feeding/elimination/sleep disorders

eating non-nutritive, nonfood substances

pica

pica

eating non-nutritive, nonfood substances for 1+ months and not due to developmental level or culture. can occur at any age but is most common in children and pregnant women

what demographic is pica most common in

can occur at any age but is most common in children and pregnant women

timeframe for pica

1+ months

anorexia

• restriction of energy intake that causes a low weight for their age, sex, development, and health

• intense fear of gaining weight or engage in behavior that interferes with weight gain

• dysmorphia, negative self-talk, or lack of awareness of seriousness.

• restriction of energy intake that causes a low weight for their age, sex, development, and health

• intense fear of gaining weight or engage in behavior that interferes with weight gain

• dysmorphia, negative self-talk, or lack of awareness of seriousness.

anorexia

anorexia specifiers

type (restrict or binge/purge), course (partial or full remission), and severity

specifiers include: type (restrict or binge/purge), course (partial or full remission), and severity

anorexia

disorders comorbid with anorexia

depression or anxiety disorder (especially OCD). anorexia is often proceeded by anxiety

how common is anorexia relapse

frequent relapses before stable eating and weight is obtained

one of the most difficult disorders to treat because people deny its a problem and resist treatment

anorexia

anorexia prognosis

similar to bulimia but usually worse

which prognosis is worth, anorexia or bulimia?

anorexia

the first treatment goal for anorexia

restore to a healthy weight and address physical complications

anorexia goals

• restore healthy weight

• increase motivation for treatment

• psychoed

• identify and change beliefs/emotions

• treat psychological conditions (low self-esteem)

• enlist family support

• relapse prevention

main treatments of anorexia

CBT, CBT-E, FBT (family-based)

a post hospitalization intervention based on the assumption that shape and weight concerns cause restriction and extreme weight loss methods

CBT

this treatment uses behavioral strategies to establish regular eating patterns, eliminate negative thoughts, and increase motivation in patients with anorexia

CBT

a personalized and flexible treatment that focuses on the factors that are maintaining symptoms. says eating disorders are all shaped by the same core issue: excessive value given to weight and appearance.

CBT-E

CBT-E

a personalized and flexible treatment that focuses on the factors that are maintaining symptoms. says eating disorders are all shaped by the same core issue: excessive value given to weight and appearance.

FBT

outpatient intervention for medically stable teens. includes 3 phases:

• parents take charge of their health

• control gradually returned to teen

• address developmental issues (establishing independence and healthy parent-child relationship)

outpatient intervention for medically stable teens. includes 3 phases:

• parents take charge of their health

• control gradually returned to teen

• address developmental issues (establishing independence and healthy parent-child relationship)

FBT

drugs used for anorexia

antipsychotic olanzapine and SSRI fluoxetine. but research has been inconsistent so some people only treat comorbid depression and anxiety

diagnostic criteria for bulimia

binging, lack of control, inappropriate compensatory behavior (vomiting, exercise) at least 1x/week for 3+ months

bulimia specifiers

course (partial or full remission) and severity

in bulimia, the frequency and timeline of binging/compensatory behavior is

1x/week for 3+ months

bulimia comorbid disorders

depression and anxiety (which often comes before the eating disorder)

describe the weight of people with bulimia

average or overweight

medical complications with bulimia

average or overweight, issues as a result of compensatory strategies (purging impacts dental problems, GI, dehydration, electrolyte imbalance, heart arrhythmia, death

main treatments for bulimia

nutritional rehabilitation plus CBT, CBT-E, IPT, or FBT for bulimia

comparison between CBT, CBT-E, and FBT for bulimia

similar effects but CBT and CBT-E are usually preferred because IPT takes longer

the first goal of FBT for bulimia (compared to anorexia)

disrupting binge/purge and other behaviors and establish healthy eating. in anorexia, treatment is more collaborative with parent-teen because they are less motivated

meds for bulimia

antidepressants (especially fluoxetine)

binge-eating disorder criteria

eating an amount of food larger than what most people would eat in the same time frame, plus lack of control. 1x/week for 3+ months.

must have 5:

• eating faster than usual

• eat until uncomfortable full

• eating large amounts when not hungry

• embarrassment about binging

binge-eating disorder frequency of episodes/timeframe

1x/week for 3+ months.

specifiers for BED

severity (mild, moderate, severe, extreme) determined by number of episodes per week.

binge-eating disorder frequency women v men

women 2-3x more common

binge-eating disorder demographics

women (2-3x more than men), and in people who are average, overweight, or obese.

difference between bulimia and BED

BED they have more motivation for treatment and don’t engage in compensatory behaviors

does dieting come before or after bulimia diagnosis?

before

does dieting come before or after binge-eating diagnosis

after

treatments for binge-eating disorder

CBT-E and IPT

which treatment is most effective for binge-eating disorder?

CBT-E

meds for binge-eating disorder

SSRIs, anti-seizure med topiramate, the CNS stimulant lisdexamfetamine

meds vs CBT for binge-eating disorder

CBT is better than medication alone and is no different from combining CBT with meds

frequency and timeline of enuresis

2x/week for 3+months OR causes distress/impair functioning

age onset for enuresis

must be 5+ years old or equivalent developmental level

most common treatments for enuresis

moisture alarm/bell-and-pad, antidiuretic desmopressin

meds for enuresis

antidiuretic desmopressin but has high risk for relapse when its stopped

insomnia diagnostic criteria

difficulty initiating or maintaining sleep or early-morning awakening with inability to return to sleep. 3x/week for 3+ months despite opportunities for sleep, causes distress/impaired functioning

insomnia frequency and timeline

3x/week for 3+ months

3 types of insomnia

sleep-onset (initial) - difficulty falling asleep

sleep maintenance (middle)

late insomnia - waking up early

most common type of insomnia

in most cases it is all 3, but the most common single type is sleep maintenance

when asked later, how well do insomniacs remember their sleep quality compared to EEG?

they remember it being worse (overestimate latencies, overestimate time awake, underestimate total sleep time

behavioral treatments for insomnia

CBT-I and CT-I

CBT-I

first-line treatment for insomnia that focuses on stimulus control (pair bed with sleep), sleep restriction and then increase as sleep improves on sleep diary, sleep hygiene, relaxation training, cognitive restructuring

first-line treatment for insomnia that focuses on stimulus control (pair bed with sleep), sleep restriction and then increase as sleep improves on sleep diary, sleep hygiene, relaxation training, cognitive restructuring

CBT-I

what is stimulus control in CBT-I

going to bed only when tired and only for sleep

what is sleep restriction in CBT-I

restricting the time in bed to the amount of time they usually sleep, then slowly increasing as sleep efficiency (time spent asleep) improves

CT-I

focuses on reversing sleep-related worry and rumination, selective attention and monitoring for sleep-related threats, unhelpful beliefs about sleep, misperceptions about sleep deficits, and sleep-related safety behaviors

focuses on reversing sleep-related worry and rumination, selective attention and monitoring for sleep-related threats, unhelpful beliefs about sleep, misperceptions about sleep deficits, and sleep-related safety behaviors

Harvey’s model CT-I

what are sleep-related safety behaviors in CT-I

counterproductive coping strategies to increase control but actually worsens insomnia by preventing discomfort (avoiding talking about it, canceling night plans, constantly checking time, try to suppress thoughts)

narcolepsy

irrepressible need to sleep that causes sleep or daytime naps 3x/weeks for 3+ months, includes cataplexy (often triggered by strong emotion), hypocretin deficiency, or REM of 15 minutes or less, and sometimes hallucinations

irrepressible need to sleep that causes sleep or daytime naps 3x/weeks for 3+ months, includes cataplexy (often triggered by strong emotion), hypocretin deficiency, or REM of 15 minutes or less, and sometimes hallucinations or sleep paralysis

narcolespy

hypnagogic or hypnopompic hallucinations

in narcolepsy, occurs just before falling asleep or right after awakening

treatment for narcolepsy

behavioral strategies + meds to improve alertness and reduce cataplexy (modafinil and armodafinil)

meds to treat narcolepsy and cataplexy, and how they work

modafinil and armodafinil - increase dopamine

other stimulants - increase dopamine, serotonin, norepinephrine

for cataplexy → antidepressant and sodium oxybate

non-REM sleep arousal disorders

sleepwalking and sleep terrors

non-rapid eye movement sleep disorders and when they occur

recurrent episodes of incomplete awakening (sleepwalk, sleep terror), usually in stage 3 or 4 in the first third of a major sleep period

age onset sleepwalking

most common in childhood and decreases in frequency with age

nightmare disorder and when they occur

repeated dysphoric and well-remembered dreams involving avoiding threat. they occur during REM in the second half of a major sleep period. they may continue to have dysphoric mood after wakening but will be alert