p.9
ICD-11 Diagnostic Requirements for Feeding and Eating Disorders
What is the BMI criterion for hospital admission in anorexia patients?
BMI < 13 kg/m² (or rapid weight reduction).
p.11
Physical and Psychological Management of Anorexia Nervosa
What are the responsibilities of the medical team in inpatient care?
Safely refeed the patient, avoid refeeding syndrome, manage fluid and electrolyte problems, and arrange discharge to community care.
p.8
Physical and Psychological Management of Anorexia Nervosa
How many weekly sessions does SSCM typically consist of for adults with anorexia nervosa?
20 or more weekly sessions, depending on severity.
p.3
Clinical Features and Risk Factors of Anorexia Nervosa
What is the Body Mass Index (BMI) formula?
Weight in kilograms divided by height in meters squared (kg/m²).
p.9
Prognosis and Long-term Outcomes of Anorexia Nervosa
What is the recovery rate for anorexia patients?
Around 30-60% fully recover, 20% show residual symptoms, and 20% remain chronically ill.
p.1
Types of Feeding and Eating Disorders
What distinguishes feeding disorders from eating disorders?
Feeding disorders involve behavioral disturbances not related to body weight or shape concerns, while eating disorders involve abnormal eating behavior and preoccupation with food, often with body weight or shape concerns.
p.5
Anorexia Nervosa: Symptoms and Diagnosis
What behaviors are associated with maintaining abnormally low body weight in anorexia nervosa?
Restrictive eating, excessive exercise, and purging behaviors.
p.1
Anorexia Nervosa: Symptoms and Diagnosis
What BMI threshold is commonly used to diagnose anorexia nervosa in adults?
BMI less than 18.5 kg/m².
p.8
Physical and Psychological Management of Anorexia Nervosa
How many sessions does FPT typically consist of for adults with anorexia nervosa?
Up to 40 sessions over 40 weeks.
p.9
ICD-11 Diagnostic Requirements for Feeding and Eating Disorders
What psychiatric factors indicate the need for hospital admission?
Risk of suicide, chronicity > 5 years, co-morbid impulsive behavior, intolerable family or social situation, failure of outpatient treatment.
p.3
Anorexia Nervosa: Symptoms and Diagnosis
What unusual eating behaviors might males with anorexia nervosa exhibit?
Excessive protein consumption along with caloric restriction and excessive exercise.
p.11
Physical and Psychological Management of Anorexia Nervosa
What should the mental health team focus on in inpatient care?
Managing behavioral problems, assessing patients under compulsion, addressing family concerns, and advising on onward care.
p.5
Anorexia Nervosa: Symptoms and Diagnosis
What is a significant indicator of anorexia nervosa in children and adolescents?
Failure to gain weight as expected based on developmental trajectory.
p.1
Anorexia Nervosa: Symptoms and Diagnosis
What is a key feature of anorexia nervosa?
Significantly low body weight for the individual’s height, age, developmental stage, or weight history.
p.10
Refeeding Syndrome: Causes and Prevention
Who is at high risk for developing refeeding syndrome?
Patients with anorexia nervosa, chronic alcoholism, oncology patients, postoperative patients, elderly patients, patients with uncontrolled diabetes mellitus, and those with chronic malnutrition.
p.8
Physical and Psychological Management of Anorexia Nervosa
What is one of the aims of SSCM regarding weight?
To restore weight and establish a weight range goal.
p.8
Physical and Psychological Management of Anorexia Nervosa
What type of therapy should be considered if individual CBT, MANTRA, or SSCM is ineffective?
Eating-disorder-focused focal psychodynamic therapy (FPT).
p.10
Refeeding Syndrome: Causes and Prevention
What are some potential complications of refeeding syndrome?
Cardiac compromise, respiratory failure, liver dysfunction, central nervous system abnormalities, myopathy, and rhabdomyolysis.
p.7
Physical and Psychological Management of Anorexia Nervosa
What is a key goal when treating anorexia nervosa?
Helping individuals reach a healthy body weight or BMI for their age.
p.10
Guidelines for Medical Emergencies in Eating Disorders
What should medical and psychiatric staff be aware of regarding patients with eating disorders?
They may be at high risk despite appearing well and having normal blood parameters.
p.11
Refeeding Syndrome: Causes and Prevention
What is refeeding syndrome and how can it be avoided?
Refeeding syndrome is a dangerous condition caused by too rapid refeeding; it can be avoided by careful monitoring and gradual refeeding.
p.11
Guidelines for Medical Emergencies in Eating Disorders
What should health commissioners ensure regarding local provisions for eating disorder patients?
They should ensure robust plans are in place with adequately trained medical, nursing, and dietetic staff.
p.3
Clinical Features and Risk Factors of Anorexia Nervosa
What methods can be used to assess body image distortion?
Drawing perceived body size, adjusting light distances, selecting silhouette cards, and using computer techniques.
p.5
Anorexia Nervosa: Symptoms and Diagnosis
What is a key feature of bulimia nervosa?
Frequent, recurrent episodes of binge eating.
p.5
Anorexia Nervosa: Symptoms and Diagnosis
What must be assessed regarding eating patterns in the diagnosis of eating disorders?
The start of symptoms, changes over time, and reasons for avoiding food.
p.8
Physical and Psychological Management of Anorexia Nervosa
What does the second phase of FPT focus on?
Relevant relationships with others and how these affect eating behavior.
p.2
Anorexia Nervosa: Symptoms and Diagnosis
Is an explicit fear of weight gain required for the diagnosis of anorexia nervosa?
No, it is not an absolute requirement if other behaviors indicate preoccupation with body weight or shape.
p.11
Physical and Psychological Management of Anorexia Nervosa
What is the core team composition for inpatient care of eating disorder patients?
A lead physician/paediatrician, a dietitian with specialist knowledge of eating disorders, and a lead nurse.
p.9
Prognosis and Long-term Outcomes of Anorexia Nervosa
What are some poor prognostic factors for anorexia?
Older age at onset, male gender, bulimic behavior, chronic illness, excessive weight loss, premorbid obesity, personality disorder.
p.11
Guidelines for Medical Emergencies in Eating Disorders
What type of treatment should health commissioners support for eating disorder patients?
Intensive community treatment, including outpatient and day patient services for both young people and adults.
p.6
Clinical Features and Risk Factors of Anorexia Nervosa
What family history factors are relevant in assessing eating disorders?
Family history of eating disorders or other psychiatric illnesses, and family dynamics such as being rigid, overprotective, or overly controlling.
p.6
Clinical Features and Risk Factors of Anorexia Nervosa
What are some key components of a mental state examination for eating disorders?
Appearance and behavior, speech, mood, thought abnormalities, perception, cognition, and insight.
p.3
Epidemiology and Aetiology of Anorexia Nervosa
What psychological traits increase the risk of anorexia nervosa?
Low self-esteem, depression, poor body image, perfectionism, and rigid thinking patterns.
p.1
Anorexia Nervosa: Symptoms and Diagnosis
What is a specifier for underweight status in anorexia nervosa?
Anorexia nervosa with significantly low body weight, with BMI between 18.5 kg/m² and 14.0 kg/m² for adults.
p.2
Clinical Features and Risk Factors of Anorexia Nervosa
What is a significant prognostic factor associated with anorexia nervosa?
Dangerously low body weight.
p.2
Types of Feeding and Eating Disorders
What characterizes the restricting pattern of anorexia nervosa?
Inducing weight loss through restricted food intake or fasting without binge eating or purging.
p.2
Clinical Features and Risk Factors of Anorexia Nervosa
What are some signs of low body weight in individuals with anorexia nervosa?
Emaciation, cold extremities, hair loss, amenorrhea, and low blood pressure.
p.4
Physical and Psychological Management of Anorexia Nervosa
What neurological complications can arise from anorexia nervosa?
Seizures, peripheral neuropathy, decreased brain volume, and Wernicke encephalopathy.
p.4
Prognosis and Long-term Outcomes of Anorexia Nervosa
What is the mortality rate of anorexia nervosa compared to other mental illnesses?
Anorexia nervosa has one of the highest mortality rates of any mental illness.
p.1
Types of Feeding and Eating Disorders
List some types of disorders included in ICD-11 feeding or eating disorders.
Anorexia nervosa, Bulimia nervosa, Binge eating disorder, Avoidant-restrictive food intake disorder, Pica, Rumination-regurgitation disorder, Other specified feeding or eating disorders.
p.3
Epidemiology and Aetiology of Anorexia Nervosa
Which gender is more affected by anorexia nervosa?
Females are more affected than males.
p.1
Clinical Features and Risk Factors of Anorexia Nervosa
What behaviors are associated with anorexia nervosa?
Restrictive eating, excessive exercise, and extreme fear of weight gain.
p.7
Physical and Psychological Management of Anorexia Nervosa
What should be avoided when treating anorexia nervosa?
Using medication as the sole or primary treatment.
p.6
Clinical Features and Risk Factors of Anorexia Nervosa
What biological investigations are important for patients with eating disorders?
Weight and height (BMI), blood tests (FBC, RFT, LFT, etc.), ECG, CXR, CT brain, DEXA scan, and urine drug screen.
p.5
Anorexia Nervosa: Symptoms and Diagnosis
What physical symptoms may indicate an eating disorder?
Menstrual changes, symptoms of anemia, constipation, and decreased concentration.
p.2
Types of Feeding and Eating Disorders
What behaviors are associated with the binge-purge pattern of anorexia nervosa?
Episodes of binge eating or purging behaviors aimed at getting rid of ingested food.
p.4
Physical and Psychological Management of Anorexia Nervosa
What dental issues are associated with repeated self-induced vomiting in anorexia nervosa?
Dental caries, erosion of tooth enamel, and dry mouth.
p.8
Physical and Psychological Management of Anorexia Nervosa
What is the primary goal of SSCM for adults with anorexia nervosa?
To help individuals understand their condition and the problems it causes, linking it to the wider social context.
p.10
Refeeding Syndrome: Causes and Prevention
What is refeeding syndrome?
A condition that can occur when feeding is restarted in patients who have been malnourished, leading to severe electrolyte imbalances.
p.3
Epidemiology and Aetiology of Anorexia Nervosa
How does cultural perception influence anorexia nervosa?
In many societies, extreme thinness is seen as the standard of beauty and success, leading to dieting pressures.
p.8
Physical and Psychological Management of Anorexia Nervosa
What is the focus of the first phase of FPT?
Developing the therapeutic alliance and addressing pro-anorexic behavior and egosyntonic beliefs.
p.8
Physical and Psychological Management of Anorexia Nervosa
What is the focus of the final phase of FPT?
Transferring the therapy experience to everyday life and addressing concerns about treatment ending.
p.2
Epidemiology and Aetiology of Anorexia Nervosa
What age range is typically associated with the onset of anorexia nervosa?
Between the ages of 10 and 24 years.
p.2
Prognosis and Long-term Outcomes of Anorexia Nervosa
What is a common outcome for individuals diagnosed with anorexia nervosa within five years of onset?
Most individuals experience remission.
p.4
Physical and Psychological Management of Anorexia Nervosa
What endocrine issues are associated with anorexia nervosa?
Amenorrhea, anovulation, infertility, and decreased levels of several hormones.
p.5
Anorexia Nervosa: Symptoms and Diagnosis
What BMI threshold is commonly used to suggest anorexia nervosa in adults?
BMI less than 18.5 kg/m².
p.10
Refeeding Syndrome: Causes and Prevention
What are the main causes of refeeding syndrome?
Metabolic and hormonal changes during starvation that lead to electrolyte depletion and a rapid change in basal metabolic rate during refeeding.
p.1
Clinical Features and Risk Factors of Anorexia Nervosa
How do individuals with anorexia nervosa typically perceive their body weight?
They may inaccurately perceive their body weight or shape as normal or excessive, often leading to body image distortion.
p.6
Clinical Features and Risk Factors of Anorexia Nervosa
What psychological assessments are relevant for eating disorders?
Risk assessment, eating disorder rating scales (like EAT or EDI), and depression rating scales (like Beck Depression Inventory).
p.10
Refeeding Syndrome: Causes and Prevention
What is the biggest risk factor for developing refeeding syndrome?
Low BMI; the lower the BMI, the higher the risk.
p.2
Co-morbidities Associated with Anorexia Nervosa
What is a significant risk associated with anorexia nervosa?
Premature death, often due to medical complications of starvation or suicide.
p.4
Clinical Features and Risk Factors of Anorexia Nervosa
What stressful life events are associated with an increased risk of anorexia nervosa?
Onset of puberty, break-up of a relationship, death of a loved one, going away to school.
p.4
Physical and Psychological Management of Anorexia Nervosa
What haematological conditions can occur in anorexia nervosa?
Hypocellular marrow, normocytic or iron-deficient anemia, and leucopenia.
p.11
Physical and Psychological Management of Anorexia Nervosa
What role does the eating disorders or liaison psychiatry service play in inpatient care?
They provide support and training to medical/paediatric wards to manage eating disorder patients.
p.5
Anorexia Nervosa: Symptoms and Diagnosis
What is the first step in diagnosing eating disorders?
Taking a detailed history of the presenting difficulties.
p.6
Clinical Features and Risk Factors of Anorexia Nervosa
What past psychiatric history should be considered in patients with eating disorders?
Eating disorder history, impulsive behavior, self-harm, and previous contact with psychiatric services.
p.8
Physical and Psychological Management of Anorexia Nervosa
What should SSCM aim to help individuals recognize?
The link between their symptoms and their abnormal eating behavior.
p.6
Clinical Features and Risk Factors of Anorexia Nervosa
What physical examination findings are important in patients with eating disorders?
Current weight and height (BMI), bradycardia, hypotension, thinning hair, lanugo hair, tooth decay, and poor circulation.
p.6
Clinical Features and Risk Factors of Anorexia Nervosa
What collateral history should be gathered in the assessment of eating disorders?
Changes in eating patterns, meal settings, quantities and frequency of food intake, concealment of food, and any history of abuse or trauma.
p.10
Refeeding Syndrome: Causes and Prevention
What are the critical electrolytes affected by refeeding syndrome?
Phosphate, potassium, and magnesium.
p.6
Physical and Psychological Management of Anorexia Nervosa
What is a key aspect of the management of eating disorders?
Consideration of the most suitable treatment location (inpatient or outpatient) and a multidisciplinary approach.
p.2
Clinical Features and Risk Factors of Anorexia Nervosa
What is a common misconception among individuals with anorexia nervosa regarding their weight?
They often lack recognition that they are underweight or excessively thin.
p.4
Physical and Psychological Management of Anorexia Nervosa
What are some severe physical sequelae of anorexia nervosa?
Death, Russell's sign, dry skin, brittle nails, thinning hair, and osteoporosis.
p.9
ICD-11 Diagnostic Requirements for Feeding and Eating Disorders
What are some medical criteria for hospital admission?
Syncope, proximal myopathy, hypoglycaemia, severe electrolyte abnormality, petechial rash, and platelet suppression.
p.1
ICD-11 Diagnostic Requirements for Feeding and Eating Disorders
What are feeding or eating disorders characterized by?
Abnormal eating or feeding behaviors not better accounted for by another medical condition and not developmentally appropriate or culturally sanctioned.
p.7
Physical and Psychological Management of Anorexia Nervosa
What is a key component of physical management for anorexia nervosa?
Regular physical monitoring and multivitamin and mineral supplements if needed.
p.7
Physical and Psychological Management of Anorexia Nervosa
What type of therapy is recommended for psychological treatment of anorexia nervosa?
Cognitive behavioural therapy (CBT), interpersonal therapy, and family therapy.
p.3
Epidemiology and Aetiology of Anorexia Nervosa
What role does early menarche play in the risk of eating disorders?
It is considered a risk factor due to its relationship with adiposity and body dissatisfaction.
p.7
Physical and Psychological Management of Anorexia Nervosa
What is the focus of the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)?
To motivate the person and encourage collaboration with the practitioner.
p.10
Guidelines for Medical Emergencies in Eating Disorders
What is essential for the primary care team in managing patients with eating disorders?
To monitor patients, refer them early, and provide post-discharge monitoring in collaboration with medical services.
p.4
Clinical Features and Risk Factors of Anorexia Nervosa
What family factors contribute to the risk of developing anorexia nervosa?
Familial faddy eating, undue concern about weight and shape, increased rates of mood disorders among relatives, and rigid family dynamics.
p.9
Refeeding Syndrome: Causes and Prevention
What is refeeding syndrome?
A potentially fatal condition that occurs when patients with severely restricted food intake are given large amounts of food.
p.2
Prognosis and Long-term Outcomes of Anorexia Nervosa
When should the diagnosis of anorexia nervosa be retained during recovery?
Until a full and lasting recovery is achieved, including maintenance of a healthy weight for at least one year.
p.7
Physical and Psychological Management of Anorexia Nervosa
What should be considered when weighing individuals with anorexia nervosa?
Sharing the results with them and their family members if appropriate.
p.2
Epidemiology and Aetiology of Anorexia Nervosa
What is the gender ratio for the diagnosis of anorexia nervosa?
It is much more commonly diagnosed in females, with a ratio of 10:1.
p.4
Clinical Features and Risk Factors of Anorexia Nervosa
What lifestyle choice do some people argue anorexia nervosa represents?
A lifestyle choice, using the internet for mutual support and weight-loss tips.
p.4
Physical and Psychological Management of Anorexia Nervosa
What gastrointestinal issues are common in patients with anorexia nervosa?
Delayed gastric emptying, constipation, and impaired liver function.
p.4
Physical and Psychological Management of Anorexia Nervosa
What are some ophthalmic complications of severe anorexia nervosa?
Lagophthalmos (inability to close the eyelids completely).
p.8
Physical and Psychological Management of Anorexia Nervosa
What is a key component of SSCM in relation to the practitioner?
Developing a positive relationship between the person and the practitioner.
p.3
Epidemiology and Aetiology of Anorexia Nervosa
What is a significant risk factor for developing anorexia nervosa?
Having relatives with anorexia nervosa or a family history of depression or alcohol misuse.
p.7
Physical and Psychological Management of Anorexia Nervosa
What is the goal of individual CBT for adults with anorexia nervosa?
To reduce the risk to physical health and encourage healthy eating and weight.
p.7
Physical and Psychological Management of Anorexia Nervosa
How many sessions does individual CBT for adults typically consist of?
Up to 40 sessions over 40 weeks.
p.6
Physical and Psychological Management of Anorexia Nervosa
What is the goal for weight restoration in inpatient settings for eating disorder patients?
Aiming for an average weekly weight gain of 0.5 - 1 kg until a target BMI is reached.
p.5
Anorexia Nervosa: Symptoms and Diagnosis
What is a common manifestation of excessive preoccupation with body weight or shape?
Repeatedly checking body weight or using mirrors to check body shape.
p.10
Refeeding Syndrome: Causes and Prevention
How can refeeding syndrome be prevented?
By gradually increasing caloric intake and starting vitamin supplementation during refeeding.
p.10
Guidelines for Medical Emergencies in Eating Disorders
What is the aim of the guidance on medical emergencies in eating disorders?
To make preventable deaths due to eating disorders a thing of the past.
p.4
Physical and Psychological Management of Anorexia Nervosa
What cardiovascular changes are associated with anorexia nervosa?
Decreased cardiac mass, bradycardia, hypotension, and QT interval prolongation.
p.7
Physical and Psychological Management of Anorexia Nervosa
What should be included in the support for individuals with anorexia nervosa?
Psychoeducation, monitoring of health, and family involvement.
p.7
Physical and Psychological Management of Anorexia Nervosa
What is the role of social work input in the management of anorexia nervosa?
To assist with employment opportunities and supported accommodation.
