Feeding, Eating, and Sleep-Wake Disorders Review

Comprehensive practice flashcards covering feeding and eating disorders, sleep-wake disorders, diagnostic criteria, prevalence, differential diagnoses, case conceptualization, and treatment modalities based on the lecture notes.

What is the primary diagnostic criterion regarding the duration and nature of nonfood substances consumed in Pica?

Persistent eating of nonnutritive, nonfood substances over a period of at least $1\,\text{month}$ that is inappropriate to the developmental level of the individual.

What is the estimated prevalence of Pica among pregnant women who experience food insecurity?

Roughly one-third of pregnant women with food insecurity (i.e., without reliable access to affordable and nutritious food) engage in pica.

How is Rumination Disorder defined in terms of regurgitation and duration?

A condition in which a person repeatedly regurgitates undigested or partially digested food from the stomach over a period of at least $1\,\text{month}$.

What are the key physical symptoms and characteristics of regurgitation in Rumination Disorder?

Effortless regurgitation typically within minutes of eating, belly pain or pressure relieved by regurgitation, a feeling of fullness, nausea, and losing weight without trying.

How does Avoidant/Restrictive Food Intake Disorder (ARFID) differ fundamentally from Anorexia Nervosa regarding body image?

ARFID causes a limit to the amount and type of food eaten, but it is not the result of a distorted self-image or an attempt to lose body weight.

What are the three core diagnostic criteria for Anorexia Nervosa?

1. Restriction of energy intake relative to requirements leading to a significantly low body weight.
2. Intense fear of gaining weight/becoming fat, or persistent behavior interfering with weight gain.
3. Disturbance in how body weight or shape is experienced, undue influence on self-evaluation, or lack of recognition of low weight seriousness.

What is the crude mortality rate per decade for Anorexia Nervosa, and what are its primary causes?

The crude mortality rate is approximately $5\%$ per decade, with death most commonly resulting from medical complications associated with the disorder itself or from suicide.

What minimum frequency and duration of binge eating and compensatory behaviors are required for a diagnosis of Bulimia Nervosa?

Binge eating and inappropriate compensatory behaviors must both occur, on average, at least once a week for $3\,\text{months}$.

Which distinct facial symptom is listed as a physical sign of Bulimia Nervosa due to purging?

Facial swelling, commonly referred to as "chipmunk cheeks," as well as bloodshot eyes.

What distinguishes Binge-Eating Disorder from Bulimia Nervosa?

Binge-Eating Disorder is characterized by recurrent episodes of eating large amounts of food with a lack of control, but it is not associated with the recurrent use of inappropriate compensatory behaviors (purging).

How is Atypical Anorexia Nervosa defined under Other Specified Feeding/Eating Disorders?

All of the criteria for anorexia nervosa are met except that the individual's weight is within or above the normal range.

What are the diagnostic features of Night Eating Syndrome?

Recurrent episodes of night eating (eating after awakening from sleep or excessive food consumption after the evening meal) with awareness and recall of the eating, causing significant distress or impairment.

What frequency and duration criteria are required for diagnosing Insomnia Disorder?

The sleep difficulty must occur at least $3\,\text{nights}$ per week and be present for at least $3\,\text{months}$.

What main sleep period duration and symptom frequency are required for a diagnosis of Hypersomnolence Disorder?

Self-reported excessive sleepiness despite a main sleep period lasting at least $7\,\text{hours}$, occurring at least $3\,\text{times}$ per week for at least $3\,\text{months}$.

What distinguishes Type 1 Narcolepsy (NT1) from Type 2 Narcolepsy (NT2)?

Type 1 (NT1) features cataplexy or hypocretin deficiency, whereas Type 2 (NT2) occurs without cataplexy and either without hypocretin deficiency or with hypocretin unmeasured.

What polysomnographic evidence options are required to diagnose Obstructive Sleep Apnea Hypopnea?

Either evidence of at least $5$ obstructive apneas or hypopneas per hour of sleep with nocturnal breathing disturbances/daytime sleepiness, OR evidence of $15$ or more obstructive apneas/hypopneas per hour regardless of accompanying symptoms.

How are the severity levels of Obstructive Sleep Apnea Hypopnea classified using the Apnea-Hypopnea Index (AHI)?

Mild: AHI is less than $15$; Moderate: AHI is $15\text{--}30$; Severe: AHI is greater than $30$.

What pattern of tidal volume variation characterizes Cheyne-Stokes breathing in Central Sleep Apnea?

A pattern of periodic crescendo-decrescendo variation in tidal volume that results in central apneas and hypopneas occurring at a frequency of at least $5\,\text{events}$ per hour.

Which specific gene mutation is associated with Congenital Central Alveolar Hypoventilation?

Mutations of the $PHOX2B$ gene, which is crucial for the development of the embryonic autonomic nervous system and neural crest derivatives.

What sleep-wake pattern disruption defines Delayed Sleep Phase Type circadian rhythm disorder?

A pattern of delayed sleep onset and awakening times, with an inability to fall asleep and awaken at a desired or conventionally acceptable earlier time.

Which physical condition is identified as a major genetic/physiological risk factor for Non-24-Hour Sleep-Wake Type disorder?

Blindness, due to lack of light perception needed to synchronize circadian rhythms to the 24-hour environment.

When during the sleep episode do NREM Sleep Arousal Disorders typically occur, and what is recalled regarding dream imagery?

They usually occur during the first third of the major sleep episode, with no or little (e.g., only a single visual scene) recalled dream imagery, along with amnesia for the episode.

During which part of sleep do nightmares occur in Nightmare Disorder, and how does state of consciousness differ upon awakening compared to NREM arousal disorders?

Nightmares generally occur during the second half of the major sleep episode (REM sleep), and upon awakening, the individual rapidly becomes oriented and alert.

Individuals with idiopathic REM Sleep Behavior Disorder have a high risk of developing which neurodegenerative condition within 10–15 years?

A synucleinopathy, most often Parkinson's disease, major or mild neurocognitive disorder with Lewy bodies, or multiple system atrophy (approximately $75\%$ risk within $10\text{--}15\,\text{years}$).

What are the diagnostic features of the urge to move legs in Restless Legs Syndrome (Willis-Ekbom disease)?

The urge begins or worsens during rest/inactivity, is partially or totally relieved by movement, is worse in the evening or at night, and occurs at least $3\,\text{times}$ per week for at least $3\,\text{months}$.

In the case study of Lucy Tonge, what vaccine was associated with her narcolepsy onset, and what biological dysfunction underlies this disorder?

Her symptoms developed several months after receiving the Pandemrix swine flu vaccine; biologically, narcolepsy with cataplexy is associated with the dysfunction or loss of orexin-producing neurons.

How do Obstructive Sleep Apnea (OSA) and Central Sleep Apnea (CSA) differ in terms of respiratory cause?

OSA results from physical upper airway blockage with prominent snoring, while CSA is caused by reduced or absent respiratory effort, with snoring being less common or absent.

What behavioral and medical treatments are specified for Anorexia Nervosa and Bulimia Nervosa?

Anorexia Nervosa: CBT-E, Nutritional Rehabilitation, Family-Based Therapy. Bulimia Nervosa: CBT-E, Nutritional Rehabilitation, SSRIs.

Which medications are listed for treating Narcolepsy and Hypersomnolence Disorder?

Hypersomnolence Disorder: Modafinil/Armodafinil, Changes in sleep hygiene, Methylphenidate. Narcolepsy: Modafinil/Armodafinil, SSRIs/SNRIs, Methylphenidate.