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24 Cards in this Set
- Front
- Back
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What is the difference between Anorexia nervosa, Bulimia nervosa and Binge eating disorder? |
Anorexia = Very low weight patients, achieved because of fear of fatness. Bulimia = Patients are often normal weight, weight loss is attempted but they fall into viscous cycle of restriction/binge/purge repeat. Called a dysregulation disorder. Binge eating disorder = Patients are often overweight. They binge as compensation to restrictive beheviours but not strong enough to starve and so eventually become overweight in an attempt to lose weight. They can't bring themselves to purge and so become overweight. |
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Out of the three eating disorders which one brings with it the highest acute illness risks? |
Bulimia nervosa is the most dangerous acutely. This is because of the electrolyte imbalance caused by the excessive vomiting leading to risk of heart problems and seizures. |
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The name of the questionnaire used to screen for eating disorders is called SCOFF - what are the questions? If patients have 2 or more yes answers then they are almost guaranteed to have an eating disorder. |
Do you ever make yourself SICK becasue you feel uncomfortably ill? Doyou worry you have lost CONTROL overhow much you eat? Haveyou recently lost more than ONE stone in a three month period? Doyou believe yourself to be FAT whenothers say you are too thin? Wouldyou say that FOOD dominates yourlife? *very beneficial as has a 90% accuracy* |
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What are the etiological causes for a person developing anorexia nervosa? |
Main cause is inheritaned/genetic personality type: Inherited pre-dispostion to OCD, anxiety disorders, strict up tight parents. Also linked with the onset of puberty - patients suddenly develope and adult mind which is very aware of the 21st centruary society pressures. *genetic link proven by the fact that if monozygotic twin has an ED then other twin has 65% chance of developing one themselves* |
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What are the psychological disorders that are linked and share co-morbidities with anorexia nervosa? |
Anorexia often found in individuals (and families) who also have... OCD Anxiety disorders Autism Compulsive exercise disorders |
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What is the common pathway of progression that leads a patient into becoming Bulimic? |
Predisposing genetic factors - Life events/triggers - Food restriction - Extreme hunger - Out of control binge - Purge - Leading back to food restriction to make up for binge, and so the cycle goes on |
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Why do patients with Bulimia nervosa get into a cycle of making themselves sick after a binge? |
Making yourself sick stimulates the vagus nerve. When stimulated the vagus nerve actually illicit a pleasurable calming feeling. They become hooked on the feeling of relaxation and control that purging creates. * more common in those who inherited more impulsive, addictive personality traits* |
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What methods do patients with bulimia nervosa use to get rid of unwanted calories?
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Vomiting Chewing food then spitting it out Overexercise Cooling - inadequate dress, opening windows Blood letting Medication abuse - e.g laxatives Deliberate self harm - as a punishment to themselves for if they dont stick to their eating regime. Almost as if they are treating themselves as a prison and illicting punishment for stepping out of line. |
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What is the average time from diagnosis of anorexia/bulimia nervosa to full recovery?
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Average time from diagnosis to full recovery = 7 years |
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What are the common psychological consequences of eating disorders? |
Often eating disorders lead to.. Depression - difficult to treat because low weight people don't respond well to antidepressants Anxiety OCD |
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What are the life threatening consequences of eating disorders? Particularly for the brain and heart |
Starvation causes - heart problems, anaemia, infertility, reduced immune system Purging causes - electrolyte imbalance, leading to seizures and arythmias (risk of MI) Overexercise - brittle bones (osteoporosis), heat stroke and dehydration If ED occurs during development then growth is affected, height and brain growth ect. Intentional hypothermia - increased risk of infections Water loading - drinking lots of water, black coffee, diet drinks to replace empty stomach can lead to hypoatreamia (very low sodium levels - leads to kidney damage) *has the highest death rate of any psychiatric disorder* |
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What is the most vulnerable time for death for a patient with a diagnosed ED? |
The most vulnerable time for patients is when they transition from child services (CAMHS) to adult services. *average life expectancy for patient with ongoing anorexia or bulimia is 39* |
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Of the 3 eating disorders, which is the most treatable and has the best recovery rates? |
Binge eating disorder has the best recovery rates. |
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What is the 1st line treatment for Bulimia Nervosa?
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The best treatment for Bulimia is CBT IPT & High dose antidepressant - Fluoxetine is second line |
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In anorexia nervosa what type of psychotherapy has been proven to be the most effective? |
Most effective psychotherapy in anorexia nervousa is FBT (family based treatment) |
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If a patient presents with dangerously low weight anorexia nervosa then what is the first line treatment? |
Very low weight anorexia: Food supplements + Olazapine - helps anxiety + Once weight restored then high dose antidepressants. *antidepressants dont work in low doses on very thin patients, although there weight needs to built up to a certain point before they can be given otherwise very dangerous* |
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What behaviours increase the likelihood of relapse in recovering ED patients? |
Continuing to be overactive + exercising in solitude Drinking calorie free drinks and black coffee Following a restrictive diet Purging behaviours Isolation and secrecy Having a baby (50% relapse rates) Weight losing illness - e.g Diabetes |
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If a patient presents with very low weight, then what tests should be ran to assess potential damage caused to their bodies? |
BMI - less than 14 greatly increases morbidity Physical exam Muscle power ECG |
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What methods might a bulimic patient use beyond purging to cause forced weight loss? |
Use of over exercise Laxatives Hunger suppressants |
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At what age does a patient have right to make decisions over their own treatment and whether to involve family or not? |
Patients 16+ have right to make decisions on one treatment and whether to involve family members ect. |
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In bulimia what is the recommended treatment and how does this differ from the treatment for anorexia? |
Recommended treatment for Bulimia in patients of a normal weight is CBT and Antidepressants (e.g Fluoxetine if under 18, Citalopram if over) In anorexia they are often too underweight to be stated on antidepressants. Instead focus is on Family based therapy and positive interviewing. Sometimes they will be started on antipsychotics. |
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In a patient who presents to A&E with bulimia, what blood tests is it important to carry out? |
Bulimia often causes electrolyte imbalance so check for Na, K and Ca levels + Also check for hypoglycaemia and anaemia |
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What are possible co-morbities which are associated with Bulimia? |
Bulimia is associated with... Teeth problems (due to excessive sickness) Electrolyte disturbances causing Seizures and Arrythmias Depression/Anxiety Self harm |
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What is the recommended antidepressant for under 18s? |
Under 18s are recommended to take Fluoxetine *Citalopram is for over 18s with anxiety, OCD related depression* |
