Term
| What are the major characteristics of AN? |
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Definition
| a disturbed sence of body image, a morbid fear of obesity, a refusal to maintain a minimally normal body weight, and, in women, amenorrhea |
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Term
| Are there genetic components? |
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Definition
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Term
| what type of neurotransmitters systems have been found in people with ED? |
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Definition
| serotoniergic and opiodergic neurotrans |
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Term
| Is AN necessarily severe and long standing? |
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Definition
| No--can be mild and transient or severe and long standing |
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Term
| What are first indications of AN? |
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Definition
| concern about body weight, restriction of food intake. preoccupation and anxiety about weight increase occur, even as emaciation develops |
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Term
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Definition
| yes-denial of the disorder is a prominant feature. pts are decpetive and attempt to resist treatment. |
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Term
| what is the key to diagnosis? |
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Definition
| eliciting the central fear of obesity--which is not diminished by weightloss. in females, amenorrhea is required for diagnosis |
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Term
| what are the differential diags for AN? |
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Definition
| depression, schiz, regional enteritis, ulcerative colitis, CNS tumor |
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Term
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Definition
| short term intervention (weight gain, save life), long term therapy (improve psychological functioning and prevent relapse). |
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Term
| When is prompt weight restoration crucial? |
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Definition
| when weight has fallen below 75% of ideal, weight restoriation and hospitalization become critical |
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Term
| is there any evidence that psychiatric medications assist accute or LT treatment of pts w/ AN for weight gain or stabilization? |
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Definition
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Term
| what are antidepressants used for? |
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Definition
| they + psychotherapy, may be used for concurrent conditions such as depression, OCD, substance abuse, and family problems. |
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Term
| what are some physical complecations of purging? |
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Definition
Hypokalemia and erosion of dental enamel, both resulting from vomiting.
Electrolyte imbalance can be associated with weakness, lethargy, rarely with cardiac arryhthmias (rarely resulting in death). cardia myopathy from ipecac.
Parotid gland enlargement associated with elevated serum amylase levels. |
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Term
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Definition
| yes. also, less introverted, more likely to admit concerns, more prone to impulsive behaviors, drug /alcohol abuse, and overt depression |
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Term
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Definition
1. eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
2. a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating) |
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Term
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Definition
| psychotheray and use of antidepressants/ |
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Term
| what are 2 types of theray? |
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Definition
| CBT and Interpersonal therapy |
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Term
| what is the focus of CBT? |
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Definition
| changing behavior (binging, and purging) and on the over-eval of eating, shape, and weight and their control |
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Term
| what is the focus of IPT? |
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Definition
| to help people to become aware of their relationship problems which may in part trigger episodes of binge eating |
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Term
| what type of antidepressants are used for BN? |
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Definition
|
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Term
| what are the main differences between BED and BN? |
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Definition
| more male, older, obese, (OMO) for BED) |
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Term
| what weight loss medication is used for BED pts? |
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Definition
|
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Term
| what is normative discontent? |
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Definition
| 50-75% of adolescent females of average weight are dissatisfied with their weight and shape and diet regularly; higher number in the obese. Adolescent males are much less dissatisfied with their weight. |
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Term
| what are diagnostic criterion for AN? |
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Definition
1, Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or 2. failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influences of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
4. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen administration.) |
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Term
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Definition
1. Restrictive Type: during the current episode of Anorexia Nervosa, the person has not regularly engaged in binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)
2. Binge-Eating/Purging Type: during the current episode of Anorexia Nervosa, the person has regularly engaged in binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas) |
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Term
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Definition
Amenorrhea (100%) Bradycardia (25-90%)
Dry Skin (25-85%) Hypotension (20-85%)
Lanugo (20-85%) Hypothermia (15-85%)
Excess Energy (35%) Bloating (20%)
Edema (20-25%) Co-Morbid Depression
6-10% Lifetime Mortality: Cardiovascular
(related to malnutrition and suicide)
1,000 deaths per year in the US |
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Term
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Definition
Onset frequently follows a crisis with the family, school, or sexuality.
Loss of self-esteem is countered in dieting in effort to “take control.”
Dieting may be initially reinforced by family and/or peers. |
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Term
| what is life life prevelance? |
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Definition
| Life-time prevalence in American and British women: 0.5 to 2%. Prevalence has increased 2 to 3 fold in the past 50 years. |
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Term
| when is mean age of onset? |
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Definition
Onset is early to late adolescence; mean age is 17. Onset may be as late as 40.
Course is variable, ranging from single course with good recovery to multiple episodes ending in death. |
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Term
|
Definition
| Candidate genes for anorexia on chromosome 1: serotonin 1 D and delta opioid receptor |
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Term
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Definition
| Monoamines: serotonin may plan a role in anorexia and bulimia nervosa, since this neuronal system contributes to the modulation of feeding, mood, and impulse control (both obsessional and impulse undercontrol). |
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Term
| Do antidepressants work for BN? |
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Definition
| Positive response to antidepressants for bulimia. |
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Term
| what metabolites are reduced with AN? |
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Definition
| Anorexia: reduction in serotonin metabolite 5-hyrroxyindoleacetic acid (5-HIAA) in CSF. 5-HIAA levels are elevated during recovery. |
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Term
| are there ANs with BN symptoms? |
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Definition
yes--30-40%--They may binge eat and then control their weight by vomiting, diuretic abuse, laxatives, or punishing exercise.
These patients are more likely to have been plump.
“Restrictors” maintain their low weight by chronic calorie restriction. |
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Term
| when is impatient treatment indicated? |
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Definition
| Inpatient treatment is indicated in cases of marked weight loss, significant complications (changes in vital signs, hypokalemic alkalosis, cardiac arrhythmia), psychological distress (including suicidal ideation), and family conflicts. |
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Term
| are antidepressants helful in the acute phase or LT phase for AN? |
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Definition
| Pharmacotherapy (antidepressants) are not helpful for weight gain in acute phase nor for long term weight maintenance (Walsh BT et al JAMA 2006). |
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Term
| Are atypicals used for AN? |
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Definition
| Open-label case studies suggest atypical antipsychotics may be useful in treatment resistant anorexia. Controlled trials needed. |
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Term
| what are diagnostic criterion for BN? |
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Definition
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
2. a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other mediations; fasting; or excessive exercise.
The binge eating and inappropriate compensatory behavior both occur, on average, at least twice a week for 3 months.
Self-evaluation in unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of Anorexia Nervosa. |
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Term
| what are the 2 subtypes of BN? |
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Definition
Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
Non-Purging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas |
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Term
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Definition
Desire to be thin (and to avoid fat), but intensity of desire and disturbance in body image (seeing self fat when thin) are far less severe than in anorectics; not delusional.;;
1-3% of women 18 - 35 years have bulimia;;
10-20% may binge once a week, but without psychological distress or purging;;
Course may be chronic |
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Term
| what are BN determinants? |
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Definition
Sensitivity to cultural demands for thinness
Tend to be restrained eaters (chronic dieters trying to eat less than they would like to);
Low self-esteem and seek thin figures as a remedy (to win approval from others)
Significant subset have depression
Vomiting/laxative abuse decreases anxiety from binge eating
Genetics |
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Term
| what does vomiting provide? |
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Definition
Vomiting provides method of reducing anxiety (about weight gain) in response to overeating. Patients are negatively reinforced to increase frequency of vomiting.
Overeating increases Anxiety while
Vomiting decreases Anxiety |
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Term
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Definition
Behavior Therapy is used to have patients record food intake, impulses to binge, and binge episodes
Anti-depressant medications (desipramine, fluoxetine) reduce bingeing and vomiting as well as treats depression
Interpersonal psychotherapy and cognitive therapy address low self-esteem, negative thinking, and relationship problems |
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Term
| what is CBT supposed to do for BN? |
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Definition
Stop Dieting and Weighing-In ;
Self-Monitor Food Intake and Binge Episodes;
Determine Events Associated With Binge Episodes;
Eat at Regular Times;
Loosen Dietary Rules, Including “Good” and “Bad” Foods;
Correct Cognitive Distortions Concerning Weight and Shape;
Minimize Binge Episodes;
Learn to Recover from Overeating without Purging |
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