MEDI7301 Study Guide - Final Guide: Sertraline, Cortisol, Libido

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apricotchimpanzee245

23 Jun 2018

School

Department

Medicine

Course

MEDI7301

Professor

multiple

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Feeding and eating disorders

Introduction

Overview AN and BN are characterised by an intense preoccupation with weight and shape

issues as an expression of self worth

Young age of onset

13-20yo (AN), 16-18yo (BN)

Biological - pubertal age where individual's bodies are changing drastically

(size, shape, weight)

Social - idealistic view of beauty and perfection is to be thin

Genetic vulnerability + family conflict + possible exposure to disordered

eating (parents dieting or obese)

F:M ratio is 10:1

History taking - restriction exercise, purging, vomiting, use of laxatives/ diuretics,

body image, amenorrhoea

Cognition &

starvation

Cognitive distortion realms

Personalization

All or nothing (no flexibility)

Mind reading

Catastrophizing

Future telling

Labelling

Starvation can be associated with symptoms of depression, difficulties in school

and academics & communication issues with friends and parents

Short-term effects - excessive sleeping and deprivation of cognitive and social

stimuli (school, social events, friends are neglected), decline in concentration/ comprehension/

judgement capabilities

Long-term effects - loss of white and grey matter in brain during severe weigh loss/

semi-starvation; weight restoration results in return of white matter to premorbid levels, but

grey matter loss persists

Suicidal ideation is common

Risk factors Physical Obesity

Chronic medical illness (diabetes mellitus)

Psychological Individuals that are expected to be thin by career choice

Family hx (mood disorders, eating disorders, substance abuse)

Sexual abuse hx

Homosexual males

Competitive athletes

Concurrent associated mental illness (depression, OCD, anxiety

disorder, substance abuse)

Key

characteristics

of digression

into eating

disorder

Body dissatisfaction

Skipping meals

Fasting 24hrs

Weight loss to bottom to healthy range

Excessive exercise

Preferring to eat in private

A tendency towards perfectionism

Developing odd eating habits

Vomiting after occasional large meal

Pick only low fat or carb food, vegetarian

Not hungry in regular cycles (over eat -> starve)

Rigid diet plans

Study food labels for fat and carb content

MHA regulations Adolescents

An individual <18yo should have decisions made by a parental guardian in

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the child's best interests

An adolescent who displays Gillick competence (see capacity below) may

be able to have input into some of their medical management, pending they fully

understand their condition, treatment and can communicate decisions about it

Decision making capacity to consent

Do they understand the information & the consequences of non-

treatment?

Do they believe the information?

Can they weigh up the information and arrive at a choice?

Are they cognitively impaired by severe starvation?

Are they delusional about the necessity of adequate nutrition, threat to

life & need for medical intervention?

If the patient doesn't satisfy all criteria, they don't have the ability to

consent to medical decisions

NGT feeding under MHA

Ideal feeding method is oral, however many patients with severe AN

require NG feeding for optimal treatment

Mental health act may be required if patient is non-compliant with eating

plan, hence a grave risk to their health and wellbeing

Complications Starvation/ restriction Binge/ purge

Traits Abnormal eating not

acknowledged

Introverted

Turn away food to cope

Preoccupation with losing

increasing amounts of weight

Abnormal eating

behaviour recognised

Extroverted

Turn to food to cope

Preoccupation with

attaining unrealistic weight

Psychiatric Sad, moody, irritable

Oral Dental cavities Loss of dental enamel

and caries

Periocular and palatal

petechiae

Parotid gland

enlargement

Endocrine Primary or secondary

amenorrhoea

Decreased T3/T4

Neurologic Grand mal seizure

(decreased Ca, Mg, PO4)

Poor concentration,

memory

Cutaneous Dry skin

Lanugo hair

Hair loss or thinning

Brittle nails

Yellow skin (high carotene)

Easy bruising

Low temperature

Vitamin deficiencies

Russell's sign (knuckle

callus on dorsal surface of hand

from self-induced vomiting)

Perioral skin irritation

GIT Constipation

GORD

Delayed gastric emptying

(bloating)

Acute gastric dilation/

rupture

Pancreatitis

GORD

Esophageal erosion

Hematemesis 2* to

Mallory-Weiss tear

Cardio-

pulmonary

Low blood pressure

Low heart rate

Arrhythmias

Cardiomyopathy (use

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Palpitations

Orthostatic changes +/-

syncopal episodes

Arrhythmias

CHF

of ipecac)

Sudden cardiac death

(low K)

Aspiration pneumonia

MSK Weak muscles

Swollen joints

Osteoporosis secondary to

hypogonadism

Stress fractures with earlier

onset and shorter stature

Muscle wasting

Renal Pre-renal failure

(hypovolemia)

Renal calculi

Renal failure

(electrolyte disturbance)

Extremities Pedal oedema (decreased

albumin)

Pedal oedema

(decreased albumin)

Lab values Starvation

Decreased RBC,

WBC, LH, FSH, estrogen,

testosterone

Increased GH,

cholesterol

Dehydration

Increased BUN

Low K, Mg, Na

Vomiting

Decreased Na,

K, Cl, H, Ca (2* to vomiting or

laxatives)

Increased

amylase

Metabolic

alkalosis

Laxatives

Decreased Na,

K, Cl

Increased H

Metabolic

acidosis

Comorbid Depression

Anxiety (OCD, social

phobia)

Cluster C personality traits

Depression

Anxiety

Cluster B and C

personality traits

Substance

dependence/ abuse

Anorexia nervosa

Overview AN is a potentially fatal condition with significant mortality levels & high morbidity

2 different types

Restrictive type (+/- compulsive exercise) - fasting, introverted, deceased

risk of substance abuse, family conflict covert

Binge eating/ purging type (uncontrolled overeating + vomiting/ laxative/

diuretic misuse) - binge eating or purging, more volatile, family frequently disengaged,

substance abuse common

Common patterns of dieting, excessive exercise and smoking habits to combat

weight

Risk factors

Puberty, perfectionist, family hx (OCD, anxiety, affective disorder),

impaired family interactions, stressful life events (sexual abuse, start university, leave

home)

40% have good 5-year recovery, 40% remain symptomatic with limited disability,

20% remain severely symptomatic with chronic disability

Highest mortality rate in psychiatry (10+% death rate after 10yrs diagnosi)

Etiology Genetics

Psychosocial - no childhood physical or sexual abuse

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Document Summary

An and bn are characterised by an intense preoccupation with weight and shape issues as an expression of self worth. Biological - pubertal age where individual"s bodies are changing drastically (size, shape, weight) Social - idealistic view of beauty and perfection is to be thin. Genetic vulnerability + family conflict + possible exposure to disordered eating (parents dieting or obese) History taking - restriction exercise, purging, vomiting, use of laxatives/ diuretics, body image, amenorrhoea. Starvation can be associated with symptoms of depression, difficulties in school and academics & communication issues with friends and parents. Short-term effects - excessive sleeping and deprivation of cognitive and social stimuli (school, social events, friends are neglected), decline in concentration/ comprehension/ judgement capabilities. Long-term effects - loss of white and grey matter in brain during severe weigh loss/ semi-starvation; weight restoration results in return of white matter to premorbid levels, but grey matter loss persists. Individuals that are expected to be thin by career choice.

MEDI7301 Study Guide - Final Guide: Sertraline, Cortisol, Libido

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