Psychiatric Undereating Disorders

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Questions and Answers

What characterizes cachexia in relation to energy balance?

Reduced appetite leading to decreased caloric intake (correct)

Increased appetite and energy storage

Improved metabolism with increased muscle mass

Stable weight with balanced caloric intake

Which chronic illnesses are associated with cachexia?

Common cold and influenza

Obesity and metabolic syndrome

Cancer, AIDS, and COPD (correct)

Hypertension and diabetes

What is a key component of the clinical diagnostic criteria for cachexia?

Improvement in physical strength and endurance

Weight gain of more than 5%

Weight loss greater than 5% or greater than 2% in depleted individuals (correct)

Stable caloric intake with increased muscle mass

How can nutritional support affect cachexia?

It may improve caloric intake but does not reverse muscle loss. Signup and view all the answers

What defines cachexia according to the consensus definition?

A syndrome associated with ongoing loss of skeletal muscle mass with or without fat mass Signup and view all the answers

Which of the following best describes the energy balance in cachexia?

Negative energy balance driven by reduced food intake and abnormal metabolism Signup and view all the answers

What characterizes anorexia nervosa in terms of energy intake?

Restriction of energy intake relative to physiological needs Signup and view all the answers

Which statement about the weight-related risk of being underweight is true?

The risks of being underweight are comparable to those of obesity. Signup and view all the answers

What is a key factor that contributes to the weight loss in individuals with anorexia and ARFID?

Higher energy expenditure relative to food intake Signup and view all the answers

What is the lifetime prevalence of anorexia nervosa in women?

0.9% Signup and view all the answers

How much higher is the risk of death by suicide in individuals with anorexia nervosa?

Thirty-two times that expected for the age group Signup and view all the answers

What distinguishes avoidant restrictive food intake disorder (ARFID) from anorexia nervosa?

ARFID does not involve a significant fear of gaining weight. Signup and view all the answers

What is the increased risk of death from physical causes for those with anorexia nervosa?

Five times the expected rate Signup and view all the answers

Which condition is NOT classified as a psychiatric undereating disorder?

Bulimia Nervosa Signup and view all the answers

What is a common consequence of inadequate food intake in anorexia and ARFID?

Malnutrition and psychosocial disability Signup and view all the answers

What is a common physiological consequence of low body weight in individuals with anorexia nervosa?

Amenorrhea and loss of fertility Signup and view all the answers

Cognitive flexibility is best defined as the ability to:

Switch between different concepts or tasks Signup and view all the answers

Which of the following is indicative of cognitive inflexibility in individuals with anorexia nervosa?

Ritualistic behaviors Signup and view all the answers

Improvements in cognitive flexibility among individuals with anorexia nervosa are linked with what outcome?

Improvements in anorexia nervosa symptoms Signup and view all the answers

What does research suggest about cognitive inflexibility in relation to anorexia nervosa?

It may be a predisposing trait rather than a result of starvation Signup and view all the answers

Which therapeutic approach is being explored for improving cognitive flexibility in anorexia nervosa?

Psychedelic drugs combined with psychotherapy Signup and view all the answers

Cognitive inflexibility in anorexia nervosa may lead to which of the following behaviors?

Ritualistic meal planning Signup and view all the answers

What is a key effect of starvation on cognitive functioning?

Cognitive impairment Signup and view all the answers

Which of the following statements about cognitive inflexibility is true?

It can be present before the onset of anorexia nervosa Signup and view all the answers

What are potential outcomes of psychotherapeutic interventions for cognitive inflexibility?

Breaking down rigid thought patterns Signup and view all the answers

What is a characteristic hormonal change observed in patients with anorexia nervosa?

Low leptin and high ghrelin levels Signup and view all the answers

How does chronic starvation in anorexia nervosa affect cortisol levels?

It results in elevated cortisol levels. Signup and view all the answers

Which cytokines are consistently elevated in patients with anorexia nervosa?

IL-1 beta, IL-6, and TNF alpha Signup and view all the answers

What effect does chronic stress from anorexia nervosa have on organ receptors?

It leads to remodeling of end organ receptors. Signup and view all the answers

What is a significant distinguishing factor between ARFID and anorexia nervosa?

ARFID does not involve body image disturbance. Signup and view all the answers

What differentiates anorexia nervosa from primary malnutrition in terms of cytokine levels?

Cytokine levels are elevated in anorexia but low in malnutrition. Signup and view all the answers

In which conditions is ARFID most often observed alongside?

Autism and ADHD Signup and view all the answers

What behavioral symptom is commonly associated with anorexia nervosa?

Perfectionism and rigid thinking. Signup and view all the answers

In anorexia nervosa, the remodeling of which receptors can lead to increased tissue breakdown?

Beta-adrenal receptors. Signup and view all the answers

What psychological response is commonly associated with ARFID regarding unfamiliar foods?

Hyperactive fear processing. Signup and view all the answers

What psychological disorder is significantly overlapped with anorexia nervosa?

Generalized anxiety disorder. Signup and view all the answers

Which symptom is NOT typical of individuals diagnosed with ARFID?

Significant weight gain as a primary concern. Signup and view all the answers

Which of the following statements is true regarding the sympathetic nervous system in anorexia nervosa?

It shows increased activity as a stress response. Signup and view all the answers

What treatment technique is primarily tailored for younger children with ARFID?

Messy food picnic. Signup and view all the answers

What is a potential outcome of the receptor remodeling caused by chronic stress in anorexia nervosa?

Increased tissue breakdown. Signup and view all the answers

Why was ARFID developed as a distinct diagnosis in DSM-V?

To clarify classifications of eating disorders. Signup and view all the answers

How do ARFID sufferers typically view unfamiliar foods?

As genuinely frightening objects. Signup and view all the answers

Which approach is most commonly used for older patients with ARFID?

Cognitive behavioral therapy. Signup and view all the answers

What type of food preferences do individuals with ARFID usually exhibit?

Homogenous and heavily processed foods. Signup and view all the answers

What aspect needs to be considered for the severity of ARFID as a diagnosis?

It must exceed expectations based on any primary disorder. Signup and view all the answers

Study Notes

Overview of Disorders of Negative Energy Balance

Disorders characterized by limited food intake include anorexia nervosa and avoidant restrictive food intake disorder (ARFID).
Underweight individuals face high risks comparable to obesity, with severe health hazards associated with low BMI.

Anorexia Nervosa

Recognized as the deadliest psychiatric illness with a 20% death rate within 20 years.
Physical causes of death are five times more likely than expected for the patient demographic.
Suicide risk is significantly elevated, being 32 times more prevalent than in the general population.
Lifetime prevalence rates are 0.9% in women and 0.3% in men.
Diagnostic criteria include significant restriction of energy intake leading to a low body weight relative to age, sex, and health.

Avoidant Restrictive Food Intake Disorder (ARFID)

Distinguished from anorexia nervosa by the absence of body image disturbance.
Often co-occurs with conditions like autism and ADHD; severity surpasses that of primary disorders.
Associated with heightened fear responses to unfamiliar foods, perceived as terrifying.
Preferred foods are typically predictable and heavily processed.

Treatment Approaches for ARFID

Younger children may benefit from creative engagement with food, such as "messy food picnics," fostering a safe environment.
Older patients often receive cognitive behavioral therapy (CBT) to address food-related fears.

Cognitive and Behavioral Symptoms of Anorexia Nervosa

Perfectionism, rigid thinking, and a strong focus on details are common traits.
Significant overlap occurs with anxiety disorders, obsessive-compulsive disorders, and autism spectrum disorders.

Hormonal and Physiological Changes in Anorexia Nervosa

Patients exhibit a profile of low leptin and insulin, and high ghrelin levels due to prolonged starvation.
Chronic starvation leads to continuous stress responses, indicated by elevated cortisol levels and an overactive sympathetic nervous system.
Dysregulated cytokine levels, particularly pro-inflammatory cytokines (IL-1 beta, IL-6, TNF alpha), indicate an inflammatory state inconsistent with typical malnutrition responses.
Physiological effects include amenorrhea, loss of fertility, and altered bone marrow morphology resulting in anemia.

Cognitive Flexibility in Anorexia Nervosa

Cognitive flexibility refers to adapting behavior based on changing circumstances; flexibility is often reduced in anorexia nervosa.
Cognitive inflexibility is linked to fixation on restrictive eating patterns and specific foods.
Improvements in cognitive flexibility may correlate with symptom relief.
Cognitive inflexibility may exist pre-morbidly, suggesting a genetic predisposition.

Therapeutic Innovations

Psychotherapy is a standard treatment, with emerging research into the use of psychedelic drugs (e.g., psilocybin, DMT, LSD) showing promise in enhancing cognitive flexibility.

Cachexia

This condition occurs as a secondary illness related to chronic diseases like cancer and heart failure.
It involves a significant energy balance disturbance, marked by reduced appetite and increased metabolic demands.
Defined as a multifactorial syndrome characterized by the ongoing loss of skeletal muscle mass that cannot be reversed with nutritional support.
Clinical criteria include weight loss exceeding 5%, or at least 2% in those already exhibiting weight depletion based on BMI metrics.

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Description

Explore the complexities of psychiatric undereating disorders in this quiz. Focus on Anorexia Nervosa and Avoidant Restrictive Food Intake Disorder (ARFID) and their implications on health. Understand how these disorders relate to overall energy balance and the impact on metabolism.