1 / 17

Eating Disorders

Eating Disorders. Anorexia Nervosa DSM-IV Definition 1) Refusal to maintain body weight within a normal range for height and age ( > 15% below ideal weight) 2) Fear of weight gain 3) Severe body image disturbances (self-worth and denial of serious illness)

chevelier
Download Presentation

Eating Disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Eating Disorders • Anorexia Nervosa DSM-IV Definition • 1) Refusal to maintain body weight within a normal range for height and age ( > 15% below ideal weight) • 2) Fear of weight gain • 3) Severe body image disturbances (self-worth and denial of serious illness) • 4) Absence of menstrual cycle/ amenorrhoea (for > 3 cycles) • 2 subtypes = restricting + binge/purging

  2. Eating Disorders • Bulimia Nervosa DSM-IV Definition • 1) Episodes of binge eating (loss of control) • 2) Followed by compensatory behaviour of • Purging type (vomiting, laxatives, diuretics) • Non-purging (execise, fasting, diets) • 3) Occurring > 2x / week for 3/12 • 4) Dissatisfaction with body shape / weight

  3. Epidemiology • 1-2 million BN in USA • 1/2 million AN in USA • AN prevalence overall = 0.27% • AN prevalence in 15-19y = 0.48% • BN prevalence overall = 1.5% • BN is more common in the >18y • Women 10:1 Men • Many more have ED-NOS ( eating disorder not otherwise specified

  4. Pathogenesis • Social pressure • Female athelete triad (eating disorder, amenorrhoea, and osteoprosis) • Related to a combination of psychological, biological, family, genetic, environmental and social factors. • Decreased self esteem or self control then using dieting behaviour and weight loss as a way of providing stability/ control on life. • Genetics = Monozygotic twins and 1st degree relatives have higher rates of eating disorders, Xolism, affective disorders

  5. Pathogenesis • Sexual abuse - no evidence • Family characteristics = high parental expectations, difficulty managing conflict, poor communication skills, enmeshment, estrangement, devaluation of maternal role and maritial tensions. • CNS / Hormonal • Nad = bradycardia and hypotension in starvation • Serotonin = high in AN, affects the appetite and satiety centres

  6. Screening • SCOFF Score >2 • Sick • Control ( or rather loss of it ) • One stone in < 3/12 • Fat • Food dominates life

  7. Examination • Vital signs ( PR and BP) • Lanugo hair • Callous formation • Parotid gland hypertrophy • Erosion of dental enamel on anterior teeth • CVS ( bradycardia, arrhythmias, MVP ) • GI • Neuro

  8. Investigations • FBC (anaemia) • Ur + Cr (dehydration) • Electrolytes + K, Ca, Mg, PO4 • B- HCG • TFTs • Prolactin (prolactinoma) • FSH

  9. Complications • Osteoporosis • Cardiac impairment • Psychiatric + Cognitive Changes • Infertility • GI Dysfunction ( slow motility, N, bloating) • Electrolytes ( K, metabolic alkalosis ) • Endocrine • low LH and FSH • Sick euthyroid ( high rT3 ) • low DHEA + IGF-1 • high cortisol + GH

  10. Osteopenia / Osteoporosis • Women accrue 40-60% of their bone mass during the adolescent years • Seen in 90% of those with AN • Long term risk of fracture increases x 3 • Causes - oestogen deficiency • - inadequate Vitamin D and Ca • - Lean body mass and nutritional • Pathophysiology - increased bone resorption • - decreased bone formation • (differing from meopause)

  11. Osteopenia / Osteoporosis Rx • Ix with DEXA then; • 1) Weight gain • 2) Elemental Ca 1200 - 1500 mg/ day • 3) Multivitamins providing 400 IU Vit D / day • 4) Oestrogen/ Progestin • no proven benefit as process is different to menopause • some benefit if < 70% ideal body weight • 5) IGF-1 (short term effects) • 6) DHEA • increases formation and decreases resorption in the short term

  12. Cardiac Mx • MVP occurs in 30 - 60% (3Xpopulation) • this is partly due to enhanced ability to detect MVP in patients with intravascular volume depletion • Prolonged QT interval seen in 33% • independent marker for arrhythmias and sudden death • Heart Failure in the first 2/52 of Re-feeding • Reduced cardiac contractility • Refeeding oedema • Mx by slow refeeding, repletion of PO4, avoid high Na

  13. Amenorrhoea • Seen in 90% of AN • Low levels of LH + FSH = low Oestrogen • Mx = Increase weight • Menses restarts in 90% in < 6/12 after achieving 90% ideal body weight

  14. Multidisciplinary Mx • a) Medical Provider • Vital signs • Fluoxetine (proven benefits in BN>AN) • Anxiolytics in AN prior to eating • Metoclopramide (delayed transit = bloating + constip) • b) Mental Health Provider • Individual and cognitive behavioral therapy • superior to medication, but synergistic with it • c) Nutritionalist • Specific and meal plan requirements • Weight goals

  15. Hospitalisation • Severe malnutrition (<75% IBW) • Dehydration • Electrolyte Disturbance • Cardiac Dysrythmias • Physiological AbNs (eg brady, hypotensive) • Arrested Growth and Development • Failure of Outpatient treatment • Complications (medical of psychiatrical) • Admission long enough to increase weight >90% IBW improves eventual outcome

  16. Management • Nutritonal • IP Expected weight gain 0.9-1.4 kg/week • OP Expected weight gain 0.2-0.5 kg/week • Start intake at 30-40 kcal/day (1000-1600kcal/day) • Rapid early weight gain is related to fluid retention and to low metabolic rate • Refeed Syndrome • At risk are those > 10% beneath their ideal body weight • Hypophosphataemia • Decreased IC ATP = impaired enegy stores • Decreased rbc 2,3-DPG = tissue hypoxia

  17. Outcome • AN • 50% good outcome • 25% intermediate ( with relapses) • 25% poor ( associated with later age of onset, duration, lower minimum weight, strong maturity fears ) • 30 - 70% fully recovered at 20y follow up • 10% continue to meet criteria for AN at 12y • BN • 30% continue to meet criteria for BN at 10y • Low self esteem associated with a poor outcome • Dehydration • Mortality Rate in AN = 6.6% • 54% complications, 27% suicide, 19% others

More Related