Block 3 PSYCH Exam -- Eating Disorders (# 19)
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- 4 criteria of Anorexia Nervosa
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Refusal to maintain body weight at normal level (85%)
Intense fear of gaining weight or becoming fat
Disturbance in way one's body weight or shape is experienced
Amenorrhea (absence of at least 3 consecutive cycles) - Two subtypes of Anorexia Nervosa
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Restricting - NO binge eating or purging
Binging/Purging - binge eating or purging during current episode - 3 criteria for Bulimia Nervosa
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Recurrent episodes of binge eating (sense of lack of control)
Recurrent inappropriate compensatory behavior
Self evaluation is unduly influenced by body shape and weight - Two subtypes of Bulimia Nervosa
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Purging - vomiting, misuse of laxatives, etc.
Non-purging - other, inappropriate compensatory methods - Time period for inappropiate behaviors in Bulimia
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BOTH eating and compensatory behavior on average:
At least twice a week for three months - Positive reinforcement
- When behavior is rewarded by something positive
- Negative reinforcement
- When behavior results in a release from something negative
- 95% eating disorders begin as what?
- Normal dieting
- How do men respond to hunger?
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More acute hunger
Eat earlier in the day
Eat more rapidly - What does dieting alter in women that it does not affect in men?
- Serotonin and prolactin
- When men feel overweight, what are they more likely to do?
- Exercise, as opposed to dieting
- What finding is peculiar in ultramarathoners?
- 1/3 to 1/2 of them stop menstruating BEFORE dieting/training
- Why is anorexia a misnomer?
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Because "anorexics" DO experience hunger
They just fight their urge to eat - Pure restricting anorexia develops in people w/ what type of personality?
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Perfectionistic, rigid, socially insecure people
~OCPD - Binge/purge anorexia develops in people w/ what type of personality?
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Extroverted, impulsive, sensitive to rejection
Often meet criteria for Borderline - How do binge/purgers usually interact with their parents?
- More alienated from (rather than enmeshed with) their parents
- How do binge/purgers tend to see the world?
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As a stressful, uncaring place
They turn to dieting for gratification - How are mothers of restrictive anorexics most often described?
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Intrusive, dominating, and critical
Often also introverted and phobic - How are fathers of restrictive anorexics most often described?
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Passive, submissive
Often belittled by their wives - This family feature is shown by families of both anorexics and bulimics
- High expectations of the children
- Starvation associated with what brain finding in 82% of pts.
- Cerebral atrophy
- Starvation leads to what metabolic change in the brain?
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Increased caudate metabolism
Remember, also a sign of OCD - What is missing in bulimics, preventing them from feeling sated?
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An appropriate CCK resposne
Injected exogenous CCK makes bulimics feel sated - Peptide YY
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The most potent feeding stimulator known
Stimulates carb craving
Feeding decreases levels and leads to satiety - This occurs ~2 hours after a purge and can be associated with increased hunger
- Rebound hypoglycemia
- Use of Olanzapine in Anorexia
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Modestly useful in decreasing anxiety, depression, and obsessions
INCREASES likelihood of weight gain - What type of pts. are SSRIs effective in?
- WEIGHT RESTORED
- Use of Amitriptyline in Anorexia
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Small reduction in number of days to target weight
NOTE: side effects limit use - Use of Fluoxetine in Anorexia
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Useful in preventing relapse in WEIGHT RESTORED pts.
NOT useful in emaciated state
NOTE: tryptophan is required for serotonin synthesis - Use of SSRIs in Bulimia
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Decrease urge to binge and purge
NOTE: risk of hyponatremia in pts. who are Na depleted - Use of MAO-Is in Bulimia
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Very effective
BUT, risk of hypertensive crisis if dietary restrictions not obeyed - Use of Buproprion in Bulimia
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Effective
BUT, contraindicated due to high risk of seizures - Which drugs do you NOT want to prescibe to anorexics/bulimics?
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BDZs
High risk of addiction
High seizure potential - Treatment steps for eating disorders (5)
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STOP THE BEHAVIOR
Treat medical complications
Treat comorbid psych conditions
Address reinforcers
Treat in an ambulatory setting - What are the primary obstacles to treating eating disorders (2)?
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Pts. lack of insight
Difficulty chaging established patterns of behavior