Kk&s Ch.23 Eat Disor

Front 1

Anorexia key features?

Back 1

The first is a self-induced starvation to a significant degree;
the second is a relentless drive for thinness or a morbid fear of fatness;
and the third is the presence of medical signs and symptoms resulting from starvation

Front 2

DSM Dx of AN

Back 2

anorexia nervosa is characterized as a disorder in which persons refuse to maintain a minimally normal weight, intensely fear gaining weight, and significantly misinterpret their body and its shape

Front 3

Does loss of appetite occur in AN?

Back 3

not in early part of disorder

Front 4

How do AN's lose weight?

Back 4

Approximately half of anorexic persons will lose weight by drastically reducing their total food intake.
The other half of these patients will not only diet but will regularly engage in binge eating followed by purging behaviors.

Front 5

Anorexia nervosa is much more prevalent in GENDER and usually has its onset in AGE

Back 5

Females
Teens

Front 6

Hypotheses of an underlying psychological disturbance in young women with disorder?

Back 6

conflicts surrounding the transition from girlhood to womanhood. Psychological issues related to feelings of helplessness
and difficulty establishing autonomy have also been suggested as contributing to the development of the disorder

Front 7

Eating disorders of various kinds have been reported in up to XX percent of adolescent and young adult students

Back 7

4

Front 8

Anorexia nervosa has been reported (MORE OR LESS) frequently over the past several decades, with increasing reports of the disorder in ?

Back 8

MORE frequently
prepubertal girls and in boys.

Front 9

The most common ages of onset of anorexia nervosa are the XX, but up to Xpercent of anorectic patients have the onset of the disorder in their early ?

Back 9

midteens,
5% onset in early 20's

Front 10

According to DSM-IV-TR, the most common age of onset is between?

Back 10

14 and 18 years

Front 11

Anorexia nervosa is estimated to occur in about XX percent of adolescent girls

Back 11

0.5 to 1%

Front 12

It occurs XX times more often in females than in males

Back 12

10 to 20

Front 13

The prevalence of young women with some symptoms of anorexia nervosa who do not meet the diagnostic criteria is estimated to be close to X percent.

Back 13

5%

Front 14

AN is associated with which SES?

Back 14

no clear distribution

Front 15

AN variance by country? profession?

Back 15

It seems to be most frequent in developed countries, and it may be seen with greatest frequency among young women in professions that require thinness, such as modeling and ballet.

Front 16

Top 3 AN comorbidities? give %

Back 16

Anorexia nervosa is associated with depression in 65 percent of cases,
social phobia in 34 percent of cases, and
obsessive-compulsive disorder in 26 percent of cases.

Front 17

Neurochemically, (INCREASED OR DECREASED) norepinephrine turnover and activity are suggested by (INCREASED OR DECREASED) 3-methoxy-4-hydroxyphenylglycol (MHPG) levels in the urine and the cerebrospinal fluid (CSF) of some patients with anorexia nervosa

Back 17

DECREASED
DECREASED

Front 18

In patients with AN, an increase in MHPG is associated with a (INCREASE OR DECREASE) in depression

Back 18

DECREASE

Front 19

evidence in AN points to (lower, =, higher, unpredictable) concordance rates in monozygotic twins than in dizygotic twins

Back 19

higher

Front 20

Sisters of patients with anorexia nervosa are likely to be afflicted: does this reflect social influences or genetic factors?

Back 20

more likely social factors

Front 21

In AN, Major mood disorders are (less, =, more) common in family members than in the general population

Back 21

more

Front 22

What biological factor may contribute to the denial of hunger in patients with anorexia nervosa.

Back 22

Endogenous opiods

Front 23

What happens if give AN patient opiate ANTAGONISTS? give eg of opiate antagonist

Back 23

drama weight gain; naltrexone

Front 24

Biochemical changes in AN?

Back 24

Starvation results in many biochemical changes, some of which are also present in depression, such as hypercortisolemia and nonsuppression by dexamethasone.

Thyroid function is suppressed as well. These abnormalities are corrected by realimentation.

Starvation produces amenorrhea, which reflects lowered hormonal levels (luteinizing, follicle-stimulating, and gonadotropin-releasing hormones). Some patients with anorexia nervosa, however, become amenorrheic before significant weight loss.

Front 25

AN & CT Studies?

Back 25

Several computed tomographic (CT) studies reveal enlarged CSF spaces (enlarged sulci and ventricles) in anorectic patients during starvation, a finding that is reversed by weight gain

Front 26

AN & PET findings?

Back 26

In one positron emission tomographic (PET) scan study, caudate nucleus metabolism was higher in the anorectic state than after realimentation

Front 27

AN: CRH relation?

Back 27

incraesed

Front 28

AN: Plasma cortisol?

Back 28

increased, mildly

Front 29

AN: Diurnal cortisol difference?

Back 29

blunted

Front 30

AN: LH?

Back 30

Decreased

Front 31

AN: Growth hormone?

Back 31

Impaired regulation
Increased basal levels and limited response to pharmacological probes

Front 32

AN: Somatomedin C

Back 32

Decreased

Front 33

AN: Thyroxine (T4)

Back 33

Normal or slightly decreased

Front 34

AN: Triiodothyronine (T3)

Back 34

Mildly decreased

Front 35

AN: Reverse T3

Back 35

Mildly increased

Front 36

AN: Thyrotropin-stimulating hormone (TSH)

Back 36

Normal

Front 37

AN: TSH response to thyrotropin-releasing hormone (TRH)

Back 37

Delayed or blunted

Front 38

AN: Insulin

Back 38

Delayed release

Front 39

AN: C-peptide

Back 39

Decreased

Front 40

AN: Vasopressin

Back 40

Secretion uncoupled from osmotic challenge

Front 41

AN: Serotonin

Back 41

Increased function with weight restoration

Front 42

AN: NE

Back 42

Reduced turnover

Front 43

AN: Dopamine

Back 43

Blunted response to pharmacological probes

Front 44

AN: Some studies have shown evidence for dysfunction in (WHICH) three neurotransmitters involved in regulating eating behavior in the (NEUROANATOMICAL STRUCTURES)

Back 44

serotonin, dopamine, and norepinephrine,

paraventricular nucleus of the hypothalamus

Front 45

What family structure is often there in AN?

Back 45

No family constellations are specific to anorexia nervosa, but some evidence indicates that these patients have close, but troubled, relationships with their parents

Front 46

Families of children who present with eating disorders, especially binge eating or purging subtypes, may exhibit?

Back 46

high levels of hostility,
chaos, and
isolation and low levels of nurturance and empathy

An adolescent with a severe eating disorder may tend to draw attention away from strained marital relationships

Front 47

Which vocations assoc with AN?

Back 47

girls - ballet
boys- wrestling

Front 48

Sexual oreintation and AN?

Back 48

A gay orientation in men is a proved predisposing factor, not because of sexual orientation or sexual behavior per se, but because norms for slimness, albeit muscular slimness, are very strong in the gay community, only slightly lower than for heterosexual women.

In contrast, a lesbian orientation may be slightly protective, because lesbian communities may be more tolerant of higher weights and a more normative natural distribution of body shapes than their heterosexual female counterparts.

Front 49

Psychological explanation of AN?

Back 49

patients typically lack a sense of autonomy and selfhood.

Many experience their bodies as somehow under the control of their parents, so that self-starvation may be an effort to gain validation as a unique and special person.

Only through acts of extraordinary self-discipline can an anorectic patient develop a sense of autonomy and selfhood.

unable to separate psychologically from their mothers

The body may be perceived as though it were inhabited by the introject of an intrusive and unempathic mother. Starvation may unconsciously mean arresting the growth of this intrusive internal object and thereby destroying it.

Many anorectic patients feel that oral desires are greedy and unacceptable; therefore, these desires are projectively disavowed.


Other theories have focused on fantasies of oral impregnation.
Parents respond to the refusal to eat by becoming frantic about whether the patient is actually eating. The patient can then view the parents as the ones who have unacceptable desires and can projectively disavow them; that is, others may be voracious and ruled by desire but not the patient.

Front 50

An intense fear of gaining weight and becoming obese is present in (XX) % patients with the disorder and undoubtedly contributes to their lack of interest in, and even resistance to, therapy

Back 50

100%

Front 51

Some key behaviour features of AN?

Back 51

Most aberrant behavior directed toward losing weight occurs in secret.

patients are constantly thinking about food

Front 52

AN: physical signs?

Back 52

physical signs such as hypothermia (as low as 35°C), dependent edema, bradycardia, hypotension, and lanugo

Front 53

AN: vomiting and chemical change?

Back 53

hypokalemic alkalosis
Low potassium
Low pH

Front 54

An: ECG Changes?

Back 54

Electrocardiographic (ECG) changes, such as T wave flattening or inversion, ST segment depression, and lengthening of the QT interval, have been noted in the emaciated stage of anorexia nervosa. ECG changes may also result from potassium loss, which can lead to death.

Front 55

AN: GI problems?

Back 55

Gastric dilation is a rare complication of anorexia nervosa. In some patients, aortography has shown a superior mesenteric artery syndrome

Front 56

Anorexia nervosa has been divided into two subtypes?

Back 56

—the food-restricting category and the binge-eating or purging category

Front 57

AN: The food-restricting category is present in approximately XXpercent of cases

Back 57

50%

Front 58

AN: how does purging occur?

Back 58

Purging represents a secondary compensation for the unwanted calories,

most often accomplished by self-induced vomiting,

frequently by laxative abuse, less frequently by diuretics,

and occasionally with emetics

Front 59

List medical complications due to weight loss

Back 59

Cachexia: Loss of fat, muscle mass, reduced thyroid metabolism (low T3 syndrome), cold intolerance, and difficulty in maintaining core body temperature

Cardiac: Loss of cardiac muscle; small heart; cardiac arrhythmias, including atrial and ventricular premature contractions, prolonged His bundle transmission (prolonged QT interval), bradycardia, ventricular tachycardia; sudden death

Digestive-gastrointestinal: Delayed gastric emptying, bloating, constipation, abdominal pain

Reproductive: Amenorrhea, low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

Dermatological: Lanugo (fine baby-like hair over body), edema
Hematological: Leukopenia

Neuropsychiatric: Abnormal taste sensation (?zinc deficiency), apathetic depression, mild cognitive disorder

Skeletal: Osteoporosis

Front 60

List medical complications due to purging

Back 60

Metabolic: Electrolyte abnormalities, particularly hypokalemic, hypochloremic alkalosis; hypomagnesemia

Digestive-gastrointestinal: Salivary gland and pancreatic inflammation and enlargement with increase in serum amylase, esophageal and gastric erosion, dysfunctional bowel with haustral dilation

Dental: Erosion of dental enamel, particularly of front teeth, with corresponding decay

Neuropsychiatric: Seizures (related to large fluid shifts and electrolyte disturbances), mild neuropathies, fatigue and weakness, mild cognitive disorder

Front 61

What type of history is AN: binge eating type to be associated with?

Back 61

Those who binge eat and purge tend to have families in which some members are obese, and they themselves have histories of heavier body weights before the disorder than do persons with the restricting type
Binge eating–purging persons are likely to be associated with

substance abuse,
impulse control disorders, and

personality disorders.

Front 62

Persons with restricting anorexia nervosa often have (type of) traits

Back 62

Obsessive-compulsive

Front 63

major depressive disorder or dysthymic disorder has been reported in up to XX percent of patients with anorexia nervosa

Back 63

50

Front 64

The suicide rate is (LOWER, =, HIGHER) in persons with the binge eating–purging type of anorexia nervosa than in those with the restricting type

Back 64

HIGHER

Front 65

AN: A complete blood count often reveals ? in emaciated patients with anorexia nervosa

Back 65

leukopenia with a relative lymphocytosis

Front 66

What labs would you order in ED?

Back 66

CBC, Lytes, Fasting Glucose, Serum Salivary Amylase,
ECG, TSH, CRH

Front 67

If binge eating and purging are present, serum electrolyte determination reveals ?

Back 67

hypokalemic alkalosis

Front 68

Fasting serum glucose concentrations are often (high, low, normal) during the emaciated phase

Back 68

low

Front 69

serum salivary amylase concentrations are often elevated if?

Back 69

patient vomitting

Front 70

cardiovasc changes in AN?

Back 70

The ECG may show ST segment and T-wave changes, which are usually secondary to electrolyte disturbances; emaciated patients have hypotension and bradycardia

Front 71

AN & Cholesterol?

Back 71

Young girls may have a high serum cholesterol level

Front 72

Which endocrine changes revert to normal after weight gain?

Back 72

Endocrine changes that occur, such as
amenorrhea,
mild hypothyroidism, and
hypersecretion of corticotrophin-releasing hormone are caused by the underweight condition and revert to normal with weight gain.

Front 73

How would you distinguish MDD from AN?

Back 73

Generally, a patient with a depressive disorder has decreased appetite, whereas a patient with anorexia nervosa claims to have normal appetite and to feel hungry;

only in the severe stages of anorexia nervosa do patients actually have decreased appetite.

In contrast to depressive agitation, the hyperactivity seen in anorexia nervosa is planned and ritualistic. The preoccupation with recipes, the caloric content of foods, and the preparation of gourmet feasts is typical of patients with anorexia nervosa, but is absent in patients with a depressive disorder.

In depressive disorders, patients have no intense fear of obesity or disturbance of body image.

Front 74

What other dx is associated with AN?

Back 74

SOMATIZATION Disorder
Generally, the weight loss in somatization disorder is not as
severe as that in anorexia nervosa, nor does a patient with somatization disorder express a morbid fear of becoming overweight, as is common in those with anorexia nervosa

Amenorrhea for 3 months or longer is unusual in somatization disorder

Front 75

hypo or hyper activity of the vagus nerve can cause weight loss?

Back 75

hyperactivity

Front 76

A recent study reviewing subtypes of anorectic patients found that restricting-type anorectic patients seemed (LESS OR MOE) likely to recover than those of the binge eating-purging type

Back 76

LESS

Front 77

The short-term response of patients to almost all hospital treatment programs is (GOOD, OK, POOR).

Back 77

GOOD

Front 78

In general, the prognosis is (GOOD, OK, POOR)

Back 78

POOR

Front 79

Studies have shown a range of mortality rates from?

Back 79

Studies have shown a range of mortality rates from 5 to 18 percent

Front 80

AN: Indicators of a favorable outcome

Back 80

admission of hunger,

lessening of denial and immaturity,

and improved self-esteem

Front 81

AN: predictors of poor outcome?

Back 81

childhood neuroticism,

parental conflict,

bulimia nervosa,

vomiting,
laxative abuse, and

various behavioral manifestations (e.g., obsessive-compulsive, hysterical, depressive, psychosomatic, neurotic, and denial symptoms)

Front 82

Ten-year outcome studies in the United States have shown that about XX of patients recover completely and another YY% are markedly improved and functioning fairly well. The other ZZ% includes an overall AA% percent mortality rate and those who are functioning poorly with a chronic underweight condition

Back 82

XX=25
YY=50%
ZZ = 25
AA=7%

Front 83

Swedish and English studies over a 20- and 30-year period show a mortality rate of XX percent

Back 83

18%

Front 84

About XX% patients with anorexia nervosa eventually will have the symptoms of bulimia, usually within the YY year(s) after the onset of anorexia nervosa

Back 84

50%
1st

Front 85

First goal of hospitalization in AN?

Back 85

The first consideration in the treatment of anorexia nervosa is to restore patients' nutritional state;

dehydration, starvation, and electrolyte imbalances can seriously compromise health and, in some cases, lead to death

Front 86

Decision to Hosp AN =?

Back 86

The decision to hospitalize a patient is based on the patient's medical condition and the amount of structure needed to ensure patient cooperation.

Front 87

In general, patients with anorexia nervosa who are XX percent below the expected weight for their height are recommended for inpatient programs, and patients who are YY percent below their expected weight require psychiatric hospitalization for ZZ months.

Back 87

20%

30%

ZZ = 2 to 6

Front 88

Inaptient approach?

Back 88

maintain a firm yet supportive approach to patients,
often through a combination of positive reinforcers (praise) and negative reinforcers (restriction of exercise and purging behavior).

The program must have some flexibility for individualizing treatment to meet patients' needs and cognitive abilities.

Patients must become willing participants for treatment to succeed in the long run.

Front 89

Compulsory admission or commitment should be obtained only when?

Back 89

the risk of death from the complications of malnutrition is likely.

Front 90

Hosp tx program guidelines?

Back 90

Patients should be weighed daily, early in the morning after emptying the bladder.

The daily fluid intake and urine output should be recorded.

If vomiting is occurring, hospital staff members must monitor serum electrolyte levels regularly and watch for the development of hypokalemia.

Because food is often regurgitated after meals, the staff may be able to control vomiting by making the bathroom inaccessible for at least 2 hours after meals or by having an attendant in the bathroom to prevent vomiting.

Constipation in these patients is relieved when they begin to eat normally.

Stool softeners may occasionally be given, but never laxatives. If diarrhea occurs, it usually means that patients are surreptitiously taking laxatives.

Because of the rare complication of stomach dilation and the possibility of circulatory overload when patients immediately start eating an enormous number of calories, the hospital staff should give patients about 500 calories over the amount required to maintain their present weight (usually 1,500 to 2,000 calories a day). It is wise to give these calories in six equal feedings throughout the day, so that patients need not eat a large amount of food at one sitting.

Giving patients a liquid food supplement such as Sustagen may be advisable, because they may be less apprehensive about gaining weight slowly with the formula than by eating food

Front 91

Psychotherapy:

Type of therapy has been found effective for inducing weight gain;
Cognitive therapy evidence in AN?

Back 91

Behavior therapy has been found effective for inducing weight gain; no large, controlled studies of cognitive therapy with behavior therapy in patients with anorexia nervosa have been reported

Front 92

What is relationship to AN, Family therapy and age?

Back 92

In one controlled family therapy study in London, anorectic patients under the age of 18 benefited from family therapy, whereas patients over the age of 18 did worse in family therapy than with the control therapy

Front 93

What is level of evidence for Rx in AN?

Back 93

Pharmacological studies have not yet identified any medication that yields definitive improvement of the core symptoms of anorexia nervosa

Front 94

Some reports support the use of (RX) for patients with the restricting type of anorexia nervosa. Rx has also been reported to have some benefit

Back 94

cyproheptadine (Periactin), a drug with antihistaminic and antiserotonergic properties,
Amitriptyline (Elavil) has also been reported to have some benefit

Front 95

Which Rx have been tried in AN?

Back 95

clomipramine,
pimozide (Orap), and
chlorpromazine (Thorazine). Trials of fluoxetine have resulted in some reports of weight gain,

Front 96

What often terminates binge eating in Bulimia nervosa?

Back 96

Social interruption or physical discomfort—that is, abdominal pain or nausea

Front 97

Body weight in BN?

Back 97

usually normal

Front 98

What is more prevalent - BN or AN?

Back 98

BN

Front 99

BN prevalence?

Back 99

2 to 4 %

Front 100

BN: gender?

Back 100

women >men

Front 101

BN vs AN: onset?

Back 101

BN is later than AN, i.e., late adolescence or early adulthood

Front 102

Approximately XX percent of college women experience transient bulimic symptoms at some point during their college year

Back 102

20%

Front 103

In industrialized countries, the prevalence of BN is about X% of the general population

Back 103

1

Front 104

Which NT implicate in BN and why?

Back 104

Because antidepressants often benefit patients with bulimia nervosa and because serotonin has been linked to satiety, SEROTONIN and NOREPINEPHRINE have been implicated.

Front 105

What is bio explanation of why patients feel better after vomiting?

Back 105

Because plasma endorphin levels are raised in some bulimia nervosa patients who vomit, the feeling of well-being after vomiting that some of these patients experience may be mediated by raised endorphin levels

Front 106

Is BN in higher frequency among 1st degree relatives?

Back 106

Yes

Front 107

BN associated with depression?

Back 107

Yes

Front 108

Compare families of BN with AN

Back 108

the families of patients with bulimia nervosa are generally
less close and
more conflictual
than the families of those with anorexia nervosa
Patients with bulimia nervosa describe their parents as
neglectful and
rejecting

Front 109

outgoing, angry, and impulsive describes AN or BN?

Back 109

BN

Front 110

Alcohol dependence: AN or BN?

Back 110

BN

Front 111

Shoplifting? AN or BN

Back 111

BN

Front 112

Emotional Lability? AN or BN

Back 112

BN

Front 113

Suicide Attempts? AN or BN?

Back 113

BN

Front 114

Ego-dystonia: AN or BN?

Back 114

BN

Front 115

Help seeking: AN or BN?

Back 115

BN

Front 116

High or Low Super Ego control associated with BN?

Back 116

Lower than AN

Front 117

Self-destructive sexual relationships: AN or BN?

Back 117

BN

Front 118

BN: difficulties seperating from caregivers or difficulties with being distanst

Back 118

difficulties seperating

Front 119

Do people with BN have good, bad or no hx of transitional objects?

Back 119

No. Some say BN is the transitional object.

Front 120

Psychological theory of BN?

Back 120

Patient struggle for independence from maternal figure which is played out in the ambivalence toward food; eating = fuse with caretaker, regurgitating = seperation (all unconscious)

Front 121

Time criteria for BN?

Back 121

episodes 2X/week or more for at least 3 months

Front 122

BN: compensatory behaviors are practiced after binge eating to prevent weight gain, primarily self-induced vomiting, laxative abuse, diuretics, or abuse of emetics (XX percent of cases)

Back 122

80

Front 123

BN: severe dieting and strenuous exercise (XX percent of cases)

Back 123

20%

Front 124

Which comes first, binging or vomiting and by how much?

Back 124

Binging usually precedes vomiting by about 1 year.

Front 125

When is depression associated with BN - before or after binge?

Back 125

after, postbinge anguish

Front 126

What type of food is preferred in binges?

Back 126

binges, patients eat food that is sweet, high in calories, and generally soft or smooth textured, such as cakes and pastry. Some patients prefer bulky foods without regard to taste. The food is eaten secretly and rapidly and is sometimes not even chewed

Front 127

Which patients are more concerned with sexual activity - AN or BN

Back 127

Most are sexually active, compared with anorexia nervosa patients, who are not interested in sex

Front 128

Pica -- AN or BN?

Back 128

BN

Front 129

Patients with BN have increased rates of?

Back 129

Patients with bulimia nervosa also have increased rates of anxiety disorders, bipolar I disorder, and dissociative disorders, and histories of sexual abuse

Front 130

List the features associated with BN - purging type.

Back 130

Non-Purging: less image distortion, less anxiety about eating, tend to be obese

Purging:greater risk hypokalemia, and hypochloremic alkalosis, gi tears,

Front 131

Who is more likely to have an electrolyte abnormality:
Low weight AN or BN?
Which lytes?

Back 131

BN, especially if purge
low potassium
hypochloremic alkalosis
low Mg
High Amylase

Front 132

Thyroid function in BN?

Back 132

normal generally

Front 133

Dexamethasone suppression test?

Back 133

non-suppression

Front 134

DDX of BN?

Back 134

Epilepsy/Seizure Ds
CNS tumors
Kluver-Bucy syndrome
Kleine-Levin syndrome

Front 135

What is Kluver-Bucy Syndrome?

Back 135

ors, Klüver-Bucy syndrome, or Kleine-Levin syndrome. The pathological features manifested by Klüver-Bucy syndrome are visual agnosia, compulsive licking and biting, examination of objects by the mouth, inability to ignore any stimulus, placidity, altered sexual behavior (hypersexuality), and altered dietary habits, especially hyperphagia.

Front 136

Kleine-Levin syndrome is what?

Back 136

Kleine-Levin syndrome consists of periodic hypersomnia lasting for 2 to 3 weeks and hyperphagia. As in bulimia nervosa, the onset is usually during adolescence, but the syndrome is more common in men than in women

Front 137

If have BN and Seasonal Affective Ds, can you get seasonal variation in BN also?

Back 137

Yes, so tx with 10 000 lux for 30 minutes in am at 20 inches away

Front 138

Some patients with bulimia nervosa—perhaps XX percent—have multiple comorbid impulsive behaviors, including:

Back 138

Some patients with bulimia nervosa—perhaps 15 percent—have multiple comorbid impulsive behaviors, including substance abuse, and lack of ability to control themselves in such diverse areas as money management (resulting in impulse buying and compulsive shopping) and sexual relationships (often resulting in brief, passionate attachments and promiscuity)

They exhibit self-mutilation, chaotic emotions, and chaotic sleeping patterns

Front 139

BN often meet criteria for which Axis I/II ds?

Back 139

They often meet criteria for borderline personality disorder and other mixed personality disorders and, not infrequently, bipolar II disorder

Front 140

(AN or BN) is characterized by higher rates of partial and full recovery compared with (AN or BN)

Back 140

BN vs AN

Front 141

What is course of untx BN?

Back 141

unimpressive improvement with time

Front 142

What is 10 year outcome of those who received tx?

Back 142

progressive decline with BN

Front 143

10 year follow-up of BN
Approximately XX percent continued to engage in recurrent binge-eating or purging behaviors

Back 143

30%

Front 144

BN and 10 year outcome, what predicted worse outcome?

Back 144

substance use

Front 145

At 10 year follow-up of BN, what % of women were fully recovered

Back 145

38 to 47%

Front 146

Who are more secretive about sx: AN or BN?

Back 146

AN

Front 147

Do most people with BN need hosp or outpatient tx?

Back 147

outpatient

Front 148

Does psychotherapy work in BN?

Back 148

Some OBESE patients with bulimia nervosa who have had prolonged psychotherapy do surprisingly well.

Front 149

When hosp BN?

Back 149

failed outpatient
SI
Substance abuse
Medical: lytes

Front 150

What is the 1st line Tx for BN?

Back 150

CBT

Front 151

Describe CBT for BN?

Back 151

Sessions: 20
Months: 6
Goals:
1. Interrupt self-maintaining behavioral cycle of binging and dieting
2. Change individual's dysfxnal congitions; beliefs about food, weight, body image; and overall self-concept

Front 152

Dynamic view of BN?

Back 152

Splitting & Projection

splitting -- nutrious food = good introjects, junk food = bad, expelling = also expelling associated bad introjects, all destructiveness, hate, badness

After expelling bad, all good short-lived because of unstable combo of splitting with PROJECTION.

Front 153

Which Rx have been shown to be helpful in treating Bulimia?

Back 153

This includes the selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine.

Front 154

In BN what do antidepressants do that may help in BN?

Back 154

increase central 5-hydroxy
Try-Ptamine 5HTP levels

Front 155

Do Antidep help in BN even if don't have depression?

Back 155

yes

Front 156

Which other drugs besides SSRI helpful in BN?

Back 156

Imipramine (Tofranil), desipramine (Norpramin), trazodone (Desyrel), and monoamine oxidase inhibitors (MAOIs) have been helpful

Front 157

What dose of antidepressant in BN?

Back 157

In general, most of the antidepressants have been effective at dosages usually given in the treatment of depressive disorders. Dosages of fluoxetine that are effective in decreasing binge eating, however, may be higher (60 to 80 mg a day) than those used for depressive disorders.

Front 158

BN and Mood stablizers. Any role?

Back 158

Not for BN only,
but if comorbid ds, like BP1 then yes especially
Carbamazepine and lithium

Front 159

Evidence indicates that the use of antidepressants alone results in a XX percent rate of abstinence from bingeing and purging

Back 159

22

Front 160

BN: what is best tx: CBT alone, Antidepressant alone, combo?

Back 160

Combo

Front 161

What are some features of EdNOS

Back 161

Binge-eating disorder—that is, recurrent episodes of binge eating in the absence of the inappropriate compensatory behaviors characteristic of bulimia nervosa (Table 23.2-3)—falls into this category. Such patients are not fixated on body shape and weight.

Front 162

List three main causes obesity:

Back 162

genetics
high energy diet
low activity

Front 163

What is the leading cause of death in the US?

Back 163

obesity

Front 164

What % of male, female body weight is fat?

Back 164

Male 25%
Female: 18%

Front 165

What are BMI categories?
How is BMI calculation done?

Back 165

20 to 25 normal
25 to 27 elevated risk
27 clearly increased
>30 greatly increased risk
kg/m2

Front 166

US population overweight prevalence?

Back 166

34%
one third, BMI 25 to 30

Front 167

Obesity (BMI >30) = % of US?

Back 167

32%

Front 168

Extreme obesity: BMI >40 % of US?

Back 168

2.8% men
6.9% women

Front 169

Which population has highest obesity?

Back 169

non-hispanic black women

Front 170

% Children obese in 2004?
How about kids 2 to 5?

Back 170

18 (increase from 15%)
10%

Front 171

If difference between intake and out-take is XX percent, get 30 pound change in body weight in 1 year

Back 171

10%

Front 172

NT's involved in obesity?

Back 172

Some studies have shown evidence for dysfunction in serotonin, dopamine, and norepinephrine involvement in regulating eating behavior through the hypothalamus.

Front 173

Hormonal factors involved in obesity?

Back 173

CRF,
Neuropep Y,
Gonadotropic-releasing horm
TSH
Leptin

Front 174

What is obestatin?

Back 174

hormone made in stomach that produces satiety

Front 175

What is relationship of cannabis to appetite?

Back 175

cannabis stimulates appete
a cannabis inverse antagonist, RIMONABAUT, blocks appetite

Front 176

Leptin Role?

Back 176

suppresses feeding, in hypothalamus

Front 177

Neuropeptide Y fxn?

Back 177

stimulates feeding

Front 178

Ghrelin fxn?

Back 178

in stomach, activates Neuropeptide Y (So stimulates food intake)

Front 179

Melanocortins: fxn?

Back 179

acts on hypothalamus
suppresses appetite because disrupted receptor on mice associated with obesity

Front 180

Carboxypeptidase E fxn?

Back 180

Dyxnfxn (mutated gene) = obesity ... which can be treated by insulin in mice

Front 181

Mitochondrial uncoupling proteins

Back 181

found in brown and white fat
involved in energy expenditure and body weight regulation

Front 182

Tubby protein

Back 182

Highly expressed in PVN
mutated gene = obesity

Front 183

What % of people with obesity have family hx of obesity?

Back 183

80%

Front 184

What is the difference between childhood and adulthood body fat?

Back 184

Once the number of adipocytes has been established, it does not seem to be susceptible to change. Obesity that begins early in life is characterized by adipose tissue with an increased number of adipocytes of increased size. Obesity that begins in adult life, on the other hand, results solely from an increase in the size of the adipocytes

Front 185

Which fat pattern is associated with CV disease?

Back 185

pot-belly (waist, flanks, abs) versus thighs and buttocks

Front 186

Is cellulite a medical term?

Back 186

NO

Front 187

When leptin is low, more or less fat is consumed? how about when high?

Back 187

when low, more fat consumed
when high less fat consumed

Front 188

Which brain damage areas can produce obesity?

Back 188

destruction of VentroMedial Hypothalamus
CNS, lateral and ventromedial hypothalamic areas, adjusts to food intake in reponse to changing energy requirements

Front 189

What illnesses can cause obesity?

Back 189

Prader Willi
Neuroendocrine problems
damage to VMH
Some Deprssion, especially Seasonal
Cushing's disease

Front 190

Which Rx assoc with obesity?

Back 190

long term steroid use
MDD, Psychosis, Bipolar ds gain 3 to 10kg with psychotropics

Front 191

What is night eating syndrome associated with?

Back 191

eat excessively after eve meal ... precipitated by stressful life circumstances

Front 192

Which drug has been associated with night eating?

Back 192

Zolpidem (Ambien)

Front 193

What is Pickwickian syndrome?

Back 193

When person is 100% over desirable weight

Front 194

What % of obese people have Body Dysmorphic ds?

Back 194

Mainly people obese since childhood

Front 195

What are the 5 risk factors for Metabolic syndrome?

Back 195

1. Abdominal obesity
2. High triglyceride levels
3. Low HDL cholesterol level
4. HTN
5. Elevated fasting blood glucose level.

Front 196

Which Antidepressant has greatest likelihood of increasing appetite?

Back 196

Amitriptyline (Elavil)

Front 197

Which mood stablizers associated with greatest weight gain? least?

Back 197

Lithium and Valproic Acid most
Least: Topiramate

Front 198

What are some effects of obesity on health?

Back 198

oberweight patients have more HTN
and High cholesterol
Diabetes
Men: Higher mortality from :
colon, rectal, and prostate cancer
Women: Cancer of gallbladder, biliary passages, breast, uterus, ovaries

Front 199

Risk of death and overweight?

Back 199

more overweight, higher risk of death

Front 200

Extreme obesity =?

Back 200

twice desirable weight

Front 201

A number of studies have demonstrated that decreasing caloric intake by XX percent or more in young or middle-aged laboratory animals prevents or retards age-related chronic diseases and significantly prolongs maximal life span

Back 201

30

Front 202

How does eating less in young/middle age prolong lifespan?

Back 202

reductions in metabolic rate, oxidative stress and inflammation, improved insulin sensitivity, and changes in neuroendocrine and sympathetic nervous system function

Front 203

What % of people who lose significant weight, regain it

Back 203

90%

Front 204

Problems with fasts?

Back 204

orthostatic hypotension,
sodium diuresis, and
impaired nitrogen balance

Front 205

ketogenic diet

Back 205

nausea, hypotension, and lethargy.

Front 206

What is recommended weight loss calories?

Back 206

1,100 to 1, 200 calories supplemented with vitamins:
iron, folic acid, zinc and
vitamin b6

Front 207

What is approach to drug therapy for weight loss?

Back 207

Drug treatment is effective because it suppresses appetite, but tolerance to this effect may develop after several weeks of use. An initial trial period of 4 weeks with a specific drug can be used; then, if the patient responds with weight loss, the drug can be continued to see whether tolerance develops. If a drug remains effective, it can be dispensed for a longer time until the desired weight is achieved.

Front 208

Which rx can you use for weight loss, and is approved by FDA?

Back 208

orlistat (Xenical), which is a selective gastric and pancreatic lipase inhibitor that reduces the absorption of dietary fat (which is then excreted in stool).

The principal adverse effects of orlistat are gastrointestinal; patients must consume 30 percent or fewer calories from fat to prevent adverse events that include oily stool, flatulence with discharge, and fecal urgency

Front 209

What is Sibutramine?

Back 209

Sibutramine (Meridia) is a β-phenylethylamine that inhibits the reuptake of serotonin and norepinephrine (and dopamine to a limited extent)

It was approved by the FDA in 1997 for weight loss and the maintenance of weight loss (i.e., long-term use).

Front 210

Which class of drugs are among most widely used appetite suppressants?

Back 210

Dopamine receptor agonists, or sympathomimetics, are among the most widely used appetite suppressants.

Front 211

What Cannabinoid Receptor is associated with with weight loss?

Back 211

CB1 blockade by
RIMONABANT

Front 212

Rimonabant effects?

Back 212

At a dose of 20 mg rimonabant causes significant weight loss, reduction in waist circumference, increase in HDL cholesterol, and reduction in triglycerides.

At that dose it also increases in plasma adiponectin levels. Adiponectin is a protein hormone that modulates glucose regulation and fatty acid catabolism. Adiponectin is exclusively secreted from adipose tissue and its plasma levels are inversely correlated with body mass index (BMI). It appears to help suppress metabolic abnormalities that lead to type 2 diabetes, obesity, and atherosclerosis.

Front 213

Gastroplasty effects?

Back 213

In gastroplasty the size of the stomach stoma is reduced so that the passage of food slows

Front 214

Which surgey has not effect on weight loss in the long run?

Back 214

Lipectomy
liposuction

Front 215

Is surgery recommended for anyone?

Back 215

Bariatric surgery is now recommended in individuals who have serious obesity-related health complications and a BMI of greater than 35 kg/m2 (or a BMI >40 kg/m2 in the absence of major health complications).

Front 216

Which style of psychotherapy helps?

Back 216

Not so much psychodynamic
Try Behaviour Modification

Front 217

How would you set up Behav mod for obesity?

Back 217

Diary: triggers to eating
New Patterns: eat slowly, chew food well, not read while eating,
Not eat between meals or when not seated.
Reward and reinforce weight loss
Group therapy

Front 218

Benefits of weight loss and exercise?

Back 218

1) modestly contributes to weight loss in overweight and obese adults, (2) may decrease abdominal fat, (3) increases cardiorespiratory fitness, and (4) may help with maintenance of weight loss.

Front 219

Weight Loss Plan?

Back 219

Asess: BP, HTN, Cholesterol, Glucose, BMI, Circumference, WEight
Target: 10% weight loss, 1 to 2 pounds per week over 6 months
Reduce intake: deficit of 500 to 1000 cal per day from norm, decrease, fats, carbs,
Increase Physical activity, sweat everyday
Invest heavily in weight maintenance