Behav. Sci. Eating disorders

Question 1

obesity definition

Answer 1

more than 20% over ideal weight (BMI >30)

Question 2

genetic component of obesity

Answer 2

leptin receptor mutation

melanocortin 4 receptor mutation

Question 3

iatrogenic component of obesity

Answer 3

anti-psychotics and/or anti-depressants by blocking H1, Achm, 5HT2c receptors (anti-histamines turn off satiety center)
increase prolactin by D2 receptor blockade

Question 4

what are the pharmacologic options for obesity?

Answer 4

amphetamines (decreases appetite, but gain weight when you go off)
orlistat (lipase inhibitor in gut - like putting someone on a low fat diet - but get diarrhea)
see updated PP for other 3 drugs*
Lorcaserin stimulates 2C not blocks*

Question 5

what are the other options outside of medications to treat obesity?

Answer 5

surgical (bariatric and gastric banding)

realistic diet and exercise

Question 6

anorexia nervosa diagnosis

Answer 6

• restriction of energy intake requirements leading to low body weight
• fear of gaining weight
• body image disturbance

Question 7

what are the different subgroups of anorexia nervosa?

Answer 7

restricting = does not eat, does not purge

binge/purge type = does binge or purge

Question 8

what is the severity of anorexia nervosa based on?

Answer 8

BMI

Question 9

what is the personality profile of an anorexic?

Answer 9

rigid, controlling, high achieving

Question 10

what is the most likely etiology of anorexia?

Answer 10

biopsychosocial approach
also: need control in life, lack sense of autonomy self, media/industry, family mood/drug disorders, neurepinephrine imbalance - low

Question 11

comorbidity with anorexia

Answer 11

depression 50%, suicide increase, OCD, anxiety, rigid/perfectionist, delayed psychosexual development, denial, minimization, delusion

Question 12

medical issues with anorexia

Answer 12

weight loss, hypothermia, edema, bradycardia hypotension, syncope, amenorrhea, electrolyte imbalance, lanugo hair, osteoporosis, delayed gastric emptying, metabolic acidosis, organ failure

Question 13

common course for anorexia

Answer 13

• from spontaneous recover to gradual starvation and death

- recovery is only partial -> food preoccupation, poor social relations and depression continue

Question 14

treatment course hospitalization

Answer 14

• restore nutritional state once 20% typical weight lost
• 2-6 months if 30%
• forced tube feedings, especially if severe, end organ damage, electrolyte or cardiac findings or patient unwilling to comply
• firm consistency
• behavioral plan

Question 15

treatment for anorexia

Answer 15

-programming (AM weights, I/Os, labs, inaccessible bathrooms, progressives diets yield rewards, continue as day treatment then outpatient)
psychotherapy (psychodynamic, CBT, family)

Question 16

medications for anorexia

Answer 16

???

• tricyclic antidepressents (+/-)
• SSRI
• ECT if depressed
• treat all comorbidities if detected (anxiety, depression, substance use)

Question 17

what are the weight gain cocktails

Answer 17

mirtazapine and olanzapine

Question 18

bulimia nervosa criteria

Answer 18

• recurrent binge eating
• eating an atypically large amount in discrete period of time disproportionate to typical eating
• purging vs non-purging types
• no anorexia present (otherwise called purge anorexia)
• loss of control
• compensatory behaviors (vomiting, laxatives, enemas, diuretics, exercise)
• binges 1X/wk for 3 months

Question 19

how often do binges occur to be considered bulimia nervosa?

Answer 19

1X/wk for 3 months

Question 20

which eating disorder has the greater prevalence?

Answer 20

bulimia more than anorexia

Question 21

personality traits with bulimia

Answer 21

outgoing, angry, impulsive, borderline personality, less control, substance abuse

Question 22

medical problems with bulimia

Answer 22

• poor dentition, enamel loss, cavities
• abraided knuckles (Russell’s sign)
• low PO4, low Mg
• high amylase
• salivary enlargement
• esophagitis/tears

Question 23

who is bulimia common in?

Answer 23

college aged females who are normal/overweight and sexually active

Question 24

course for bulimia

Answer 24

better than anorexia
50%+ improvement in most patients
waxing/waning course
3 year follow up, 30% doing well

Question 25

treatment for bulimia

Answer 25

individual therapy (CBT vs dynamics, group therapy, family therapy) - SSRI approved - hospitalization rarely needed

Question 26

medications for bulimia

Answer 26

antidepressants (SSRI) | -imipramine, desipramine (TCAs), trazodone, MAOi

Question 27

binge eating disorder

Answer 27

binges, lack of control, ego dystonic, 1x/wk for 3 months, NO PURGES OR COMPENSATIONS

Question 28

avoidant/restrictive food intake disorder

Answer 28

don't meet full anorexia criteria - failure to meet diet/energy needs - weight loss, nutritional deficiency, supplementation needed, psychosocial distress

Question 29

PICA

Answer 29

persistent eating of non-nutritive substance x1mo - not developmentally or culturally appropriate - not medical or from intellectual disability or autism

Question 30

rumination

Answer 30

repeated regurgitation and re-chewing of food - no weight gain - not medical or from intellectual disability or autism - before 6 years