2.2 Bmed Exam 1: Eating Disorders

Front 1

What non-obvious complaints might someone w an eating disorder present w?

Back 1

fatigue, light headed, inability to exercise

depression

functional impairment (inability to focus)

dental erosion, salivary gland enlargement

amenorrhea

bloating, stomach pain

blood in vomit

Front 2

BOTH anorexia nervosa & bulimia nervosa are more common in __________

Which is more common in general?

Back 2

women

(anorexia onset at 14 or 18, bulimia, late teens/early twenties)

Bulimia nervosa

Front 3

What are some factors that Inc the likelihood of having an eating disorder?

Back 3

Dec serotonin levels

Family Hx

Obese family members

Comorbid personality disorders

Cognitive distortions about self

"Black & White" thinking

Front 4

Constipation, abdominal discomfort,

cold intolerance,

bradycardia, hypotension,

dry yellow skin,

lanugo (fine body hair), &

peripheral edema

are more common in _________

Back 4

anorexia nervosa

Front 5

Bloody vomit

menstrual irregularities

Large bowel abnormalities (laxative abuse)

Teeth enamel erosion

salivary gland enlargement

Russel Sign (ulcerations & calluses on back of hand)

are more common in __________

Back 5

Bulimia nervosa

Front 6

Hyponatremia & hypokalemia are common in BOTH anorexia & bulimia

hypochloremia

hypomagnesemia

elevated serum amylase

metabolic alkalosis or acidosis (laxative)

are mc in ____________

Back 6

Bulimia

(*high cortisol, GH, liver enzymes, & low thyroid hormones, estradiol, LH, & FSH- anorexia)

Front 7

A pt w/ _____________ is superficially sociable, has low self-esteem, intimacy conflicts, difficulty managing anger, & may have other impulsive behaviors

Back 7

Bulimia nervosa

Front 8

How does a pt w/ anorexia nervosa appear?

Back 8

early on- alert & cheerful

later- sad & withdrawn

rigid thinking, controlling, manipulative

deny illness

socially isolative

hyposexual

Front 9

Anorexia Nervosa: Dx criteria

Back 9

-restriction of calories that causes significantly low body weight

mild: BMI at least 17

moderate: 16- 17

severe: 15- 16

extreme: less than 15

-denial of seriousness of current low body weight

-intense fear of gaining weight or becoming fat

-disturbance in body img

Front 10

What are the 2 types of Anorexia Nervosa?

Back 10

Restricting Type:

no regular binge-eating or purging in last 3 months

Binge-Eating/Purging Type:

regular engagement in binge-eating or purging (laxative use, diuretics, etc) in last 3 months

Front 11

Anorexia Nervosa: comorbid disorders

Back 11

suicide

depression

anxiety (OCD, social phobia)

substance abuse (stimulants to lose weight)

personality disorders (antisocial, borderline, histronic, narcissistic, avoidant, dependent, obsessive-compulsive (cluster B & C))

Front 12

Anorexia Nervosa: Tx

Back 12

initially inpatient- behavior management, diet to gain weight, nutritional counselling

psychotherapy- cognitive-behavioral, interpersonal, psychodynamic, family therapy

*hospitalize if < 75% of normal body weight, vomiting > 10x day, bradycardia, severe hematemesis, neutropenia, hypokalemia, uncontrolled type I DM, syncope, poor outpatient response

Front 13

What is the main difference btwn Bulimia & Anorexia?

Back 13

Bulimia = normal body weight

Front 14

Bulimia Nervosa: Dx Criteria

Back 14

recurrent binge eating that is BOTH;

--eating more than normal amount of food in a period of time

--sense of lack of control during binge

recurrent compensatory behavior to prevent weight gain (vomiting, laxatives, diuretics, fasting, excessive exercise, enemas)

self-evaluation based on body weight/shape

*binge-purge must occur 1+x per week for 3+ months

Front 15

Bulimia Nervosa pts also have an inc risk of suicide

What is the tx for bulimia?

Back 15

-outpatient

-nutritional counseling

-psychotherapy (improve view of self)

-meds (SSRIs, MAOIs, atypical antidepressants)

Front 16

Binge Eating Disorder is similar to Bulimia Nervosa (characterized by uncontrolled binge eating) EXCEPT.....

*MC eating disorder

*1/2 of pts are obese

*pts don't like to eat around others

How is it tx?

Back 16

NOT accompanied by compensatory behaviors

*rated by severity (none---> extreme (14+ times a week)

Tx: cognitive-behavioral therapy, intrapersonal therapy, meds (SSRIs), bariatric surgery

Front 17

What tools are used to assess eating disorders?

Back 17

Eating disorder examination-questionnaire (EDE-Q)

Questionnaire for Eating & Weight Patterns- Revised (QEWP-R)

Eating Disorder Diagnostic Scale (EDDS)

Front 18

_____________________ is characterized by inadequate food intake w 1 of the following:

-significant weight loss

-nutritional deficiency

-dependence of enteral feeding/nutritional supps

-interference w/ social & psychological functioning

Back 18

Avoidant/Restrictive Food Intake Disorder

Front 19

How does Avoidant/Restrictive Food intake disorder differ from anorexia?

Back 19

NO disturbance in the perception of weight or shape

*usually develops in infancy or early childhood--> irritable, withdrawn

(if cond improves w/ caregivers other than parents, suggests abuse)

Front 20

________ is characterized by the persistent eating of nonfood substances over a period of 1+ month

*usually starts around 1-2 yrs & resolves by 6

* may persist in adults w/ intellectual disability

What are the common comorbidities?

Tx?

Back 20

Pica

comorbidities: autism, OCD, schizophrenia

Tx: behavioral intervention

Front 21

_____________is characterized by repeated regurgitation of food over a period of 1+ month, that is NOT d/t anorexia, bulimia, or a GI/med issue

causes- malnutrition, dehydration, esophageal ulcer, tooth decay

Tx?

Back 21

Rumination Disorder

Tx: no clear guideline, try negative reinforcement or reward