MEDI3004 MENTAL HEALTH ROTATION -YEAR 3 MBBS. Topic 5 - Eating Disorders.docx

6 Pages
89 Views
Unlock Document

Department
Medicine
Course
MEDI2022
Professor
Associate Professor Jane Turner
Semester
Spring

Description
5. EATING DISORDERS  An intense preoccupation with weight and shape issues an an expression fo self-worth is common to all people who suffer from an eating disorder  90% of anorexics and bulimeics are women TYPES  Anorexia Nervosa  Bulimia nervosa  Eating disorder not otherwise specified o Binge Eating disorder Risk factors  Obesity  Obesity – not generally regarded as psychiatric disorder  Chronic medical illness e.g. diabetes mellitus ETIOLOGY  Multifactorial: psychological, sociological and biological Career choice are expected to associations be thin e.g. ballerinas, models  FHx of mood disorders, eating  Individual disorders or substance abuse o Perfectionism  Hx of sexual abuse o Lack of control in other life areas o History of sexual abuse  Homosexual males  Personality  Competitive athletes o Obsessive-compulsive  Concurrent associated mental illness – depression, OCD, o Histrionic anxiety disorder, substance o Borderline  Familial use o Maintenance of equilibrium in dysfunctional family  Cultural factors o Prevalent in industrialised socities o Idealisation of thinness in media  Genetic COMPLICATIONS Starvation Binge-Purge General Low BP, Low HR, significant orthostatic Parotid gland enlargement, , changes, syncopal episodes, low periocular/palatal petechiae, loss of temperature, vitamin deficiencies dental enamel and carier, aspiration pneumonia, metabolic alkalosis (2’ to hypokalaemia and loss of acid) Endocrine 1’ or 2’ amenorrhea, decreased T3/T4 Neurologic Grand mal seziures ( Ca, Mg, PO4) Cutaneous Dry skin, lunago hair, hair loss, brittle Russel’s sign, Perioral skin irritation nails, yellow skin from high carotene GIT Constipation, GORD, delayed gastric acute gastric dilation/rupture, emptying pancreatitis, GORD, Mallory-Weiss tear CVS Arrthymias, CHF Arrythmias, cardiomyopathy (from use of ipecac), sudden cardiac death ( K ) MSK Osteoporosis (hypogonadism) Muscle wasting Renal Pre-renal failure (hypovolaemia), renal Renal Failure (electrolyte disturbances) calculi Extremities Pedal edema (albumin) Pedal edema (albumin) Lab   RBC,  WBCs   Na,  K,  Cl,  H   LH,  FSH,  estrogen,    amylase testosterone,  GH  hypokalaemia with metabolic   cholesterol alkalosis  BUN * laxatives result in  H with metabolic acidosis ANOREXIA NERVOSA  Relatively uncommon  Types o Restricting: during the current episode of AN, the person has not regularly engaged in binge eating or purging behavior (i.e. self-induced vomiting, laxative misuse, diuretics or enemas) o Binge-Eating/Purging: during the current episode of AN the person has regularly engaged in binge eating or purging behaviour Characterized by (DSMIV)  Extreme weight loss (>15% loss or 85% of expected weight or failure to make expected weight gain during period of growth) deliberately achieved by dieting and/or other means such as exercise or purgation  Amenorrhea in females, loss of libido in males  Abnormal attitudes to food  Distorted body image, with morbid fear of fatness EPIDEMIOLOGY  Adolescence (most cases)  95% Females  Can occur in occupations which demand a slim figure – e.g. modeling, beauty therapy, ballet  Western countries, white subjects ETIOLOGY  Psychodynamic theory o AN as ameans to avoid maturation – esp in sexual terms o Means of acquiring independence and a sense of achievement o May stem from disturbed family relationships  Cultural theories o Social and media pressures to be slim and diet-conscious o Response to family or peer influences  Hormonal imbalance o Hypothalamic dysfunction – probably secondary to weight loss Predisposing Factors Precipitating factors Perpetuating Factors    Initial positive reinforcement from family/peers  Ongoing abuse, etc. CLINICAL FEATURES  Physical o Weight loss by dietary restriction, self-induced vomiting, taking laxatives or diuretics, excessive exercising o Amenorrhea o Loss of sexual interest and impotence in males o Hypotension o Bradycardia  arrythmias o Constipation o Mild hypothermia o Growth of downy (lanugo) hair o Fluid and electrolyte imbalance (if vomiting or purging) o Bone fractures 2’ to osteoporosis  Mental o Preoccupation with food and weight o Takes pride in dieting o Feels guilty about eating more than small amounts o Do not see themselves as unwell or underweight o Feel active, healthy and fashionably slim o Greater insight may develop resulting in depression ASSESSMENT  Examination o Vitals: BP (hypotensive), HR (bradycardic, arrhythmias), temp o BMI  Investigations o FBC: anaemia, low WCC (neutrophil counts used as marker for response to Mx) o e/LFTS: potassium, abnormal LFTs o Thyroi
More Less

Related notes for MEDI2022

Log In


OR

Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


OR

By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.


Submit