eating disorders

average age of onset is

12-25yrs

what are some protective factors against developing a eating disorder

high self-esteem, positive body image, emotional well-being, eating regular meals with family, belonging to a culture that accepts a range of body shapes and sizes, involvement in a sport where there is no emphasis on physical thinness, body acceptance, a healthy relationship with food and eating

what does a healthy relationship with food and eating consist of

eating a variety of different foods from all food groups, eating an appropriate quantity of food, eating with flexibility spontaneity and enjoyment, eating when you are hungry and stopping when you are full, eating that does not interfere with everyday life

what is avoidant/restrictive food intake disorder

avoiding and restricting food, however NOT due to body image disturbance

what is PICA

when a person eats non-nutritive or non-food substances on a persistent basis over at least a month eg. eating paper

what is rumination disorder

regurgitation of food, which may be re-chewed, re-swallowed or spit out. it is understood to be subconscious behaviour

what is unspecified eating disorder

symptoms which are characteristic of a feeding and eating disorder but do not meet the full criteria for any disorders diagnostic class

______ is the major cause of mortality for people with eating disorders

suicide

what is anorexia nervosa

significant weight loss due to food restriction and starvation together with an intense fear of gaining weight

what are the 2 subtypes of anorexia

restrictive type and binge-eating/purging type

what is atypical anorexia nervosa

will meet all criteria of anorexia but still have a normal BMI eg. 18.5

the 3 domains of signs of anorexia are

physical, psychological and behavioural

What are the primary risk factors for anorexia

the degree of weight loss and chronicity of the illness

is pharmacology a standard intervention for anorexia?

no

what are the 2 approaches for anorexia

psychotherapy, nutritional support/rehab

when might someone need inpatient treatment for anorexia

medical/psychiatric stabilisation or intensive support and treatment

list some psychological therapies for children/adolescence with anorexia

family based treatment/family therapy (FBT) - parents are empowered to bring about the recovery of their child
CBT-ED, enhanced with family involvement
Adolscent focussed psychology - focusses on young persons ability to change his or her own behaviours with the support of the family and therapist

list some psychological therapies for adults with anorexia

MANTRA- developing the motivation to change and recover, improving food intake and nutrition
Specialist supportive clinical management (SSCM)- to support patients in a gradual return to normal eating, weight restoration and improved physical health
CBT-ED
Focal psychodynamic therapy- targets specific issues related to eating disorders, providing patients with the opportunity to gain insight into their emotions, thoughts, and behaviours

when do we use enteral feeding via an NG tube

if extremely underweight or highly refractory patients unable to eat sufficient food to gain weight. is better than TPN as it normalises GI function. use a TPN (parenteral) when NG not succesful

when might refeeding syndrome occur

when nutritional rehab is too aggressive. higher risk of occuring if electrolytes are not monitored

what is the hallmark syndrome of refeeding syndrome

hypophosphataemia, hypokalaemia, CCF, peripheral oedema, seizures

how do we prevent refeeding syndrome

correct electrolyte deficiencies prior to initiating refeeding within 12-24hrs
Thiamine should be given to prevent wernicke encaphalopathy because the intracellular uptake of electrolytes leads to increased utilization of thiamine, the person is most likely deficient.
daily multivitamin with selenium and zinc

what are some pharmacotherapy consideration in anorexia

low weight = increased risk of ADR’s - start low go slow
Depletion of body protein = increased free drug concentration in serum
Depletion of body fat = decreased volume of distribution

when might we use olanzapine

if person is refractory to nutritional rehab.helps with weight gain

which antipsychotics are not beneficial for weight gain for Anorexia

risperidone, quetiapine, aripiprazole

which antidepressant would you use for depression with anorexia

SSRI’s

which antidepressants would you AVOID in anorexia

TCA’s due to cardiotoxicity, Bupropion due to risk of seizures in eating disorders

which antidepressant would you use for relapse prevention in anorexia

fluoxetine

what is bulimia nervosa

characterised by recurrent episodes of binge eating, followed by vomiting or excessive exercise to prevent weight gain

how would you describe binge eating in bulimia nervosa

eating a very large amount of food within a short period of time AND feeling a sense of lack of control over eating

name some compensatory behaviours

vomiting, misusing laxatives, fasting, excessive exercise

what is the treatment of bulimia

psychotherapy and nutritional support

which condition would you use pharmacology for more? bulimia or anorexia

bulimia

does bulimia have very low BMI?

no

a reduction by _____ in frequency of binge purge cycles is clinically meaningful

50-75%

1st line bulimia

SSRI’s (fluoxetine 60mg, sertraline, escitalopram, fluvoxamine)

2nd line bulimia

topiramate 50-600mg daily, however can cause weight loss itself

describe binge eating disorder

experiencing a sense of lack of control and will eat a large amount of food within a relatively short period of time. evoking feelings of guilt and shame with NO COMPENSATORY MEASURES

who experiences binge eating disorder more? men or women

same

what are some characteristics of binge eating disorder

frequent episodes of binge eating, once a week for 3 months, eats quickly and when not hungry, guilt or shame around eating, eats alone

early mortality is significantly higher in

anorexia and bulimia

what are the psychological therapies for binge eating disorder

guided self-help CBT-ED, Cognitive behavioural therapy enhanced (focusses on addressing the characteristic disrutptions in eating habits and attitudes), interpersonal psychotherapy (IPT-ED)

what is the pharmacotherapy for BED

SSRI- fluoxetine, Topiramate, Lisdexamfetamine max 70mg weekly (under specialist). but psychotherapy is mainstay

t/f do not comment on a persons weight if they have an eating disorder

T