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20 Cards in this Set

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What has the highest mortality
rate of any psychiatric disorder?
Anorexia Nervosa
When is the peak onset of an eating disorder?
14-18 years old
Anorexia vs. Bulemia

Who is more likely to get treatment?
33% anorexia patients get treatment

6% bulemia patients get treatment
What are the demographics associated with eating disorders?

(age, academics, Socioeconomics)
Occurs most often in late adolescence to young
adults in high academic achievers and higher
socioeconomic groups
Low Body weight (15% below normal BMI or 85% of expected body weight)

• Intense fear of gaining weight

• Body Image distortion

• **Amenorrhea** (at least 3 consecutive cycles)

• Sub types:
– Restrictive type (limiting caloric intake)
– Binge eating/purging type
Anorexia Nervosa
Recurrent binge eating (large quantities and lacking control)

• Recurrent compensatory behavior (eg., selfinduced
vomiting, over-exercise, enemas, laxatives)

• Above 2 both occur together 3 consecutive
months

• Self image highly influenced by shape and weight

• Does not occur in setting of anorexia***

• Subtypes:
– Purging
– nonpurging
Bulemia Nervosa
What is the most common eating disorder?

**EXAM**
***Eating Disorder NOS***

• Aberrant eating patterns and weight management that do not meet criteria for anorexia or bulimia.

• Criteria met for Anorexia but has menses or weight normal ***

• Met for bulimia but happens less than 2x weekly
or less than 3 months duration

• Chewing and spitting out food

• Binging w/o compensation
What sign/symptom has a 90% prevalence in eating disorders?
Vomiting 90%
What is Russell's sign?
Scaring on back of hand from self induced vomiting
Neuroendocrine effects of Anorexia and Bulemia

-Cortisol

-Thyroid Hormones

- Estrogen, LH, FSH

****
Cortisol = increased

Thyroid hormones usually all decreased including TSH but TSH can be variable

Estrogen, Progesterone and LH/FSH all lowered (Amenorrhea)
- metabolic disturbances that
occur as a result of reinstitution of nutrition to
patients who are starved or malnourished

• Refeeding process requires phosphates, magnesium and potassium

• Can cause Hepatitis

• Close monitoring of blood biochemistry is therefore necessary in the early refeeding period.

• Energy intake should remain only 50-70% that
of normally required for the first 3–5 days
Refeeding Syndrome
If a patient has been starving, what should there energy intake be for the first 3-5 days?
Energy intake should remain only 50-70% that
of normally required for the first 3–5 days

(Avoid Refeeding Syndrome)
What neuroendocrine level MUST be checked in all Anorexia and Bulemia patients?

**EXAM**
Thyroid Hormones and TSH!!
What is the most common psychiatric disorder to accompany eating disorders?
Major Depression (MDD)
Anorexia Vs. Bulemia

-cold intolerance

-lack of sexual interest
Anorexia

(Bulemia has no cold intolerance and normalsex interest)
Anorexia Vs. Bulemia

-Hypokalemia is only lab symptom
Bulemia
Anorexia Vs. Bulemia

-Hypokalemia
-Metabolic Acidosis
-Increased Serum Urea
-Decresead thyroid hormones**
Anorexia
What are the most common causes of fatality for Anorexia and Bulemia?
**Anorexia = hypophosphatemia
(W/ re-feeding can lead to Resp. & Heart Failure)

**Bulemia = hypokalemia assoc. w/ purging
A patient has a BMI less than 17.5 ... What do you do?
HOSPITALIZE

Consider **Family Intervention**
When should you hospitalize a bulemic patient?
if they have medical issues secondary to their disorder

(electrolytes, esophageal scrarring)