Feeding/Eating, Elimination, and Sleep-Wake Disorders

Question 1

Pica definition

Answer 1

Eating nonfoods that have no nutrition

Question 2

Considerations when diagnosing pica

Answer 2

1. Developmental level
2. Cultural practices

Question 3

Common pica populations

Answer 3

1. Children
2. Pregnant women

Question 4

Anorexia Nervosa definition

Answer 4

Restricting food that results in low body weight

Question 5

Anorexia criteria

Answer 5

1. Fear of weight gain
2. Distortions in perceptions of weight/shape

Question 6

Anorexia specifiers

Answer 6

1. Type (restricting or binging/purging)
2. Course (in partial/full remission)
3. Severity (based on BMI)

Question 7

Common co-morbidities for anorexia, bulimia, and BED

Answer 7

1. Depression
2. Anxiety disorder (especially OCD for anorexia), often before eating disorder

Question 8

Anorexia prognosis

Answer 8

1. Relapses common
2. Difficult to treat (lack of insight)
3. Generally better than bulimia, with mixed findings

Question 9

Eddy et al (2017) study about recovery rates for anorexia and bulimia

Answer 9

9 years = anorexia recovery was half of bulimia recovery

22 years = similar recovery

Question 10

Initial treatment goals for anorexia

Answer 10

1. Healthy weight
2. Address physical complications

Question 11

Secondary treatment goals for anorexia

Answer 11

1. Motivation for treatment
2. Psychoeducation
3. Identify beliefs, attitudes, emotions
4. Treat contributing psychological factors
5. Family support
6. Relapse prevention

Question 12

Treatments for anorexia

Answer 12

1. CBT for anorexia
2. CBT-E for eating disorders
3. FBT for anorexia
4. Inconsistent support for medication

Question 13

CBT for anorexia

Answer 13

1. Post-hospitalization
2. Behavioral strategies for eating patterns
3. Reduce body-checking
4. Replace thinking errors

Question 14

CBT-E for eating disorders

Answer 14

1. Individualized based on client factors
2. Assumes core problem is over-valuing weight/shape

Question 15

FBT for anorexia nervosa

Answer 15

1. Outpatient for medically stable adolescents
2. Three phases

Question 16

Three phases of FBT for anorexia nervosa

Answer 16

1. Parent control over weight/nutrition for adolescent
2. Control gradually returned to adolescent
3. Address development factors (independence, parent-child relationship)

Question 17

Medications for anorexia

Answer 17

1. Olanzapine for initial weight gain
2. Fluoxetine for weight maintenance
3. Some support for treating co-morbidities rather than anorexia

Question 18

Bulimia Nervosa definition

Answer 18

Binge eating with compensatory behaviors to prevent weight gain

Question 19

Bulimia criteria

Answer 19

1. Binge and compensatory behavior 1x/week
2. Symptoms 3+ months

Question 20

Bulimia specifiers

Answer 20

1. Couse (in partial/full remission)
2. Severity (based on episodes of compensatory behavior per week)

Question 21

Typical weight for anorexia, bulimia, and BED

Answer 21

Anorexia - far below average

Bulimia - average to overweight

BED - average to obese

Question 22

Bulimia treatment

Answer 22

1. CBT-E**
2. Nutritional rehab and CBT*
3. IPT (longer time to produce results)
4. FBT for bulimia nervosa
5. Some evidence for medication

Question 23

Three phases of FBT for bulimia nervosa

Answer 23

1. Disrupt binging and compensatory behaviors, build healthy eating patterns
2. Collaboration between parent and adolescent due to lack of insight, control back to adolescent over time
3. Teen returns to normal development overall

Question 24

Insight and treatment motivation for anorexia v. bulimia

Answer 24

Anorexia - little to no insight, little to no motivation

Bulimia - insight w/ distress and motivation

Question 25

Medications for bulimia

Answer 25

1. SSRIs (fluoxetine) for comorbid depression and reducing binging/purging without depression 2. Some evidence that combined SSRI and CBT is better

Question 26

Four stages of CBT-E for bulimia

Answer 26

1. Education and monitoring 2. Review and revise as needed 3. Address overvaluation of weight/shape, other factors 4. Maintainance and relapse prevention

Question 27

Telehealth v. in-person for bulimia

Answer 27

Both positive outcomes for acceptability and retention Better abstinence and lower rates of cognitive distortions in-person

Question 28

Binge-Eating Disorder (BED) definition

Answer 28

Eating larger amounts than typical with a sense of being out of control

Question 29

BED criteria

Answer 29

1. 3+ symptoms (rapid eating, eating until uncomfortably full, large amounts w/o hunger, alone/hiding, negative emotions) 2. Episodes 1x/week 3. Symptoms 3+ months

Question 30

BED specifier

Answer 30

1. Severity (based on episodes per week)

Question 31

BED prevalence

Answer 31

2-3x more common in women than men

Question 32

BED v. bulimia

Answer 32

BED - no compensatory behaviors, better treatment response, followed by dieting Bulimia - compensatory behaviors, poorer treatment response, preceded by dieting

Question 33

BED treatment

Answer 33

1. CBT-E* 2. IPT 3. Some evidence for medication 4. Focus on binging before or alongside weight loss

Question 34

Medications for BED

Answer 34

1. SSRIs (fluoxetine, paroxetine, sertraline) 2. Topiramate 3. Lisdexamphetamine 4. Less effective than CBT alone or combined CBT and medication

Question 35

Enuresis criteria

Answer 35

1. Involuntary peeing in bed or clothing 2. 2+ times/week 3. Symptoms 3+ months OR distress/impairment 4. Not due to substance, medical conditions 5. 5+ years old (age or developmentally)

Question 36

Enuresis specifiers

Answer 36

1. Subtype (nocturnal only, diurnal only, both)

Question 37

Enuresis treatment

Answer 37

1. Moisture alarm* 2. Desmopressin (high risk for relapse when discontinued)

Question 38

Insomnia Disorder criteria

Answer 38

1. 1+ symptoms 2. 3+ nights/week 3. Symptoms 3+ months 4. Symptoms despite sufficient opportunity to sleep 5. Distress or impairment

Question 39

Insomnia types

Answer 39

1. Sleep-onset 2. Sleep maintenance 3. Late insomnia Combination of three types is most common

Question 40

Subjective reports of insomnia

Answer 40

Tend to overestimate time awake and underestimate time asleep

Question 41

Insomnia treatment

Answer 41

1. Cognitive-behavioral w/ stimulus control, sleep restriction, sleep hygiene, relaxation, cognitive therapy, etc.

Question 42

Narcolepsy criteria

Answer 42

1. Sleep or naps 3+ times/week 2. Symptoms 3+ months 3. Cataplexy, hypocretin deficiency, or REM latency <15 minutes

Question 43

Narcolepsy common co-occurring problems

Answer 43

1. Hallucinations before sleeping or after waking 2. Sleep paralysis when falling asleep or waking

Question 44

Narcolepsy treatment

Answer 44

Behavioral strategies combined with medications to improve alertness and reduce cataplexy

Question 45

Medications for narcolepsy

Answer 45

1. Modafinil and armodafinil (newer) 2. Antidepressant (venlafaxine, fluoxetine, clomipramine) for cataplexy 3. Sodium oxybate (if unresponsive to others)

Question 46

Non-Rapid Eye Movement Sleep Arousal Disorders

Answer 46

Incomplete waking w/ difficulty fully waking and little memory of episodes 1. Sleepwalking 2. Sleep terrors

Question 47

Nightmare Disorder criteria

Answer 47

Nightmares: 1. Extended 2. Dysphoric 3. Well-remembered 4. Threats to safety Typically occur during REM or second half of major sleep