1. Eating and sleping Disorders.ppt00000x

eating disorder

1. Eating Disorders By: Mohammed Gebre ( BPharm , MSc in Clinical Pharmacy 1

2. Introduction An eating disorder is an illness that causes serious disturbances to your everyday diet, such as: eating extremely small amounts of food or severely over-eating. A person with an eating disorder may have started out just eating smaller or larger amounts of food, but at some point, the urge to eat less or more spiraled out of control. Severe distress or concern about body weight or shape may also characterize an eating disorder. 2

3. Usually occurs between the ages of 12-18 Often coexists with other psychiatric disorders: major depression, anxiety disorders, obsessive-compulsive disorder, substance abuse 5-20% mortality rate, mostly from heart failure or arrhythmias 3

4. Types of Eating Disorders Anorexia nervosa Bulimia nervosa Eating disorder not otherwise specified (EDNOS) Binge eating disorder (BED) 4

5. Anorexia Nervosa Anorexia nervosa is characterized by: Extreme thinness A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight Intense fear of gaining weight Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight Lack of menstruation ( Amenorrhea ) among girls and women Extremely restricted eating. 5

6. Many people with anorexia nervosa see themselves as overweight, even when they are clearly underweight. People with anorexia nervosa typically weigh themselves repeatedly and eat very small quantities of only certain foods. 6

7. Some people with anorexia nervosa may also engage in binge-eating followed by extreme dieting, excessive exercise, self-induced vomiting, and/or misuse of laxatives, diuretics, or enemas . Some who have anorexia nervosa recover with treatment after only one episode. Others get well but have relapses. Still others have a more chronic, or long-lasting, form of anorexia nervosa, in which their health declines as they battle the illness. 7

8. Other symptoms may develop over time, including: Thinning of the bones (osteopenia or osteoporosis) Brittle hair and nails Dry and yellowish skin Growth of fine hair all over the body (lanugo) Mild anemia and muscle wasting and weakness Severe constipation Low blood pressure, slowed breathing and pulse 8

9. Damage to the structure and function of the heart Brain damage Multiorgan failure Drop in internal body temperature, causing a person to feel cold all the time Lethargy, sluggishness, or feeling tired all the time Infertility 9

10. Malnutrition 10

11. Prevalence of AN More prevalent in industrialized countries that idealize a thin body type although expected to become more widely distributed Lifetime prevalence among women is 0.5 % to 3.7 % Prevalence among men is one tenth of that among women 11

12. Diagnostic Criteria for AN American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria are the standard 12

13. AN APA Diagnostic Criteria Weight <85% of standard Intense fear weight gain/fat although underweight Distorted body image Women: amenorrhea: absence of 3 consecutive periods Restricting type Not regularly engaged in binge eating-purging behavior Binge eating/purging type Regularly engaged in binge eating and purging behavior 13

14. Bulimia nervosa Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that compensates for the overeating such as: forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors. 14

15. Unlike anorexia nervosa, people with bulimia nervosa usually maintain a healthy or normal weight, while some are slightly overweight. But like people with anorexia nervosa, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. 15

16. Diagnosis requires: Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances a lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating) 16

17. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as: self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months 17

18. Other symptoms include: Chronically inflamed and sore throat Increasingly sensitive and decaying teeth as a result of exposure to stomach acid Acid reflux disorder and other gastrointestinal problems Intestinal distress and irritation from laxative abuse Severe dehydration from purging of fluids Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to heart attack. 18

19. Binge-eating disorder With binge-eating disorder a person loses control over his or her eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are over-weight or obese. 19

20. People with binge-eating disorder who are obese are at higher risk for developing cardiovascular disease and high blood pressure. They also experience guilt, shame, and distress about their binge-eating, which can lead to more binge-eating. 20

21. Treatment of eating disorders Adequate nutrition, reducing excessive exercise, and stopping purging behaviors are the foundations of treatment. Specific forms of psychotherapy and medication are effective for many eating disorders. Some patients may also need to be hospitalized to treat problems caused by mal-nutrition or to ensure they eat enough if they are very underweight. 21

22. Treating anorexia nervosa Treating anorexia nervosa involves three components: Restoring the person to a healthy weight Treating the psychological issues related to the eating disorder Reducing or eliminating behaviors or thoughts that lead to insufficient eating and preventing relapse. 22

23. Some research suggests that the use of medications, such as: antidepressants, antipsychotics, or mood stabilizers, may be modestly effective in treating patients with anorexia nervosa. These medications may help resolve mood and anxiety symptoms that often occur along with anorexia nervosa. 23

24. Treating bulimia nervosa As with anorexia nervosa, treatment for bulimia nervosa often involves a combination of options and depends upon the needs of the individual. To reduce or eliminate binge-eating and purging behaviors, a patient may undergo: nutritional counseling and psychotherapy, especially cognitive behavioral therapy (CBT), or be prescribed medication. 24

25. CBT helps a person focus on his or her current problems and how to solve them. The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize, and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly. 25

26. Some antidepressants, such as fluoxetine , which is the only medication approved by the U.S. Food and Drug Administration (FDA) for treating bulimia nervosa, may help patients who also have depression or anxiety. Fluoxetine also appears to help reduce binge-eating and purging behaviors, reduce the chance of relapse, and improve eating attitudes. 26

27. Treating binge-eating disorder Treatment options for binge-eating disorder are similar to those used to treat bulimia nervosa. Psychotherapy, especially CBT that is tailored to the individual, has been shown to be effective. Again, this type of therapy can be offered in an individual or group environment. Fluoxetine and other antidepressants may reduce binge-eating episodes and help lessen depression in some patients. 27

28. Sleep Disorders 28

29. Two Major Categories 1. Dyssomnias The sleep itself is pretty normal. But the client sleeps too little, too much, or at the wrong time. So, the problem is with the amount (quantity), or with its timing, and sometimes with the quality of sleep . 2. Parasomnias Something abnormal occurs during sleep itself, or during the times when the client is falling asleep or waking up (e.g., bad dreams). The quantity and timing of the sleep are essentially normal. 29

30. Dyssomnias Primary Insomnia Primary Hypersomnia Narcolepsy Breathing-Related Sleep Disorder Circadian Rhythm Sleep Disorder Dyssomnia NOS 30

31. A. Primary Insomnia - too little sleep Characteristics Difficulty initiating or maintaining sleep Persists for 1 month or longer Often due to: Major Depressive Episode, Manic Episode, or anxiety disorder Commonly misused substances, as well as some prescription medicines. Breathing-related problems The cause sometimes can not be identified. 31

32. Treatment of insomnia Difficulty in falling asleep. Fast onset hypnotics Difficulty in maintaining sleep. Long acting hypnotics Both Combination of drugs (fast acting + long acting hypnotics). 32

33. Factors affecting selection of hypnotics Nature of sleep disorder Characteristics of patients daily activity Students Vs housewives Past experience with medication Tolerance General patients' attitude towards drugs Positive…decrease dose Negative….normal or large dose 33

34. Drug therapy of insomnia BZDs Long acting and short acting. BZDs bind to GABA-A receptors, and they have sedative, anxiolytic, muscle relaxant, and anticonvulsant properties. Short t 1/2 – Triazolam and oxazepam . Intermediate duration of action: Lorazepam , Estazolam & temazepam. The effects of diazepam, flurazepam and quazepam are long because of active metabolites. 34

35. Nonbenzodiazepine Hypnotics Less effective than BZDs, but side effects are usually minimal. Antihistamines : diphenhydramine, doxylamine , and pyrilamine . Amitriptyline, doxepin, and nortriptyline are effective, but side effects include anticholinergic effects, adrenergic blockade, and cardiac conduction prolongation . 35

36. Non-pharmacologic therapy Vigorous daytime exercise, not exercising before sleep Sexual intercourse, if pleasurable Decrease stimulation and increase soothing environments, such as ear plugs or calm reading Practice good sleep habits 36

37. B . Primary Hypersomnia (sleeping too much, as well as being drowsy at times when client should be alert) Characteristics Excessive sleepiness Persists for 1 month or longer Often due to: Major Depressive Episode Use of substances is less likely to produce hyersomnia than insomnia, but it can happen (e.g., sleeping pills overdose ) The cause sometimes can not be identified. Treatment: Exercise when becoming sleepy 37

38. C . Narcolepsy (Sleeping at the wrong time ) Characteristics Sleep intrudes into wakefulness, causing clients to fall asleep almost instantly May also have sleep paralysis, sudden loss of strength, and hallucinations as fall asleep or awaken. Treatment: Stimulants, sometimes antidepressants 38

39. D . Breathing-Related Sleep Disorder Characteristics Sleep disruption Due to sleep-related breathing condition (e.g., Obstructive Sleep Apnea Syndrome) Treatment In mild cases: weight loss, sleeping on one’s side, and avoiding hypnotics and alcohol In more serious cases: a machine that provides continuous positive airway pressure 39

40. E . Circadian Rhythm Sleep Disorder Characteristics Persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia, due to mismatch between sleep-wake schedule required by a person’s environment and his/her circadian sleep-wake pattern (e.g., shift work, jet lag). 40

41. Treatment : Difficult to treat, because it has to involve the entire family Darken bedroom and use soundproofing Limit caffeine and hard to digest food. Ensure all family members learns shift To help jet lag, exposure to sun helps 41

42. F . Dyssomnia NOS This category is for insomnias, hypersomnias , or circadian rhythm disturbances that do not meet criteria for any specific Dyssomnia . 42

43. Parasomnias Nightmare Disorder Sleep Terror Disorder Sleepwalking Disorder Parasomnia NOS 43

44. A . Nightmare Disorder Characteristics: (1) Repeated awakenings from bad dreams ( 2) When awakened client becomes oriented and alert 44

45. Nightmare Disorder: Usually occurs in early morning when REM sleep dominates. The same nightmare may recur repeatedly or different ones may pop up three times a week. Stress may induce 60% of nightmares. Half of the cases of nightmare disorder appear before age 10; 2/3 before age 20. Dreams are clearly remembered Drugs can trigger nightmares. 45

46. B . Sleep Terror Disorder Characteristics: ( 1) Abrupt awakening from sleep, usually beginning with a panicky scream or cry. ( 2) Intense fear and signs of autonomic arousal ( 3) Unresponsive to efforts from other to calm client ( 4) No detailed dream recalled ( 5) Amnesia for episode 46

47. Usually only children have sleep terror disorder . The client is not having a nightmare. The eyes are open, screams erupt. Usually happens in early evening. In contrast to nightmares, sleep terrors do not respond to psychotherapy. 47

48. C . Sleepwalking Disorder Characteristics : (1) Rising from bed during sleep and walking about . ( 2) Usually occurs early in the night . ( 3) On awakening, the person has amnesia for episode 48

49. Most sleepwalking children are psychologically normal. Runs in families. Begins between ages 6 and 12 and may be stress-related. Adult sleepwalking is far less common, usually worse and more chronic . Treatment: Relaxation techniques Hypnotics . 49

50. D . Parasomnia NOS Characteristics: Abnormal behavioral or physiological events during sleep or sleep-wake transitions, but that do not meet criteria for a more specific Parasomnia Examples Sleep-Talking: Often more annoying to partner than to sleeper. Has no memory in morning. Can be during REM or delta sleep. In REM sleep, pronunciation is clear and understandable; in deep sleep (delta) a patient to be mumbled and unintelligible 50

51. Sleep paralysis: inability to perform voluntary movement during the transition between waking and sleep. Usually associated with extreme anxiety, and sometimes fear of impending death. 51