Eating Disorders, Family Issues + Grief

Question 1

Female athlete triad

Answer 1

amenorrhea, ED, OP

Question 2

Anorexia sx

Answer 2

Restriction of energy intake relative to requirements
Intense fear of gaining weight
Body dysmorphia - preoccupation with >1 perceived defect in physical appearance that is not noticeable to others

Question 3

Types of AN

Answer 3

Restricting
Binge/ purge

Question 4

Bulimia sx

Answer 4

Recurrent binge eating and inappropriate compensatory behaviour such as vomiting, laxatives, diuretics, fasting or exercise
Both on average once a week

Question 5

RF for ED

Answer 5

Hx of dieting in childhood
Preoccupation with body + weight
Sports where leanness is good
Family hx of ED
Psych illness

Question 6

Screening for ED

Answer 6

SCOFF

Question 7

Complications of ED

Answer 7

CV = palpitations, CP, SOB, arrhythmia, edemia, MVP
Oral/ dental = lacerations, erosions, cavities
GI = epigastric pain, GERD, haematemesis, hemorrhoids, constipation
Endocrine = amenorrhea, reduced libido, reduced BMD, infertility
Derm = lanugo hair, hair loss, poor healing, brittle nails
General = weak, dizzy, fatigued, syncope, hot flashes

Question 8

Ix + results for ED

Answer 8

CBC (anemia, leucopenia, thrombocytopenia)
Extended lytes (decreased)
FBG (low glucose)
LFTs (dysfunction)
TSH (low TSH + T4)
B-HCG
ECG (arrhythmia, prolonged QT)
BMD

Question 9

Refeeding syndrome RF

Answer 9

little to no intake for >10 days, abnormal lytes, pt w/ profound wt loss

Question 10

Prevention of refeeding syndrome

Answer 10

Inpatient unit
Reefed slowly
Monitor fluids, lytes , vitals + cardiac status

Question 11

General management of EDs

Answer 11

MDT with doctor, dietician + MH
Nutritional rehab
Weight restoration
Cessation of bingeing + purging

Question 12

Anorexia management

Answer 12

Nutritional rehab - multivitamin
Controlled wt gain - 30-40 cal/ kg/ day (1lb a week)
CBT, family therapy, MANTRA
Drugs only for comorbidities

Question 13

Bulimia management

Answer 13

Nutritional counselling
CBT, family therapy
Fluoxetine

Question 14

Complicated grief sx

Answer 14

Complicated grief: >6mo
Daily distress >6 months
4 of the following:
- difficulty accepting death
- difficulty trusting others
- difficulty moving on with life
- excessive bitterness or anger
- numbness or detachment
- life is meaningless
- lack of hope for future
- agitation

Question 15

Complications of complex grief

Answer 15

Increased risk of cancer, HTN, CV disease + suicide
Social + occupational dysfunction
Reduced QoL

Question 16

RF for complicated grief

Answer 16

Close relationship with deceased
Childhood abuse or neglect
Separation anxiety in childhood
Hx of psych problems
Poor social support
Loss of child or fetus
Unexpected or traumatic death

Question 17

Management of complicated grief

Answer 17

Confronting avoided siutuations
Repeating story of death
CBT, IPT, group therapy
Healthy lifestyle
Join support group
Paroxetine or bupropion

Question 18

Reasons for admission in anorexia

Answer 18

wt <75% of ideal wt, temp <35.5, hr <45, systolic BP <80, orthostatic changes in HR >20