Year 2 Semester 2 - Psychiatry [Block A] - 12

Body weight less than 85% of expected
Intense fear of gaining weight of becoming fat
Disturbance in the way in which one's body weight or shape is experienced
postmenarchal and amenorrheic females
However, the two essentials are underweight and amenorrhea!@

Restricting type: Person has restricted whta they eat
Binge-eating/purging type: regularly engaging in binge eating or purging behavior
Remember - Anorexia = underweight + Amenorrhea irrespective of process

History of sexual abuse
Problems expressing aggression and a recently stressful life situation
Personality profile: Best and the brightest, perfectionist, peacemakers, family of body health conscious freaks!

Mood disorders (50-75%)
Lifetime history of OCD (25%)
Personality Disorder (40-75%)

Death rate 5-18%
Most frequent cause of death is cardiac arrhythmia with sudden cardiac death

BINGE EATING - Eating in a discrete period of time (within any 2 hour period), an amount of food way bigger than most peeps. (A giving in period after starvation)
Following binges is inappropriate compensations:
Self-induced vomiting, laxatives, diuretics, enemas...
Fasting
Excessive exercise (uh-oh! Really I'm just trying to get buff!)

on average 2x a week for 3 months

Purging type: self induced vomiting or the misuse of laxatives, diuretics, or enemas
Nonpurging type: other inappropriate compensatory behaviors, such as fasting or excessive exercise
Little Hint: Often bulimics are not underweight looking

Mid adolescence with a chronic intermittent course
Typically family history of obesity

Cardiac Arrhythmias, hypokalemia, hyponatremia, leukopenia

Regression of secondary sexual characteristics (phew!)
Orthostatic hypotension - Fainting
Lowered core body temperature
and other stuff....

Nausea
spontaneous (nonvolitional) reflex vomiting of any food
Persistent lancinating epigastric pain
Flatulence
Eroded dentition
Russell's sign - cuts on back hand from being scraped on teeth while pugilisticating(not a word)

low WBCAnemia
Diminished RBC mass
Macrocytic RBC indices
Hypochloremia
Hyperphosphatemia
Low protein
Hypomagnesemia
and a partridge in a pear tree

Inpatient facility - close monitoring
partial hospitalization - daytime monitoring
Outpatient management - fuck em

Weight restoration (slow refeeding due to possible cardiac overload)
Correction of electrolyte abnormalities
Monitor for attempts to purge

Cognitive-Behavioral Therapy - bad bad don't do this... spank spank!
Family therapy - may be less beneficial for those over 18 due to return to family which will inhibit progress
Pharmacotherapy - no medications specifically for anorexia or bulimia however may treat comorbid conditions

Avoid TCAs because TCAs carry a risk of cardiac arrhythmias which in an eating disorder patient is even higher risk
Avoid Buproprion (wellbutrin) due to the lower seizure threshold of eating disorder patients