Eating Disorders

Question 1

True or False - EDs have the highest mortality rate out of all mental illness

Answer 1

True

Question 2

what is the gender split for eating disorders

Answer 2

F>M 10:1

Question 3

When is the peak age for eating disorder presentation

Answer 3

adolescence

Question 4

Aetiology for eating disorders

Answer 4

hypothalamic dysfunction
perfectionism
decreased self-esteem
early sexual development
history of abuse
personality disorder 
parental overprotection

Question 5

How do you assess a suspected eating disorder

Answer 5

Establish eating behaviour - method of weight loss, daily intake, relationship with body image, binge eating

Medical history - specifically: menstrual history, sexual dysfunction, starvation complications, digestive complications, known physical illness

Personal /social history - past abuse + context, bullying, bereavements, major change at home or school, and the effect of the behaviour on school, home life, relationships, socialising, hobbies and careers

Question 6

How do you Diagnose anorexia

Answer 6

<15% expected weight OR BMI <17.5

Weight loss is self-induced via avoidance of ‘fattening’ foods, as well as 1 or more of: purging, excessive exercise, use of appetite supplements, diuretics

Body image distortion with an intrusive, overvalued idea of becoming/being fat, resulting in the patient imposing a low weight barrier on themselves

Widespread endocrine disorder involving the hypothalamic-pituitary-gonadal axis resulting in: amenorrhoea in women and sexual impotence in men

if pre pubertal: delayed development

Question 7

How do you diagnose Bulimia

Answer 7

Persistent occupation with eating and irresistible craving for food resulting in binge eating sessions

Patient attempts to counteract with one or more of
self induced vomiting
appetite suppressants
voluntary starvation
in diabetics - insulin neglect 

Morbid dread of obesity

Question 8

Differentials for an eating disorder

Answer 8

Hyperthyroidism
Depression 
OCD
Body dysmorphic disorder 
Psychosis

Question 9

Prognosis for anorexia

Answer 9

slow
1/3 in 3 years
2/3 in 3-6 years
>15 years of no recovery = far less likely to recover

Question 10

What is the 10-year mortality for anorexia

Answer 10

10%

Question 11

Poor Prognosis indicators for anorexia

Answer 11

very low weight
bulaemic features
family difficulty
personality diffiulty 
longer illness duration

Question 12

Prognosis for bulimia

Answer 12

70% recover in 10 years

1% mortality

Question 13

Poor prognostic indicators for bulimia

Answer 13

low weight and depression

Question 14

What are some common comorbidities for eating disorders

Answer 14

Anxiety
Depression
Self-harm

Question 15

What are some hair-related consequences of anorexia

Answer 15

brittle-thin hair 
lanugo hair (fine baby hair) on face/body

Question 16

What are some psychological consequences of anorexia

Answer 16

Poor concentration
Inflexible thinking
interest centers on food
irritated mood

Question 17

What are some cardiovascular consequences of anorexia

Answer 17

decreased BP/HR
increased risk of arrythmia
increased risk of Heart failure

Question 18

What are some bone-related consequences of anorexia

Answer 18

osteoporosis

Question 19

what are some endocrine/GU related consequences of anorexia

Answer 19

decreased libido
decreased testosterone
amenorrhoea

Question 20

what are some fat-related consequences of anorexia

Answer 20

cold extremities
broken skin
swollen feet/ankles

Question 21

What are some miscellaneous consequences of anorexia

Answer 21

hypothermia
increased infection risk
hematological disturbances
metabolic disturbance

Question 22

what are some CNS consequences of bulimia

Answer 22

Poor concentration
irritability
seizure (electrolyte imbalance)

Question 23

What are some oropharyngeal consequences of bulimia

Answer 23

Tooth decay
hoarse voice
mouth/throat bleeding
swollen parotid

Question 24

cardiovascular consequences of bulimia

Answer 24

hypokalaemia leading to arrythmia

Question 25

abdominal consequences of bulimia

Answer 25

``` swollen stomach stomach pain constipation delayed gastric emptying oesophageal tears oesophagitis rectal prolapse renal failure UTI ```

Question 26

hand consequences of bulimia

Answer 26

Russels's sign - callosing of the knuckles due to repeated grazing when purging

Question 27

feet and ankles consequences bulimia

Answer 27

swollen feet/ankles | cold extremities

Question 28

miscellaneous consequences of bulimia

Answer 28

Dehydration Electrolyte imbalance Muscle paralysis

Question 29

BioPsychoSocial Management of eating disorders

Answer 29

``` BIO Weight restoration key Dietician necessary to prevent refeeding syndrome regular weight monitoring Regular bloods and ECG DEXA scan ``` Psycho Specialist psychotherapy services Family therapy if <18 years old <13 BMI = psychological therapy unlikely to work Social carer support inclusion In social plans

Question 30

what blood monitoring is recommended in underweight patients

Answer 30

BMI >16 FBC, U+E glucose LFT | BMI <15 same as above + phosphate, magnesium, CK, zinc, B12, folate

Question 31

What are you looking for on an ECG for underweight patients

Answer 31

QTc prolonging arrythmia rate <50 heart block

Question 32

what do derranged bloods indicate for eating disorder patients

Answer 32

general medical ward admission

Question 33

what is refeeding syndrome

Answer 33

chronic depletion of serum insulin/electrolytes(especially phosphate)/glucose/intracellular phosphate then food is induced causing an insulin spike as well as increased serum glucose and electrolytes this insulin spike drives even more phosphate into the cells leading to extremely low serum phosphate (along with many other vitamins and electrolytes) leading to a variety of life threatening pathologies, including multi-organ failure