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Questions and Answers
Psychogenic vomiting often occurs before meals and is characterized by the presence of nausea.
Psychogenic vomiting often occurs before meals and is characterized by the presence of nausea.
False
Pica may be associated with pregnancy and can lead to poisoning or nutritional deficiencies.
Pica may be associated with pregnancy and can lead to poisoning or nutritional deficiencies.
True
Avoidant/Restrictive Food Intake Disorder includes concerns about body image and preoccupation with weight.
Avoidant/Restrictive Food Intake Disorder includes concerns about body image and preoccupation with weight.
False
Psychogenic vomiting is less common in women than in men.
Psychogenic vomiting is less common in women than in men.
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Pica is diagnosed only if the behavior is infrequent and mild.
Pica is diagnosed only if the behavior is infrequent and mild.
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Avoidant/Restrictive Food Intake Disorder was introduced in DSM-4.
Avoidant/Restrictive Food Intake Disorder was introduced in DSM-4.
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Antidepressants are effective in reducing the frequency of binge eating in 50% of cases.
Antidepressants are effective in reducing the frequency of binge eating in 50% of cases.
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Bulimia nervosa requires management of complications from starvation and weight restoration.
Bulimia nervosa requires management of complications from starvation and weight restoration.
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Topiramate is suggested as a first-line treatment for bulimia nervosa.
Topiramate is suggested as a first-line treatment for bulimia nervosa.
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Binge eating disorder has compensatory behaviors such as purging or vomiting.
Binge eating disorder has compensatory behaviors such as purging or vomiting.
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Approximately one-third of patients show good progress with guided cognitive behavioural self-help.
Approximately one-third of patients show good progress with guided cognitive behavioural self-help.
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Lisdexamfetamine is licensed for treating binge eating disorder in Europe.
Lisdexamfetamine is licensed for treating binge eating disorder in Europe.
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Electrolyte status monitoring is not necessary in bulimia nervosa patients who vomit frequently.
Electrolyte status monitoring is not necessary in bulimia nervosa patients who vomit frequently.
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The age group affected by binge eating disorder is generally older than that affected by bulimia nervosa.
The age group affected by binge eating disorder is generally older than that affected by bulimia nervosa.
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A 'stepped-care' approach is not effective for managing bulimia nervosa.
A 'stepped-care' approach is not effective for managing bulimia nervosa.
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Binge eating disorder patients often experience depressive symptoms more severely than those with bulimia nervosa.
Binge eating disorder patients often experience depressive symptoms more severely than those with bulimia nervosa.
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Study Notes
Psychogenic Vomiting
- Characterized by chronic and episodic vomiting with no organic cause.
- Typically occurs post-meal and without accompanying nausea.
- Differentiated from bulimia nervosa and diabetic gastroparesis.
- More prevalent in women; onset usually between early to middle adulthood.
- Treatment options include psychotherapy and behavioral therapy.
Pica
- Involves the persistent consumption of non-nutritive substances like hair, paper, or stones.
- Could indicate a mineral deficiency.
- Common in individuals with intellectual disabilities, autism, and schizophrenia.
- Associated with pregnancy and iron deficiency conditions.
- Diagnosis requires persistence or severity of the behavior.
- Risks include poisoning, obstruction, nutritional deficiencies, or parasitosis.
Avoidant/Restrictive Food Intake Disorder
- A newly defined disorder in DSM-5 focusing on inadequate dietary intake, especially in children.
- Can lead to nutritional deficiencies, failure to thrive, and social impairments.
- Individuals may show little interest in food or have concerns about food's sensory properties.
- Unlike other disorders, it lacks body image distortion or weight obsession.
- Replaces earlier category named "Feeding Disorder of Infancy and Early Childhood."
Medication for Eating Disorders
- Antidepressants can reduce binge eating frequency, effective in about 20% of cases.
- Faster action compared to depression treatment may require higher doses (e.g., fluoxetine 60mg daily).
- Long-term compliance issues evident with antidepressant use.
- Recommended as a second-line treatment after unsuccessful psychological approaches.
- Topiramate can reduce binge eating but is limited by side effects; not recommended for bulimia nervosa.
Management of Bulimia Nervosa
- Easier to manage than anorexia nervosa due to a higher likelihood of patient recovery and positive dynamics.
- No immediate need for weight restoration or severe complication management.
- Continuous monitoring of electrolyte levels necessary for patients with frequent vomiting or laxative misuse.
- Utilization of a "stepped-care" approach for diverse patient needs.
Step-by-Step Approach for Bulimia Nervosa Management
- Step 1: Identify individuals needing urgent specialist care due to severe depression, physical complications, or substance issues.
- Step 2: Provide guided cognitive behavioral self-help over approximately 4 months, typically 8-10 facilitated sessions, applicable in primary care with one-third showing good progress.
- Step 3: For individuals not improving in 4-6 weeks, initiate Cognitive Behavioral Therapy-Enhanced (CBT-E). Consider antidepressants like fluoxetine for persistent severe depressive symptoms.
- Step 4: If CBT-E fails, conduct a comprehensive reassessment considering intensive cognitive therapy or antidepressant treatment, discussing and agreeing upon a suitable plan with the patient.
Binge Eating Disorder
- Recognized as a new category in DSM-5, defined by recurrent binge eating without bulimia features.
- Non-existent compensatory behaviors such as vomiting or purging.
- Classified as unspecified eating disorder in ICD-10.
- Patients often have depressive symptoms and body dissatisfaction, typically less severe than those with bulimia nervosa.
- Similar impact on personal and public health as bulimia, linked to increased mortality often due to obesity.
- Conceptualized mechanisms are similar between binge eating disorder and bulimia nervosa.
- Roughly 25% of obesity treatment patients exhibit binge eating disorder traits.
- More prevalent among older demographics compared to bulimia; up to 25% of treatment seekers may be men.
- High rates of spontaneous remission; effective treatment options include CBT, interpersonal therapy, and antidepressants.
- Lisdexamfetamine is newly approved for binge eating disorder treatment in the USA.
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Description
Explore the complex world of eating disorders, focusing on psychogenic vomiting and pica. Learn about the characteristics, diagnosis, and treatment options for these conditions, highlighting their prevalence and distinct features. This quiz provides an in-depth look at behaviors associated with these disorders and their impact on individuals.
