First Aid Psych 13-1 Eating Disorders

Front 1

1. 2 Main subdivisions of Anorexia Nervosa?

Back 1

1. Restrictive subtype
2. Binge-eating/purging type

Front 2

2. Restrictive type of Anorexia Nervosa?

Back 2

a. Has not regularly engaged in binge-eating or purging behaviour.
b. Often w/OCPD traits

Front 3

3. Binge-eating/purging type?

Back 3

a. Eat in binges followed by self-induced vomiting, using laxatives, excessively exercising, and/or using diuretics.

Front 4

4. DSM diagnosis of Anorexia Nervosa?

Back 4

a. Refusal to maintain a minimally normal body wt. for one’s age and height (< 85% of ideal body weight or BMI <17.5
b. Intense fear of gaining weight or becoming fat
c. Disturbed body image, undue influence of weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
d. Amenorrhea in post-menarchal females (ie, absence of at least 3 consecutive menstrual cycles.

Front 5

5. Physical manifestations of Anorexia Nervosa?

Back 5

a. Amenorrhea
b. Cold intolerance/hypothermia
c. Hypotension, especially orthostasis
d. Bradycardia
e. Arrhythmia
f. Acute coronary syndrome
g. Cardiomyopathy
h. Mitral valve prolapse
i. Constipation
j. Lanugo hair
k. Alopecia
l. Oedema
m. Dehydration
n. Peripheral neuropathy
o. Seizures
p. Hypothyroidism
q. Osteopenia/osteoporosis.

Front 6

6. Lab findings in Anorexia Nervosa?

Back 6

a. Hyponatremia, hypochloremic hypokalemic alkalosis (if vomiting)
b. Arrhythmia (especially QTc prolongation)
c. Hypercholesterolemia
d. Transaminitis
e. Leukopenia
f. Anaemia (normocytic normochromic)
g. ↑ BUN
h. ↑ GH
i. ↑ Cortisol
j. Reduced LH and FSH.
k. Reduced sex steroid hormones (oestrogen and testosterone
l. Hypothyroidism
m. Hypoglycaemia

Front 7

7. How is Bulimia distinguished from Anorexia?

Back 7

a. Both may binge and purge.
b. Anorexia Nervosa involves LOW BODY EIGHT, and this distinguishes it from bulimia.

Front 8

8. Classic example of Anorexia Nervosa?

Back 8

a. An extremely thin amenorrheic teenage girl whose mother says she eats very little, does aerobics for 2 hrs a day, and ritualistically does 400 sit-ups every day (500 if she has “overeaten”).

Front 9

9. What % of Anorexia Nervosa pts are female?

Back 9

a. 90-95%.
b. Prevalence is 1%.

Front 10

10. Age of onset for Anorexia Nervosa?

Back 10

a. Bimodal:
1. 13-14: hormonal influences.
2. 17-18: environmental influences.

Front 11

11. Where is Anorexia Nervosa more common?

Back 11

a. In industrialized countries where food is abundant and a thin body is ideal.

Front 12

12. Appetite in Anorexia versus Major Depressive Disorder?

Back 12

a. Anorexia: pts have good appetite but starve themselves due to distorted body image. They are often quite preoccupied w/food, preparing it for others, etc, but do not eat it themselves.
b. Major Depressive Disorder: Pts usually have poor appetite, which -> weight loss. These pts have no interest in food.

Front 13

13. Refeeding syndrome?

Back 13

a. Occurs when severely malnourished pts are refed too quickly.
b. Look for fluid retention and ↓ levels of phosphorous, mg, and Ca.
c. Complications include:
1. Arrhythmias
2. Respiratory failure
3. Delirium
4. Seizures
d. Replace electrolytes and slow the feedings.

Front 14

14. Prognosis of Anorexia Nervosa?

Back 14

a. Mortality rate is cumulative, and approximately 10% die due to starvation, Suicide, or cardiac failure.
b. Rates of suicide are approximately 57x higher than normal.

Front 15

15. Tx of Anorexia Nervosa?

Back 15

a. Food is the best medicine!!!
b. Pts may be tx’d as outpts unless they are more than 20% below ideal body wt or if there are serious medical or psychiatric complications, in which case they should be hospitalized or supervised refeeding.
c. Tx involves behavioural therapy, family therapy (eg, Maudsley approach), and supervised weight-gain programs.

Front 16

16. Rx Tx for Anorexia Nervosa?

Back 16

a. SSRIs have not been effective, which is believed to be due to inadequate dietary intake of tryptophan, the precursor of serotonin.
b. Low-dose second-gen antipsychotics may tx excessive preoccupation w/wt. and food in addition to independently promoting wt. gain.
c. BZDs may also be administered prior to meals to reduce preprandial anxiety.

Front 17

17. 2 subcategories of Bulimia?

Back 17

1. Purging type: Involves vomiting, laxatives, enemas, or diuretics.
2. Non-purging type: Involves excessive exercise or fasting.

Front 18

18. DSM diagnosis of Bulimia?

Back 18

a. Recurrent episodes of binge eating
b. Recurrent, inappropriate attempts to compensate for overeating and prevent wt. gain (such as laxative abuse, vomiting, diuretics, or excessive exercise.
c. The binge eating and compensatory behaviours occur at least 2x a wk for 3 months.
d. Perception of self-worth is excessively influenced by body weight and shape.

Front 19

19. Physical manifestation of Bulimia Nervosa?

Back 19

a. Salivary gland enlargement (sialadenosis)
b. Dental erosion/caries
c. Calluses/abrasions on dorsum of hand (“Russell’s sign” from self-induced vomiting)
d. Petechiae
e. Peripheral Edema
f. Aspiration

Front 20

20. Lab findings in Bulimia Nervosa?

Back 20

a. Hypochloremia hypokalemia alkalosis
b. Metabolic acidosis (laxative abuse)
c. ↑ bicarb (compensation)
d. Hypernatremia
e. ↑ BUN
f. ↑ Amylase
g. Altered thyroid hormone and cortisol homeostasis
h. Esophagitis.