Eating Disorders

Question 1

If a pt has a plan for their suicide or intent, what should you do?

Answer 1

hosptialize

BN and AN have 5-7 times higher suicide rates

Question 2

What are the requirements for AN dx?

Answer 2

1. Restriction of energy intake leading to significantly low body weight (LBW)
2. Intense fear of gaining weight, behavior that interferes with weight gain
3. Distorted perception of body weight and shape, weight = their self worth, denial of medical seriousness of LBW

Question 3

What qualifies a restricting type AN? binge eating/purging?

Answer 3

1. Restricting: excessive exercising, fasting, dieting; 3 mo of no binging or purging
2. Binge eating/Purging: 3 mo of self induced purging (V, laxatives, diuretics…)

crossover is common (mixed type of AN)

Question 4

Even if they acknowledge emaciated appearance, AN pts may still deny…

Answer 4

starvation sx

weight loss offers sense of control

Question 5

What serious medical conditions are associated with AN?

Answer 5

1. Cardiac: bradycardia, hypoT, QT dispersion, cardiac atrophy, MVP
2. Electrolyte: dehydration, hypoK, hypoP, hypoMg

Question 6

What happens if you re-feed a AN pt too quickly?

Answer 6

third spacing →

hypoK/hypoP

CHF

edema

seizures

hemolysis

rhabdomyolysis

Question 7

What other pysch disorders are often found in AN pts?

Answer 7

mood disorders (depression, dysthymic disorder)

personality disorder (OC, avoidant, dependent, narcissistic, paranoid, borderline)

Question 8

What are the keys to AN tx?

Answer 8

interdisciplinary team

nutritional rehab

psychotherapy

hospitalization (until normal wt achieved)

meds

CBT and Family Therapy are very important

Question 9

What is the criteria for BN?

Answer 9

1. Recurrent epsidoes of binge eating
2. Recurrent compensatory behavior to control wt
   
   1. 1 + 2 occur at least 2x per wk for 3 mo
3. Pt’s self eval is unduly influenced by wt/shape
4. Disturbance doesn’t occur exclusively during an episode of AN

Question 10

What medical complications occur due to BN?

Answer 10

Question 11

What comorbidities are associated with BN?

Answer 11

anxiety, mood, substance use disorders

personality disorders (OC, avoidant, dependent, histrionic, paranoid, borderline)

Question 12

How do we tx BN?

Answer 12

combo of nutritional rehab, CBT, and pharm

CBT is tx of choice as it helps recude binging/purging

First line pharm is fluoxetine (second line is sertraline or fluvoxamine)

Question 13

What qualifies a BED dx?

Answer 13

1. Episodes of binge eating marked by at least 3 of the following:
   
   1. Eating large amounts of food when not hungry
   2. Eats rapidly
   3. Feels uncomfortably full
   4. Eating alone
   5. Feelings of guild, depresison disgust
2. Episodes average 1x per week for 3 mo
3. No regular use of compensatory behaviors

Question 14

How do we tx BED?

Answer 14

psychotherapy is first line (CBT, IPT)

Vyvanse (only approved med)

anit-obesity drugs are NOT recommended