N: Eating Disorders

Front 1

Is obesity an eating disorder?

How do we define obesity?

What have more of an effect on obesity: genetic factors or environmental factors?

Back 1

No

>20% of ideal weight based on common height/weight charts; BMI >30

Genetic factors.

Front 2

How do orlistat, sibutramine hydrochloride, and phendimetrazine help pts lose weight?

Back 2

orlistat: pancreatic lipase inhibitor limits breakdown of dietary fats

sibutramine HCl: blocks monoamine reuptake --> increases satiety

Phendimetrazine: amphetamine-like appetite suppressing effects

Front 3

How effective is bariatric surgery for WL?

Back 3

initially effective, but has less value for maintaining long-term weight loss.

Front 4

When a pt shows abnormal behavior associated with food despite a normal appetite, what might they have?

Back 4

anorexia nervosa or bulimia nervosa.

Front 5

Define the two subtypes each of anorexia nervosa and bulimia nervosa.

Back 5

anorexia:
- restricting type: excessive dieting
- binge-eating/purging type

bulimia
- purging type: binge eating + purging
- non-purging: binge eating + excessive dieting/exercise w/o purging.

Front 6

Physical sx of anorexia nervosa?

Back 6

>15% BW WL
Amenorrhea (3 or more consecutively missed periods)
metabolic acidosis
hypokalemia
hypercholesterolemia
mild anemia and leukopenia
lanugo (downy body hair on the trunk)
melanosis coli (blacked area of colon; seen with laxative abuse)
osteroporosis
cold intolerance
syncope

Front 7

Physical sx of bulemia nervosa?

Back 7

relatively normal BW
esophageal varices
tooth enamel erosion
swelling/infected parotid glands

metacarpal-phalangeal calluses (russel sign) from the teeth b/c the hand is used to induce gagging

electrolyte disturbances
menstrual irregularities

Front 8

Are psychoactive drugs useful in anorexia nervosa? bulimia?

Back 8

relatively ineffective.

average to high doses of AntiDepressants can be useful.

Front 9

What do you need to have for a dx of anorexia nervosa?

Back 9

Body weight less then 85% of expected or failure to gain weight as expected
Intense fear of gaining weight
Body image distortion or denial of seriousness of low body weight
Amenorrhea – absence of at least three consecutive menstrual cycles

Front 10

What dz has the highest mortality rate of any psychiatric disorder?
- Bonus: what are some predictors of lethality in this dz?

Back 10

anorexia nervosa
- Predictors of lethality (<60% IBW, low serum albumin)

Front 11

What do you need to have for a dx of bulimia nervosa?

Back 11

Recurrent episodes of binge eating
Unusually large amount of food in short time
Feeling out of control
Recurrent compensatory behavior
Vomiting, laxatives, diuretics, enemas, fasting or excessive exercise
Both occur at least twice a week for three months
Extreme focus on weight and shape
Does not occur exclusively during an episode of anorexia nervosa

Front 12

What are some indications of hospitalization in eating disorder pts?

Back 12

<75% IBW
>20bpm or >20mmHg orthostatic hypotension

<40 bpm bradycardia
<90/60 BP
<97 degrees temp

<10% body fat

- syncope
- serum K <3.2
- serum Cl <88
- esophageal tears
- prolonged OTc (& arrythmias)
- intractable vomiting
- hematemesis

Front 13

When, if ever, should antiD be added to Anorexia nervosa tx?

Bulimia?

Back 13

only after weight restoration; or in cases of severe comorbid depression, anxiety dz, etc.

They are much more effective; but still the first line for limited comorbidity is systemic, short-term psychotherapy.