Info
🌱 來自: Huppert’s Notes
Eating Disorders🚧 施工中
Eating Disorders
Anorexia nervosa
• Definition: Intense fear of gaining weight leading to low body weight (<85% ideal, BMI <18.5)
• Subtypes: Restricting (little intake, no purging); binging and purging (binge eating then self-induced vomiting, laxatives, or excessive exercise)
• Clinical features: Preoccupation with avoiding weight gain; may result in amenorrhea, cold intolerance, hypotension, bradycardia, decreased bone density
• Treatment: Goal = improve nutritional status. 1) Psychotherapy (e.g., family-based, CBT, interpersonal psychotherapy [IPT]); 2) Nutritional rehab with careful weight gain schedule; 3) Off-label pharmacotherapy (no approved medications; in clinical practice, SSRIs are often used to target mood symptoms and olanzapine may be used to target weight gain and rigid/obsessional thinking around weight).
• Common criteria for inpatient admission: Abnormal vitals/electrolytes/EKG, BMI <14, precipitous weight loss
Bulimia nervosa
• Definition: Binge eating plus reactive behavior to prevent weight gain, i.e., purging (vomiting, laxatives, diuretics) or non-purging (excessive exercise, fasting) behavior; normal body weight (BMI 18.5–30) but excess worry about body appearance
• Clinical features: Preoccupation with body appearance, parotid gland enlargement (dialadenosis), dental caries, “Russell’s sign” (calluses on knuckles due to purging), peripheral edema
• Treatment: 1) Psychotherapy (CBT, IPT, DBT, nutrition education); 2) Fluoxetine (only approved medication for bulimia nervosa, though other SSRIs are used 2nd line in clinical practice). Note: Bupropion contraindicated due to increased risk of symptoms.
Binge eating disorder
• Definition: Binging (eating more than normal sometimes without feeling hungry, feeling out of control, followed by feelings of disgust or guilt) at least 1 time per week for 3 months but without regular use of compensatory behaviors afterward. Associated with obesity but can be overweight or normal weight.
• Treatment: 1) Psychotherapy (e.g., CBT, IPT, DBT, nutrition education); 2) Off-label pharmacotherapy (no approved medications; in clinical practice, SSRIs are often used to target comorbid mood symptoms and antiepileptics are often used to target reduction of binging episodes)