Overview
This lecture covered the key features, diagnostic criteria, differences, and management strategies for eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder), followed by an overview of neurocognitive disorders (delirium and dementia).
Eating Disorders Overview
- Eating disorders are disruptions in normal eating patterns, often involving anxiety around food.
- "Nervosa" in diagnoses relates to body dysmorphia (distorted perception of body weight/shape).
- Both anorexia nervosa and bulimia nervosa often stem from a fear of gaining weight and body image concerns.
Anorexia Nervosa
- Characterized by significantly low BMI, often below 17.
- Patients show cachexia (wasting, gaunt appearance), wear baggy clothes, and preoccupation with food/calorie counting.
- May involve restricting, excessive exercise, vomiting, or laxative/diuretic misuse.
- Symptoms: poor circulation, low energy, menstrual irregularities, bradycardia, hypotension, lenugo (fine hair), and electrolyte imbalances.
- Hospitalization if 30% weight loss in 6 months, heart rate < 40, systolic BP < 70, potassium < 3, EKG changes, or suicidality.
Bulimia Nervosa
- BMI is usually normal or elevated; binging and purging are hallmark behaviors.
- Binging: consuming large amounts of food rapidly and often in secret.
- Purging: self-induced vomiting, excessive exercise, laxative or diuretic misuse.
- Parotid gland enlargement and dental erosion are common.
- Can overlap with anorexia but differentiated by BMI.
Binge Eating Disorder
- Repeated episodes of binging without compensatory purging behaviors.
- Leads to distress, guilt, and low self-esteem; no vomiting or laxative abuse.
Cognitive Distortions in Eating Disorders
- Overgeneralization: single food event affects self-image.
- All-or-nothing thinking: one dietary slip seen as a complete failure.
- Catastrophizing: magnifying minor weight changes.
- Emotional reasoning and taking things personally also contribute.
Causes & Risk Factors
- Cultural values (thinness), peer/family pressure, trauma, stress, meds, psychiatric comorbidities (anxiety, depression), and neuroendocrine disorders.
Management & Outcomes for Eating Disorders
- Prioritize medical stabilization: ABCs, normal vitals, correct labs, monitor for self-harm.
- Interventions: regular weights, monitor during/after meals, nutritionist referral, structured eating, therapy, and medications (fluoxetine/Prozac, olanzapine/Zyprexa).
- Monitor kidney (BUN, creatinine) and cardiac function.
Delirium
- Acute, rapid-onset, reversible neurocognitive disturbance; often caused by medical illness, meds, infection, or substance use.
- Presents as fluctuating alertness, disorientation, memory disturbance, hallucinations, agitation, or lethargy.
- Elderly at higher risk.
- Interventions: treat underlying cause, reorient, frequent family presence, low-stimulation environment.
Dementia/Major Neurocognitive Disorders
- Gradual, progressive, and irreversible cognitive decline (e.g., Alzheimer's).
- Risk increases with age and family history.
- Clinical features: memory loss (amnesia), language issues (aphasia), movement problems (apraxia), object/person recognition loss (agnosia), and anosmia (loss of smell).
- Stages: mild (forgetfulness), moderate (confusion, sundowning), severe (loss of functional abilities).
- Prioritize safety: least restrictive interventions first, short/clear questions, reminiscence and group therapy.
- Medications: donepezil (Aricept) slows progression but does not reverse dementia.
Key Terms & Definitions
- BMI (Body Mass Index) — a measure of body fat based on height and weight.
- Cachexia — severe muscle wasting and weight loss.
- Lenugo — fine hair development in response to low body fat.
- Body Dysmorphia — distorted perception of one's body image.
- Overgeneralization/All-or-Nothing/Catastrophizing — cognitive distortions affecting self-image.
- BUN/Creatinine — blood tests assessing kidney function.
- Amnesia — memory loss; Aphasia — language impairment; Apraxia — impaired voluntary movement; Agnosia — inability to recognize objects or people; Anosmia — loss of smell.
Action Items / Next Steps
- Review class slides and textbook on eating and neurocognitive disorders.
- Practice flashcards for key terms (especially cognitive impairment terms).
- Complete ATI practice questions and review provided rationales.
- Focus on recognizing clinical changes and prioritizing interventions in practice scenarios.
- Email instructor with any questions; next class is Tuesday.