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Anorexia Nervosa
Things you should know
- Key features
- Refusal to maintain a healthy body weight
- Intense fear of gaining weight
- A Distorted body self-perception
- Females make up 90% of cases
- Ego syntonic
- Risks associated with Anorexia Nervosa
- Iron-deficiency anemia
- Compromised immune system
- Abdominal pain, constipation, diarrhea
- Loss or disturbance of menstruation
- Increased risk of infertility in men and women
- Kidney failure
- Osteoporosis
- Bradycardia and other arrhythmias
- Death
I came in to see my physician assistant today because of…
- Anorexia is ego syntonic
- Physical Signs
- Rapid weight loss or frequent weight changes
- Disturbance of menstruation in girls and women
- Decreased libido in men
- Dizziness, fainting
- Feeling cold most of the time
- Constipated
- Feeling tired
- Difficulty sleeping
- Psychological Signs
- Intense fear of gaining weight
- Preoccupation with eating, food, body shape and weight
- Feeling anxious and irritable around meal times
- Unable to maintain a normal body weight for their age and height
- Depression and anxiety
- Reduced capacity for thinking and increased difficulty concentrating
- Rigid thoughts about food being ‘good’ or ‘bad’
- Distorted self-perception
- Low self esteem and perfectionism
- Increased sensitivity to comments relating to food, weight, body shape, exercise
- Extreme body image dissatisfaction
- Behavioral Signs
- Deliberate misuse of laxatives, appetite suppressants, enemas and diuretics
- Repetitive or obsessive behaviours relating to body shape and weight
- Binge eating
- Eating in private and avoiding meals with other people
- Anti-social behaviour
- Secrecy around eating
- Compulsive or excessive exercising
- Radical changes in food preferences
- Obsessive rituals around food preparation and eating
- Preoccupation with preparing food for others, recipes and nutrition
- Self harm, substance abuse or suicide attempts
- Physical exam
- Height and weight measurement → 20% below expected is a bad sign
- Vital signs, such as heart rate, blood pressure and temperature
- Assessment of skin and nails for dryness or other problems
Treatment
- Monitored nutrition plan
- Psychological
- Behavioural therapy
- Cognitive analytic therapy
- Cognitive behavioural therapy
- Family interventions focused explicitly on eating disorders
- Medications
- Antidepressants may be helpful, but do not use Bupropion as it lowers the seizure threshold in anorexic patients
Bulimia Nervosa
Things you should know
- Eating disorder characterized by binging and purging
- Normal or overweight
- Ego Dystonic
- Risk factors:
- Female
- Age – often begins in the late teens or early adulthood.
- Psychological and emotional issues.
- Family history
- Social / societal pressure.
I came in to see my physician assistant today because of…
- Being preoccupied with body shape and weight
- Living in fear of gaining weight
- Binging behavior
- Feeling of uncontrollable eating behavior
- Eating until the point of discomfort or pain
- Forcing to vomit or exercise too much
- Using laxatives, diuretics or enemas after eating
Diagnosis
- Psychological Evaluation
- Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for bulimia are:
- Repeatedly binge, eating an abnormally large amount of food, and feel uncontrollable eating
- Getting rid of the extra calories from bingeing by vomiting, excessive exercise, fasting, or misuse of laxatives, diuretics, enemas or other medications.
- Bingeing and purging at least twice a week for at least three months.
- Body shape and weight influence feelings of self-worth too much.
- No presence of anorexia, an eating disorder with extremely restrictive eating behaviors.
- Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for bulimia are:
- Physical Exam
- Russell’s sign – calluses on the knuckles from repeated forced vomiting.
- Broken blood vessels in the eyes due to strain from vomiting
- Dental Exam – may show cavities or gum infections.
- Laboratory tests
- Hypokalemia
Treatment
- Nutrition education and achieving healthy weight
- First goal of treatment will be to start getting back to a healthy weight
- Psychotherapy
- Cognitive behavioral therapy
- Interpersonal psychotherapy
- Family-based therapy
- Medications
- Antidepressants
- Serotonin reuptake inhibitors – Fluoxetine (Prozac)
- Antidepressants
Obesity
Things you should know
- Obesity classification
- Obesity – BMI > 30
- Causes
- Inactivity
- Unhealthy diet and eating habits
- Lack of sleep
- Certain medications
- Antidepressants
- Anti-seizure medications
- Antipsychotic medications
- Corticosteroids
- Beta blockers
- Medical problems
- Arthritis
- Low thyroid function
- Complications
- High triglycerides and low high-density lipoprotein (HDL) cholesterol
- Type 2 diabetes
- High blood pressure
- Metabolic syndrome — a combination of high blood sugar, high blood pressure, high triglycerides and low HDL cholesterol
- Heart disease
- Stroke
- Cancer, including cancer of the uterus, cervix, endometrium, ovaries, breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and prostate
- Sleep apnea
- Gallbladder disease
- Gynecologic problems, such as infertility and irregular periods
- Erectile dysfunction and sexual health issues
- Nonalcoholic fatty liver disease
- Osteoarthritis
- Skin conditions, including poor wound healing
I came in to see my physician assistant today because of…
- Visit for unrelated topic
- Difficulty sleeping
- Feeling very tired every day
- Back and joint pains
- Low self-esteem
- Low confidence levels
Diagnosis
- Physical Exams
- Waist circumference measurement
- Female – waist circumference of more than 35 inches (88 centimeters, or cm)
- Male – waist measurement of more than 40 inches (102 cm)
- Waist circumference measurement
- Laboratory tests
- Cholesterol test
- Liver function tests
- Fasting blood glucose
- Thyroid test
- Electrocardiogram
Treatment
- Diet programs
- A reduced-calorie diet
- Female – 1,200 to 1,500 calories
- Male – 1,500 to 1,800 calories
- A reduced-calorie diet
- Physical exercise
- Increase daily activity
- Behavior and lifestyle changes
- Counselling
- Support group
- Prescribed weight-loss medications
- Orlistat (Xenical) -Lipase inhibitor, unabsorbed fat is eliminated in the stool.
- SSRI
- Surgery
- Laparoscopic gastric band
- Laparoscopic gastric sleeve
- Laparoscopic gastric bypass
Autistic Disorder
Things you should know
- Characteristic behavior and social interactions
- Symptoms are apparent before 3 years old
- Strong genetic basis
- M > F
- Asperger Syndrome
- Rett Syndrome
Symptoms
- Be overly sensitive in sight, hearing, touch, smell, or taste
- Have unusual distress when routines are changed
- Difficulty with communication
- Cannot start or maintain a social conversation
- Communicates with gestures instead of words
- Develops language slowly or not at all
- Does not adjust gaze to look at objects that others are looking at
- Does not refer to self correctly
- Does not point to direct others’ attention to objects – occurs in the first 14 months
- Repeats words or memorized passages, such as commercials
- Social interaction
- Does not make friends
- Does not play interactive games
- Withdrawn
- May not respond to eye contact or smiles, or may avoid eye contact
- May treat others as if they are objects
- Prefers to spend time alone, rather than with others
- Shows a lack of empathy
- Responses to sensory information
- Does not startle at loud noises
- Has heightened or low senses of sight, hearing, touch, smell, or taste
- May find normal noises painful and hold hands over ears
- May withdraw from physical contact because it is overstimulating or overwhelming
- Rubs surfaces, mouths or licks objects
- Seems to have a heightened or low response to pain
- Play
- Doesn’t imitate the actions of others
- Prefers solitary or ritualistic play
- Shows little pretend or imaginative play
- Behaviours
- “Acts up” with intense tantrums
- Gets stuck on a single topic or task
- Short attention span
- With very narrow interests
- Is overactive or very passive
- Shows aggression to others or self
- Shows a strong need for sameness
- Uses repetitive body movements
Diagnosis
- Behavioral assessment
- Medical history – mostly focuses on child’s development,
- Clinical observations – observing the developmentally delayed child in different situations
- Developmental and intelligence tests.
- Physical assessments
- Hearing tests – to determine whether hearing problems may be causing developmental delays
Treatment
- Behavioral training and management
- Uses positive reinforcement, self-help, and social skills training to improve behavior and communication.
- Behavioral therapy
- Sensory integration
- Specialized therapies.
- Speech therapy
- Occupational therapy
- Physical therapy
- Medications
- Psychoactive drugs or anticonvulsants
- Antidepressants
- Stimulants
- Antipsychotics
- Psychoactive drugs or anticonvulsants
- Community support and parent training
Study TIps
Mind maps for note taking – www.mindmeister.com
Key Terms and Ideas
- What is the definition of obesity using BMI
- > 30
- A four year old who has a flat affect and does not make eye contact during your interview might make you think about what diagnosis?
- Autism
- Is anorexia ego dyssyntonic or ego syntonic
- How does Orlistat work?
- It is a lipase inhibitor
<< Click here to get 23 Psych questions straight from my book, The Final Step >>
