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

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Associate Professor Jane Turner

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
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