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Eating disorders

Eating disorders. Anorexia nervosa: risk factors. Anorexia Nervosa ARID. A Amenorrhoea for 3 cycles R Refusal to maintain / gain weight > 85% expected I Intense fear gaining weight despite underweight D Disturbed self-image

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Eating disorders

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  1. Eating disorders

  2. Anorexia nervosa: risk factors

  3. Anorexia Nervosa ARID • A Amenorrhoea for 3 cycles • R Refusal to maintain / gain weight > 85% expected • I Intense fear gaining weight despite underweight • D Disturbed self-image Diagnostic criteria for 307.1 Anorexia NervosaA. 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% ofthat expected; or failure to make expected weight gain during period of growth,leading to body weight less than 85% of that expected).B. Intense fear of gaining weight or becoming fat, even though underweight.C. Disturbance in the way in which one's body weight or shape is experienced,undue influence of body weight or shape on self-evaluation, or denial of theseriousness of the current low body weight.D. In postmenarcheal females, amenorrhea, i.e., the absence of at least threeconsecutive menstrual cycles. (A woman is considered to have amenorrhea if herperiods occur only following hormone, e.g., estrogen, administration.) Restricting // Binge-Eating/Purging Type

  4. Anorexia nervosa

  5. Anorexia nervosa: predictors of outcome following 1st present.

  6. Anorexia nervosa management Give family therapy & dietary advice to all, with CBT also likely to be helpful

  7. AN: criteria for inpatient mgt

  8. AN: inpatient re-feeding

  9. Re-feeding syndrome

  10. Anorexia nervosa management

  11. AN pharmacotherapy

  12. AN pharmacotherapy Antidepressants may be helpful if depressive symptoms present Antipsychotics may help if over-active. Zn, Li, cyproheptadine warrant further study.

  13. AN psychotherapies

  14. Family therapy in AN

  15. Bulimia Ox-hunger Nervosa BIAS • B Binge: recurrent, uncontrollable, 2 per week for 3/12 • I Inappropriate compensatory behaviour • A Anorexia excluded • S Self-evaluation influenced by body shape / weight • Diagnostic criteria for 307.51 Bulimia NervosaA. Recurrent episodes of binge eating. An episode of binge eating ischaracterized by both of the following:(1) eating, in a discrete period of time (e.g., within any 2-hour period), an amountof food that is definitely larger than most people would eat during a similar period oftime and under similar circumstances(2) a sense of lack of control over eating during the episode (e.g., a feeling thatone cannot stop eating or control what or how much one is eating)B. Recurrent inappropriate compensatory behavior in order to prevent weightgain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or othermedications; fasting; or excessive exercise.C. The binge eating and inappropriate compensatory behaviors both occur, onaverage, at least twice a week for 3 months.D. Self-evaluation is unduly influenced by body shape and weight.E. The disturbance does not occur exclusively during episodes of AnorexiaNervosa. • Purging // non-purging type

  16. Bulimia Nervosa

  17. Bulimia Nervosa - Treatment • CBT: the only evidence based treatment • Self-help CBT • Psychoeducation • Psychotherapy e.g. IPT • Groups/ group therapy • ?SSRI • No evidence in youngsters • Important if comorbid depression

  18. Prognosis • About half fully recover • One quarter improve • One quarter chronic • PD, suicide attempts, alcohol abuse, low self-esteem negative prognostic factors • No/contradictory evidence for other prognostic factors, including severity

  19. Anorexia Nervosa: Physical Exam findings Reproductive: Amenorrhoea/anovulation Low-birth weight babies  Spontaneous abortions Prematurity Congenital malformations

  20. Anorexia Nervosa: Investigation findings

  21. Somatoform disorders

  22. The sick role & behaviour

  23. Factitous disorder & malingering

  24. Somatization disorder • All somatoform disorder diagnostic criteria include: • Impairment • Not general medical in aetiology or symptoms in excess of GMC • Not other psychiatric esp. other somatoform (somatization trumps all) • Not intentional (vs. malingering or factitious) Up to 30-50% health care utilization reduction reported in tx studies

  25. Other somatoform diagnoses • *Neurasthenia in ICD-10: • Either fatigue after mental effort OR body weakness/fatigue after physical exertion • + > 2 of: myalgia, dizziness, headaches, insomnia, irritability, dyspepsia, inability to relax • Specific Tx:*Some evidence for pivagabine (RCT), Ganoderma lucidum (RCT) and ginko biloba

  26. Conversion

  27. Conversion Unlikely to respond to long-term intensive psychodynamic psychotherapy*!

  28. Pain disorder Anatomy Organ system Temporal manifestation Intensity of patient’s complaint Aetiology International association for the study of painTaxonomic Guidelines:

  29. Treatment of pain disorder • Multi-disciplinary approach is best: • Psychiatrist • Psychotherapist • Physio/OT • Social worker

  30. Body dysmorphic disorder

  31. Somatoform disorders: Assessment

  32. Somatoform disorders: General Principles of Management

  33. Somatoform disorders: Specific Psychological Treatments Inpatient programs in Canada/Germany: no published data • Psychosocial interventions*: • Poor methodology in studies • <1/4 showed sustained improvements

  34. Somatoform disorders: medications

  35. Factitous disorder: management

  36. Chronic Fatigue Syndrome* • No identified organic aetiology • ? A condition of physical unfitness • Moderate period of inactivity leads to physical deconditioning • There is reduced exercise tolerance so moderate activity leads to tiredness • Further rest leads to further deconditioning • Frustration at all this can lead to bursts of activity which are very exhausting • …leading to further rest • This can be depressing • Time away from social activities can lead to an anxiety disorder

  37. CFS: interventions Follow general somatoform disorder treatment guidelines focussing on gradual functional recovery through a physical rehabilitation program and keeping in mind that patients are often resistant to psychological interventions

  38. CFS: graded exercise/CBT 70% after 12-16 sessions improved vs 25% with relaxation tx Improvements sustained at 1 and possibly 5 year follow up

  39. Pseudocyesis

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