EATING DISORDERS....................pptx

EATING DISORDERS

1. EATING DISORDERS

2. Eating disorders are mental illnesses that cause serious disturbances in a person's everyday diet. It can manifest as eating extremely small amounts of food or severely overeating. The condition may begin as just eating too little or too much but obsession with eating and food over takes over the life of a person leading to severe changes. INTRODUCTION :

3. Eating disorders are psychological illnesses defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Definition

4. Anorexia Nervosa Bulimia Nervosa Types of Eating Disorder :

5. Anorexia nervosa is characterized by highly specific behavioral and psychopathological symptoms and significant somatic signs. Majority are females and the onset is during adolescence. The core psychopathological feature is the dread of fatness, weight phobia and a drive for thinness. ANOREXIA NERVOSA:

6. Types of Anorexia Nervosa ♦ Under weight ♦ Emaciated ♦ Restricting ♦ Binge-eating/ purging.

7. A) Under weight A Child is said to be under weight, if his/her BMI for age and gender is less than the 5 th percentile. BMI (kg/ ) B) Emaciation body requires a certain amount of energy to keep basic life system functioning. Body need additional energy to accomplish the activities growth and repair. Definition : emaciation is extreme thinners/ with one third or more of the body’s weight being last either gradually or suddenly  

8. C) Restricting People will loose weight by severely restricting the amount of food they eat and also try to loose the weight by exercising excessively D) Binge-eating/ purging People try to control their weight by purging get rid of food or calories by vomiting after eating, misusing laxatives, diuretics or enemas, some may binge or eat excessive amounts of food and then purge others may purge even after eating a small quantity

9. Etiology

10. SOCIAL ISOLATION FAMILY DYNAMICS SOCIAL FACTORS

11. PSYCHOLOGICAL FACTOR- DEPRESSION

12. 1. Genetic causes : Among female siblings of patients with established anorexia nervosa, 6-10% suffers from the condition compared to the 1-2% found in the general population of the same age (Strober, 1995). 2. Social factors : There is a high prevalence of anorexia nervosa among female students and in occupational groups particularly concerned with weight (for example. dancers). Influence of mass media, beauty contests are other important social causes Etiology :

13. 3. A disturbance in hypothalamic function. 4. Individual Psychological Factors : A disturbance of a body image, a struggle for control and a sense of identity are important factors in the causation of anorexia nervosa. Traits of low self esteem and perfectionism are often found. 5. Causes with the family : Disturbance in family relationships, over protection, family members having an unusual interest in food and physical appearance.

14. Clinical Features of Anorexia

15. Clinical Features of Anorexia ■ There is an intense fear of becoming obese. This fear does not decrease even if the person loses weight grossly and becomes very thin. ■ The body weight is 15 percent below the standard weight. ■ There is a body image disturbance. The patient is unable to perceive the body size accurately.

16. ■ The pursuit of thinness may take several forms. Patients generally eat little and set themselves daily calorie limits (often between 600 and 1000 calories). Some try to achieve weight loss by inducing vomiting, excessive exercise, and misusing laxatives. ■ Other signs and symptoms are secondary to starvation and include sensitivity to cold, delayed gastric emptying, constipation, low blood pressure, br adycardia , hypothermia and amenorrhea in females.

17. ■ Vomiting and abuse of laxatives may lead Treat to a variety of electrolyte disturbances, the Pharr most serious being hypokalemia. ■ Hormonal abnormalities also may be seen. Psychological findings-Preoccupation with body size, distorted body image, description Psycho of herself as fat.

18. Complications : ● Resulting from the malnutrition, dehydration and electrolyte imbalances caused by prolonged starvation, vomiting and laxative abuse. ● Increased susceptibility to infection. ● Hypoalbuminemia . ● Chronic inflammatory bowel disease (due to laxative abuse).

19. ● Esophageal erosion, ulcers, tears, bleeding, gum erosion, dental caries (due to frequent vomiting) ● Amenorrhea ● Life-threatening cardiovascular complications

20. Anorexia nervosa often runs a fluctuating course with periods of exacerbations and partial remissions. Outcome is very variable. Course and Prognosis :

21. 1) Complete physical examination including laboratory tests to rule out endocrine, metabolic and central nervous system abnormalities; cancer; malabsorption syndrome and other disorders that cause physical wasting. 2) Complete blood testing-hemoglobin levels, platelet count, cholesterol level, total protein, sodium, potassium, chloride, calcium and fasting blood glucose and serum amylase levels and blood urea nitrogen. Diagnosis :

22. 3) ECG readings irregular. 4) Differential diagnosis to rule out other psychiatric disorders like substance abuse, anxiety disorder, body dysmorphic disorder, mood disorders, schizophrenia. 5) Based on ICD10 criteria

23. 1) Dramatic weight loss. 2) Refusal to eat certain foods or food categories. 3) Consistent excuses to avoid situations involving food. 4) Excessive and rigid exercise routine. 5) Withdrawal from usual friends/relatives. ANOREXIA NERVOSA: WARNING SIGNS

24. Pharmacotherapy Neuroleptics Eg. Olanzapine Quetiapine Treatment Modalities

25. 1) Maintain a strict intake and output chart. 2) Monitor status of skin and oral mucous membranes 3) Encourage the patient to verbalize feelings of fear and anxiety related to achievement, family relationships and intense need for independence 4) Encourage family to participate in education regarding connection between family process and the patient's disorder Nursing Interventions :

26. 5) Avoid discussions that focus on food and weight. 6) Short-term management is focused on ensuring weight gain and correcting nutritional deficiencies. Maintaining normal weight and preventing relapses are long-term goals to be achieved. 7) In the early stages of treatment, it is best for the patient to remain in bed in a single room while the nurse maintains close observation. The goal should be to achieve a weight gain of 0.5 to 1 kg per week

27. 8) Hospitalization is usually required and successful treatment depends on good nursing care, with clear aims and under standing on the part of the patient as well as the nurse 9) Eating must be supervised by the nurse and a balanced diet of at least 3000 calories should be provided in 24 hours 10) Control vomiting by making the bathroom inaccessible for at least 2 hours after food

28. 11) Weight should be checked regularly. Monitor serum electrolyte levels and signs and symptoms like amenorrhea, constipation, hypoglycemia, hypotension, etc. 12) In extreme cases, when the patient refuses to eat and comply with the treatment, gavage feedings may need to be instituted.

29. Bulimia nervosa is characterized by episodes of binge-eating followed by feelings of guilt, Humiliation, Depression and self-condemnation ⚫Includes frequent binging (consuming abnormally large portions of food within a specific time period); in severe cases, can have several binge episodes in one day

⚫ Involves recurrent use of compensatory measures to prevent weight gain (such as self-induced vomiting, diuretic or laxative use, dieting, fasting, or a combination of these measures. BULIMIA NERVOSA

30. Etiology of Bulimia

31. A) Abdominal and epigastric pain B) Amenorrhea C) Fluid and electrolyte imbalances D) Perfectionism E) Distorted body image F)Exaggerated sense of guilt G) Feelings of alienation H) Poor impulse control Clinical Features :

32. I) Low tolerance for frustration J)Peculiar eating habits or rituals K) Excessive exercise regimen L) Withdrawal from friends and usual activities M) Frequent weighing N) Persistent sore throat, heartburn O) Callused or scarring on back of hands and knuckles P) Tooth staining or discolouration, loss od dental enamel, and increased dental caries

33. Q) History of eating amount of food larger than what most people would eat. R) During binge-eating episodes, sense of lack of control. S) Thin, normal or slightly overweight appearance, with history of frequent weight fluctuations.

34. 1) Wrappers/containers indicating consumption of large amounts of food 2) Frequent trips to bathroom after meals 3) Signs of vomiting e.g. staining of teeth, calluses on hands 4) Excessive and rigid exercise routine 5) Withdrawal from usual friends/relatives BULIMIA NERVOSA: WARNING SIGNS

35. ♦ Gastric rupture during periods of binge eating Dental caries, erosion of tooth enamel, parotitis, and gun infections. ♦ Dehydration or electrolyte imbalances Chronic irregular bowel movements and constipation from laxative use. ♦ Increased risk of suicide and psychoactive substance abuse. Complications :

36. ♦ Medical evaluation to rule out upper gastrointestinal disorder. ♦ Psychological evaluation and Beck Depression Inventory History. ♦ Laboratory tests (serum electrolytes, blood glucose, baseline ECG). ♦ Confirmed, if ICD10 criteria met. Diagnosis :

37. ▲ Engage patient in therapeutic alliance to obtain commitment to treatment ▲ Establish contract with patient that specifies amount and type of food she must eat at each meal ▲ Set a time limit for each meal ▲ Identify patient's elimination patterns ▲ Teach patient to keep journal to monitor high-risk situations that cue binging and purging behaviors Nursing Interventions :

38. ▲ Encourage patient to recognize and verbalize her feelings about her eating behavior ▲ Explain risks of laxative, emetic, and diuretic abuse ▲ Provide assertiveness training ▲ Assess and monitor patient's suicide potential

39. ⚫ Psychotherapy ⚫ TCSs or SSRIs ⚫ Self-help groups ⚫ Hospitalization Treatment Modalities :

40. Complete physical examination including laboratory tests to rule out endocrine, metabolic and central nervous system abnormalities; cancer; malabsorption syndrome and other disorders that cause physical wasting Complete blood testing-hemoglobin levels, platelet count, cholesterol level, total protein, sodium, potassium, chloride, calcium and fasting blood glucose and serum amylase levels and blood urea nitrogen. Diagnostic Evaluations

41. ECG readings irregular Differential diagnosis to rule out other psychiatric disorders like substance abuse, anxiety disorder, body dysmorphic disorder, mood disorders, schizophrenia . Based on ICD10 criteria

42. 1) Imbalanced Nutrition Less Than Body Requirements related to Inadequate food intake or self-induced vomiting 2) Risk for Deficient Fluid Volume related to Inadequate intake of food and liquids 3) Impaired Parenting related to Issues of control in family Disturbed Thought Process related to Severe malnutrition Nursing Diagnosis :

43. 4) Chronic Low Self-Esteem related to Morbid fear of obesity

44. 1) Engage patient in therapeutic alliance to obtain commitment to treatment 2) Establish contract with patient that specifies amount and type of food she must eat at each meal 3) Set time limit for each meal 4) Identify patient’s elimination patterns 5) Teach patient to keep journal to monitor high-risk situations that cue binging and purging behaviors Nursing Management :

45. 6) Encourage patient to recognize and verbalize her feelings about her eating behavior 7) Explain risks of laxative, emetic, and diuretic abuse 8) Provide assertiveness training 9) Assess and monitor patient's suicide potential