Eating Disorders PDF

584 SEC TION III PSYCHIATRY ` PSYCHIATRY!PATHOLOGY Eating disorders Most common in young women. Anorexia nervosa Intense fear of weight gain, overvaluation of thinness, and body image distortion leading to calorie restriction and severe weig...

584 SEC TION III PSYCHIATRY ` PSYCHIATRY!PATHOLOGY Eating disorders Most common in young women. Anorexia nervosa Intense fear of weight gain, overvaluation of thinness, and body image distortion leading to calorie restriction and severe weight loss resulting in inappropriately low body weight (BMI < 18.5 kg/m2 for adults). Physiological disturbances may present as bradycardia, hypotension, hypothermia, hypothyroidism, osteoporosis, lanugo, amenorrhea (low calorie intake Ž!!leptin Ž!!GnRH Ž!!LH, FSH Ž!!estrogen Ž!amenorrhea). Binge-eating/purging type—recurring purging behaviors (eg, laxative or diuretic abuse, self- induced vomiting) or binge eating over the last 3 months. Associated with hypokalemia. Restricting type—primary disordered behaviors include dieting, fasting, and/or over-exercising. No recurring purging behaviors or binge eating over the last 3 months. Refeeding syndrome—often occurs in signi"cantly malnourished patients with sudden !calorie intake Ž!!insulin Ž!!PO43!, !K+, !Mg2+ Ž!cardiac complications, rhabdomyolysis, seizures. Treatment: nutritional rehabilitation, psychotherapy, olanzapine. Bulimia nervosa Recurring episodes of binge eating with compensatory purging behaviors at least weekly over the last 3 months. BMI often normal or slightly overweight (vs anorexia). Associated with parotid gland hypertrophy (may see !serum amylase), enamel erosion, Mallory-Weiss syndrome, electrolyte disturbances (eg, !K+, !Cl!), metabolic alkalosis, dorsal hand calluses from induced vomiting (Russell sign). Treatment: psychotherapy, nutritional rehabilitation, antidepressants (eg, SSRIs). Bupropion is contraindicated due to seizure risk. Binge-eating disorder Recurring episodes of binge eating without purging behaviors at least weekly over the last 3!months. !diabetes risk. Most common eating disorder in adults. Treatment: psychotherapy ("rst line); SSRIs; lisdexamfetamine. Pica Recurring episodes of eating non-food substances (eg, ice, dirt, hair, paint chips) over 1 month that are not culturally or developmentally recognized as normal. May provide temporary emotional relief. Common in children and during pregnancy. Associated with malnutrition, iron de"ciency anemia, developmental disabilities, emotional trauma. Treatment: psychotherapy and nutritional rehabilitation ("rst line); SSRIs (second line). Gender dysphoria Signi"cant incongruence between one’s gender identity and one’s gender assigned at birth, lasting > 6 months and leading to persistent distress. Individuals experience marked discomfort with their assigned gender, which interferes with social, academic, and other areas of function. Individuals may pursue multiple domains of gender af"rmation, including social, legal, and medical. Transgender—any individual who transiently or persistently experiences incongruence between their gender identity and their gender assigned at birth. Some individuals who are transgender will experience gender dysphoria. Nonconformity to one’s assigned gender itself is not a mental disorder. Sexual dysfunction Includes sexual desire disorders (hypoactive sexual desire or sexual aversion), sexual arousal disorders (erectile dysfunction), orgasmic disorders (anorgasmia, premature ejaculation), sexual pain disorders (genito-pelvic pain/penetration disorder). Differential diagnosis includes (PENIS): ƒ Psychological (if nighttime erections still occur) ƒ Endocrine (eg, diabetes, low testosterone) ƒ Neurogenic (eg, postoperative, spinal cord injury) ƒ Insuf"cient blood #ow (eg, atherosclerosis) ƒ Substances (eg, antihypertensives, antidepressants, ethanol)