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rajeevkrishnadas

Bulimia and Anorexia - Basics

10 posts in this topic

BULIMIA

1. Episodes of Binge eating over a period of 3 months is necessary to diagnose Bulimia True (2/7 X 3/12)

2. There is a sense of lack of control over eating during the episode of Binge

3. Self perception of being too fat and a dread of fatness is seen in Bulimia

4. Bulimics are excessively concerned with their body shape and weight

5. Binges are typically followed by bouts of depression, guilt and self disgust

6. Recurrent episodes of bulimia are more common than anorexia

7. Compensatory behaviour (self induced vomiting etc) are seen in Bulimia

8. Bulimia is more prevalent than Anorexia

9. Bulimia is more common in women.

10 Age of onset in Bulimia is later than anorexia

11. Rate of occurance of Bulimia in males is 1/10 of that of males

12. Isolated episodes of binging and purging have been reported in upto 40% of college women.

13. Bulimics may be normal, under weight, overweight or obese

14. Prevalence of Bulimia in industrialised countries is 1%

15. Plasma endorphin levels rise folowing an episode of vomiting in Bulimia

16. There is an increased frequency of Bulimia among first degree relatives of patients

17. Families of Bulimics tend to be less close and more conflicutal than anorexics

18. Increased prevalence of depression in patients and their family members in Bulimia

19. Patients with Bulimia tend to be more outgoing, angry and impulsive than anorexia

20. Alcohol dependence is associated with Bulimia

21. Shoplifting is more associated with Bulimia

22. Binge eating is ego dystonic in patients with Bulimia

23. Patients with Bulimia tend to seek help more readily than Patients with anorexia

24. Bulimia patients have histories of difficulties seperating for caregiver

25. Bulimia patients use their own bodies as transitional objects

26. Eating represents a wish to fuse with the caretaker and purging, a wish for seperation

All answers are true

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BULIMIA CONTD

27. In Bulimia Binging precedes vomiting by about a year

28. Post binge anguish is seen in Bulimia

29. Bulimia patients usually binge on high calorie sweet objects

30. Most patients with bulimia are in their normal weight range

31. Most patients with Bulimia are sexually active

32. Patients with bulimia have increased rates of Biplar disorder

33. ,, ,, ,, Dissociative disorder

34. ',,  ,, ,, Sexual abuse

35. ,, ,, ,, variety of personality disorder

35a. ,,   ,, ,,   OCD; impulse control disorders.

36. Purging bulimic  have more body image distrubance compared to non purging ones

37. Hypokalemia and hypochloremic alkalosis are complications of Purging bulimics

38. TFT is normal in Bulimia

39. There is nonsupression in DST in Bulimia

40. Hypomagnesimia and hyperamylasemia is seen in Bulimia

41. A quarter of patients with bulimia may have menstrual disturbance including amenorrhea

42. Binge eating and purging can be symptoms of anorexia

43. Kleine Levin syndrome consist of periodic hypersomnia and hyperphagia lasting for 2 to 3 weeks

44. K L Syndrome is more common in males

45. Bulimia patients have better prognisis than anorexia

46. Rule of the thirds apply for prognisis in bulimia

47. Spontaneous remission may occur in Bulimia

48. CBT remain the first line treatment for Bulimia ??????? (or is it self help groups and materials)

49. Fluoxetine is effective in Bulimia independent of the presence of a mood disorder

49. Antidepressant use result in short term recovery rate of 25%

50. Behavioural approaches including ERP is not as effective as CBT or IPT

51. Recovery rate with CBT in BN is about 40 - 50%

52. IPT is as effective as CBT in BN

53. Transdiagnostic CBT model for the treatment of eating disorders was proposed by Fairburn

54. Group CBT is effective in BN

55. Out patient treatment is the norm for most patients with BN

All answers as far as I know are True...

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ANOREXIA

1. Age of onset of AN is mid teens

2. 5% of patients have their onset in early 20s

3. In young western females, prevalence of anorexia is around 0.3%

4. AN occurs 10 to 20 times more common in females compared to males

5. Anorectic symptoms occur in upto 5% of young women

6. Recent systematic reviews have concluded that Bulimia is a culture bound syndrome,while anorexia is not

7. Relative risk of developing AN in relative of a proband is 11.3

8. There is cross transmission of AN and BN

9. Twin studies suggest that heritability of AN is around 50 to 75%

10. Variance in liability due to genetic factors is more in BN than AN

11. AN is associated with Depression in 65%

12. AN is associated with Social Phobia

13. AN is associated with OCD in 25 % of cases

14. Major mood disorders are more common in family members of AN

15. Thyroid function is supressed in AN

16. Non supression of DST is seen in AN

17. Amenorrhea usually develops after weight loss and reflects lowered LH,FSH and GnRH

17 a.  Amenonorrhea in AN is hypothalamic

18. CT changes showing enlarged sulci and ventricles are reversed on weight gain

19. Caudate nucleus metabolism is high in AN

20. ,, ,, ,,    reverses to normal after treatment.

21. The prevalence  of AN among sisters of patients is estimated to be 6%

22. The serotonin metabolite 5-hydroxyindoleacetic acid, which has been reported

to be elevated in the cerebrospinal fl uid of patients with anorexia nervosa

23. Serum albumin and prothrombin levels are usually normal in AN (apparently reflects the normal synthetic functions of the liver)

24. Serum Cholesterol levels are elevated in AN

25. There is increased frequency of homosexuality in males with AN ????????

26. Between one-third and one-half with AN make full and complete psychological and physical recoveries

27. 10 to 20% of patients who have been hospitalized for AN will, in the next 20 years, die as a result of their illness

28. Binging and purging is associated with poor prognosis ?????

( Kaplan says restricting type has poorer prognosis)

All answers true as far as I know. (except where ???? where i am in doubt)

Reference include Wiley's textbook; Psychiatry journal; Synopsis; College Seminars

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ANOREXIA CONTD

29. Decreased appetite usually differentiates depressive patients from anorexia. True

But in later stages, patients with anorexia may present with decreased appetite.

Other points of differentiation include - Planned and ritualistic hyperactivity in AN; Preoccupation with recipes and preparing meals; Body image disturbance and fear of gaining weight...

30. About half of patients with AN will eventually develop BN within the first year after the onset of AN.

31. Most systematic reviews have shown that placebo response is minimal in anorexia nervosa

32. Non specialised services are associated with a worse outcome in AN.

33. In AN, standard treatments with Specialist registrars supervised by an eating disorder expert have worse outcome than ED specific psychotherapy  True ( Nielsen review in Journal of psychosomatic research)

34. Dietary management is ineffective for relapse prevention in AN

35. Fluoxetine has been found to prevent relapse of AN

36. Patients with anorexia rejects the sick role

37. Severe negative life event precipitant is a good prognostic factor in adolescent AN

38. Weight below 65% of expected is a negative prognostic factor in adolescent AN

39. Adolescent onset AN has better prognosis compared to adult ???????? (conflicting references)

40. According to Crisp, there is a phobia for normal weight in AN

41. ICD 10 and DSM suggest that patients with AN have a morbid fear of fatness.

42. Preoccupation with weight and shape is frequently absent in males suffering from AN.

43. Obsessive compulsive PD is commonly seen in patients with AN.

44. There is no increased risk of AN in families with affective illness.

45. Eating disorder examination, a structured interview developed by Fairburn is considered Gold standard method to assess symptoms in AN

46. Incidence of AN in primary care has been constant in the UK over the last 20 years. (20/100000) - (Turnbull et al 1996)

47. There is an increased risk of development of AN following birth trauma

48. Body mass index below 13.5 is indication for admission in AN

49. Rate of weight loss of >1kg/ week is indication for admission

50. Hypophosphatemia of refeeding is associated with Carbohydrate overload in AN

All answers True. (doubts ????)

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39. Adolescent onset AN has better prognosis compared to adult ????????

I'd say this is true

Early onset has better prognosis ( cf. schizophrenia)

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35. Fluoxetine has been found to prevent relapse of AN

would appreciate reference for this

Fluoxetine is used in AN only if there is comorbid depression

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Dear shan

fluoxetine found to prevent relapse in AN

answer is FALSE

Ref: Companion to psychiatric studies, 7th edition, page: 495

vijay

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35. Fluoxetine has been found to prevent relapse of AN

would  appreciate  reference  for  this

Fluoxetine  is  used  in AN  only  if  there  is  comorbid  depression

I think action of fluoxetine is independent of depression...

and same holds for Bulimia if I am right...

My ref:

Kaye W H, Nagata T, Weltzin T E et al. Double-blind placebo-controlled administration of fluoxetine in restricting and restricting-purging type anorexia nervosa. Biol Psychiatry 2001; 49: 644–52.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T4S-42RDSDW-C&_user=10&_coverDate=04%2F01%2F2001&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2fb2db6af0d6caf34abe05385320f747

Hope this helps...

Cheers...

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