Pharmacotherapy
Eating disorders
NOTES
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Epidemiology
• Everyone can be affected.
• Eating disorders affect 2-5% of the population.
• Over 90% of cases are women in their teenage years.
• Approximately one third of people with eating disorders have other psychiatric diagnoses (depression, anxiety - OCD common) or a
family history of psychiatric disorders.
• Mortality resulting from suicide is common, therefore must be closely monitored for suicidality.
TYPES OF EATING DISORDERS What is written in pink are just FYI
ACCORDING TO DSM-5 (The diagnostic and Statistical Manual of Mental Disorder) :
1- Anorexia disorder (AN): Characterized primarily by self-starvation and excessive wight loss ( there is a severe and strong fear of gaining
weight ).
2- Bulimia nervosa (BN) : Characterized by Binge eating (eating large amount) and compensatory behaviors ( such as self-induced vomiting )
in an a!empt to undo the effects of binge eating.
3- Binge eating disorder (BED): Characterized by recurrent binge eating without the regular use of compensatory behaviors / measures to
counter the binge eating. ( they frequently consume unusually large amounts of food and feel unable to stop eating )
Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder
INCIDENCE OF EATING DISORDERS TYPES
Incidence = the occurrence / the frequency of a disease
1- Anorexia disorder (AN): 0.5 - 1 % ( Can be fatal - has the highest mortality rate of any psychiatric disorder )
2- Bulimia nervosa (BN) : 1 - 2 %
3- Binge eating disorder (BED): 1 - 4 %
HEALTH CONSEQUENCES ASSOCIATED WITH EATING DISORDERS
• Cardiovascular ( muscle loss , low or irregular heartbeat )
• Gastrointestinal ( bloating a feeling that your tummy is over full or stretched , nausea , constipation )
• Neurological ( difficulty concentrating , sleep apnea )
• Endocrine ( hormonal changes - estrogen , testosterone , thyroid )
• Risk of DEATH from suicide or medical complications is markedly increased for individuals with eating disorders.
[[ COMMON WARNING SIGNS ]]
EMOTIONAL / BEHAVIORAL EMOTIONAL / BEHAVIORAL Physical
• Weight loss , dieting , and control of food are primary concerns. • Noticeable weight fluctuations weight goes up and down over
• Food rituals for example : many people who have eating time , it's basically an irregular wight change,
disorders take abnormally small bites of food , and when not • Gastrointestinal complaints
allowed to do so will feel extreme anxiety. • Dizziness upon standing
• Social withdrawal people with eating disorders start to spend • Difficulty concentration , sleeping
more time alone, • Issues with dental , skin , hair , and nail health
• Frequent dieting , body checking
• Extreme mood swings without fuel from food, our minds and
bodies can't function at their peak, resulting in eating disorder
mood changes.
SCOFF QUESTIONNAIRE FOR EATING DISORDERS SCREENING
1- Do you ever make yourself SICK because you feel uncomfortably full ?
2- Do you worry you have lost CONTROL over how much you eat ?
3- Have you recently lost more than ONE stone ( i.e., 14 Ib ) in a 3-month period ?
4- Do you believe yourself to be FAT when others say you are too thin ?
5- Would you say that FOOD dominates your life ? 2
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1 point for every "Yes" answer, a score Greater than or equal indicates probable anorexia nervosa or bulimia nervosa.
ASSESSING EATING DISORDERS
The evaluation of a person’s physical, medical, cognitive, psychological , and behavioral history and current condition in order to determine the
presence of any mental health disorder. more proactive or alert in considering the possibility of an eating disorder in certain individuals. This helps in early detection and intervention.
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Clinicians should adopt a lower threshold for suspecting an eating disorder in the following people :
1- Young women with low body mass index (BMI) compared with peers.
2- Those with weight concerns despite being normal or underweight.
3- Women with menstrual disturbances or amenorrhoea the absence of menstrual periods.
4- Those with GI symptoms.
5- Those with physical signs of starvation or repeated vomiting.
6- Young people with type 1 diabetes mellitus and poor treatment adherence.
7- children with poor growth.
8- women with psychological or psychiatric illness.
ASSESSING MEDICATION MISUSE
Many prescription and OTC products can cause weight loss, and may be misused by a person with an eating disorder
Examples :
1- Laxatives , diuretics , anti-obesity medications and nutritional supplements,
2- People affected by Bulimia Nervosa , stimulant laxatives are commonly misused and are associated with the most medical complications.
3- Complications include effects on the GIT , hypovolemia , and electrolyte disturbances.
4- Diuretics cause similar complications as those seen with stimulant Laxatives , particularly dizziness and e- imbalance.
FYI :
Laxatives are a type of medicine that can treat constipation
Diuretics are a type of medicine that can help kidney to reduce fluid build up in the body such as extra water and salts
Hypovolemia a decreased volume of circulating blood in the body.
Electrolyte disturbance Hypokalemia ( low potassium ) is the most common electrolyte abnormality.
EATING DISORDERS MANAGEMENT PRINCIPLES
• EATING DISORDERS characterized by disturbances in eating behavior , behavioral change is required for positive treatment outcomes.
Therefore, behavioral therapies are useful interventions,
• Focuses on addressing physical and medical complications of Eating disorders ( e.g. cardiac instability , musculoskeletal injury , and
endocrine function )
• Medications are part of the comprehensive treatment strategy for eating disorders, but are rarely recommended as the sole treatment.
• Two medications have US FDA approval for treatment of eating disorders : Lisdexamfetamine (for BED) and Fluoxetine (for BN)
• Other psychotropic medications are used to treat eating disorders symptoms as well as comorbid psychiatric conditions such as anxiety
and depression,
