anorexia

what is is the definition of anorexia nervosa?

the refusal to maintain a normal bodyweight by self-starvation

what is the ratio of female to male that have anorexia nervosa?

10:1

what is the most common ages with anorexia nervosa?

15-20 (but onset is often earlier)

what are the diagnostic guidelines for AN?

- restriction causing a body weight below 15% of that expected or BMI <17.5 (but this is now not explicitly mentioned in DSM-5) only that they have significantly low body weight

- intense fear of becoming overweight, even though underweight

- body image distortion

what are the biological features of anorexia?

- weight loss

- muscle wasting

- osteoporosis

- acrocyanosis

- sexual dysfunction

- orthostatic hypotension

- endocrine disorders

what endocrine disorders can be caused by anorexia nervosa?

- amenorrhoea

- lanugo

what is lanugo?

fine downy hair (to keep pt warm)

what is acrocyanosis?

cyanosis of hands and feet

what are the psychological signs of anorexia?

- intense fear of gaining weight

- personality changes

- denial

- perfectionism (overvalues ideas)

- low self-esteem

what are the social (behavioural) signs of anorexia?

- obsessive behaviour attached to eating

- wearing baggy clothes

- vomiting

- using laxative/diuretics

- excessive exercise

what can be the changes in the blood tests?

most things lows but the G's and C's are raised:

- hypercholesterolaemia

- hypercarotenaemia

- hypercorticolism

- raised growth hormone

- hyperglycaemia

- enlarged salivary glands

what are the key features of the blood that are low in anorexia?

- FSH and LH

- oestrogen and testosterone

- hypokalaemia

- low T3

what is hypercarotenaemia?

high levels of b-carotene in blood leading to orange discolouration of hands

what causes hypercarotenaemia?

ingesting mostly only foods containing carotenoids (vegetables) and having a slow metabolism decreases the breakdown of b-carotenoids - so they build up

what is the risk of developing anorexia nervosa if a first degree relative has it?

29%

what are the psychological/social influences contributing to AN?

- parental influences - particularly excessive parental control

- family pressures - regarding weight/diet/appearance

- societal/media influences

- stressors and negative life events - abuse, bereavement, divorce

how are EDs assessed?

SCOFF questionnaire

what are the 5 questions of the SCOFF questionnaire?

- do you make yourself Sick because you feel uncomfortably full?

- do you worry you have lost Control over how much you eat?

- have you recently lost more than One stone in a 3 month period?

- do you believe yourself to be Fat when others say you are too thin?

- would you say Food dominates your life?

what are the interpretations from the scoff questionnaire?

0 - do not have an eating disorder

1 - do not have an eating disorder (but indicates issues with food or body image)

2 - anorexia or bulimia (but not diagnostic)

what is the criteria for hospitalisation with an eating disorder?

- malnutrition

- serious physical abnormalities

- acute psychiatric emergency (suicide risk/psychosis)

what can be used to assess risk in pts with AN?

marsipan checklist

what may be the main form of treatment in hospital?

forcibly refeeding via tube

what are the other types of management that can be used for AN?

- atypical antipsychotics

- SSRIs - for symptoms of depression and anxiety

- nutritional education

- CBT

- family therapy

what is recommended as the first line treatment in children in young people?

anorexia focused family therapy

what is mantra?

maudsley anorexia nervosa treatment for adults

what is refeeding syndrome?

- hypophosphataemia

- hypomagnesaemia

- hypokalaemia

due to refeeding too quickly

what are the complications fo refeeding syndrome?

- fatigue

- weakness

- confusion

- resp distress

- high bp

- seizures

- arrhythmias

- heart failure

- coma

- death

how can refeeding syndrome be avoided?

small calorific increase - 500 cals per day whilst being renourished

what is the prognosis for anorexia?

poor

- less than 50% recover

- highest mortality rate out of any psychiatric disorder - 10%