Eating/Sleep/Gender/Elimination Disorders/Reproductive Life Stages Flashcards
What is the typical course of ‘Postpartum Blues’?
- begins 3-4 days after delivery
- peaks at day 5-6
- back to normal in 2-3 weeks
(prevalence 50-85%)
uOttawa 2014
What is the incidence and onset of Postpartum Pyschosis?
Incidence: 1-2/1000 births
Onset: mean ~ 2-3 weeks postpartum and usually within 8 weeks of delivery. Recurrence rates are high.
uOttawa 2014
What electrolyte complications occur with purging?
- hypokalemia: responsible for nearly 50% of deaths in eating disorders
- Metabolic alkalosis most usual
Dr. Blake Woodside’s lecture notes 2014
What is the normal REM latency after sleep onset in normal adults?
90 minutes
K&S, p 749
When does REM, and stage 4 sleep occur most often during sleep?
- Most REM periods occur in the last third of the night, whereas most stage 4 sleep occurs in the first third of the night.
- A REM period occurs about every 90 to 100 minutes during the night.
- The first REM period tends to be the shortest, usually lasting less than 10 minutes; later REM periods may last 15 to 40 minutes each.
K&S, p 750
How do sleep patterns change over a person’s life span?
- In the neonatal period, REM sleep represents more than 50 % of total sleep time, and the EEG pattern moves from the alert state directly to the REM state without going through stages 1 through 4.
- By 4 months of age, the pattern shifts so that the total percentage of REM sleep drops to less than 40 %, and the entry into sleep occurs with an initial period of NREM sleep.
- By young adulthood, the distribution of sleep stages is as follows: NREM (75% - stage 1 (5%); Stage 2 (45%); Stage 3 (12%); Stage 4 (13%)) and REM (25%).
- In old age a reduction occurs in both slow-wave and REM sleep.
K&S, p 750
In what stage of sleep do you see sleep spindle’s and K complex’s?
Stage 2
K&S, p 751
What does an EEG show during REM sleep?
Low-voltage, mixed frequency activity, saw-tooth waves, theta activity, and slow alpha activity.
K&S, p 752
What is the prevalence of:
Anorexia Nervosa
Bulimia Nervosa
EDNOS
AN: 0-5%
BN: 1-3%
EDNOS: 3-10% (most common disorder in tx settings; 3/4 of all community cases of eating disorders)
uOttawa; DSM-IV TR
What is the age of onset for Anorexia Nervosa and Bulimia Nervosa?
AN: 13-20 yrs (peaks 14 and 18 yrs; 5% present after 20 yrs of age)
BN: 16.5-19 yrs old
uOttawa 2014
What is the the #1 comorbidity associated with Anorexia Nervosa?
Depression (50-65%)
- > 50% have an anxiety disorder (esp. OCD, GAD, Social Phobia)
- Perfectionism
- Cluster C traits (ex. OCPD - rigidity, restraint, obsessiveness)
uOttawa 2014
What is the #1 comorbidity associated with Bulimina Nervosa?
Depression (>50%)
- Anxiety in > 550% (esp. GAD and Social Phobia)
- Substance use, impulsivity, BPD traits, PTSD, bipolar spectrum disorders.
uOttawa 2014
What effects do starvation and purging have on the CV and metabolic systems?
Starvation Purging
CV Low BP and HR Arrhythmias (K+)
small heart, QTc cardiac arrest
prolongation,
cardiac arrest
Metabolic
Hypothermia Metabolic alkolosis
Anemia Hypokalemia
Leukopenia
Poor immunity
uOttawa 2014
What effects do starvation and purging have on the reproductive, term, and GI systems?
Starvation Purging
Repro. Amenorrhea Amenorhhea
Infertility Oligomenorrhea
Complications in Infertility
pregnancy
Derm Dry skin/hair Russell’s sign
Lanugo hair Enlarged parotid
Perioral skin irritation
Petechiae
GI Constipation Hematemesis
Esophagitis
Reflex, poor muscle
tone in colon
(laxative abuse)
uOttawa 2014
What effects do starvation and purging have on the MSK, Renal, and CNS systems?
Starvation Purging
MSK Muscle wasting Dental erosions
Osteoporosis Muscle cramps
Short stature (low K+)
Renal Pre-renal failure Pre-renal failure
(dehydration) (dehydration)
CNS poor concentration (both)
severe mood changes (both)
Decreased white
& gray matter
uOttawa 2014
What lab results are typically increased in eating disorders?
BUN (from dehydration)
Amylase (from vomiting)
Cholesterol (from starvation)
uOttawa 2014
What lab results are typically decreased in eating disorders?
Na/K/Cl (from vomiting/laxatives) LH, FSH, estrogen (from starvation) RBCs (from starvation) WBCs (from starvation) T3
uOttawa 2014
How does hypophosphataemia occur in refeeding syndrome and why is it a problem?
- may occur within 4 days in severely malnourished pts (< 70% IBW)
- During starvation: there is an intracellular loss of electrolytes, particularly phosphate
- With feeding, insulin is secreted
- This stimulates cellular uptake of phosphate (and other electrolytes), which can lead to profound hypophosphataemia
- Decreased phosphate < 0.50 mmol/l (normal range 0.85-1.40 mmol/l) = rhabdomylolysis, leukocyte dysfunction, resp. arrest, cardiac failure, hypotension, arrhythmias, seizures, coma, and sudden death.
uOttawa 2014
