Questions to ask about attitude to weight + shape
1. Current weight + frequency of weighing behaviour
2. How do you feel about your body shape/weight?
3. How would you feel if you were a size bigger?
4. Do you think you're fat?
5. Have other people said you're thin? Do you believe them
49
Screening questions for eating disorder
**SCOFF (\>2=further assessment)**
* Do make yourself **SICK?**
* Do you feel like you've lost **CONTROL** of your eating?
* Have you lost more than **ONE** stone (6-7kg) in the last 3 months?
* Do you think you're **FAT** even when others tell you you're thin?
* Do you often think about **FOOD**?
50
Anorexia nervosa subtype with worse mortality
Binge-purging
51
Co-morbidity in AN
40-60% depression
Also anxiety, OCD, PD
