Date post: | 11-Jan-2016 |
Category: |
Documents |
Upload: | shanna-agnes-cannon |
View: | 217 times |
Download: | 0 times |
Eating Disorders & Eating Disorders & AlcoholismAlcoholism
Laurie McCormick, MD Laurie McCormick, MD Assistant Professor, PsychiatryAssistant Professor, Psychiatry
University of IowaUniversity of Iowa
© AMSP
2/31
Eating Disorders - Common but Difficult to Identify
5% of US population has an ED~ 1% AN ♀>> ♂
~ 3% BN ♀>♂
~ 1% BED ♀=♂
80% of US ♀ - dissatisfied with body
50% ♀ / 25% ♂ - on a diet any given day
© AMSP
3/31
Disordered Eating Continuum
1/3 of dieters → pathological dieting; 1/4 of pathological dieters → EDs
2/3 ♀ + 1/3 ♂ teens - unhealthy wt control
1/5 ♀ + 1/10 ♂ – very unhealthy wt control
Shame/secretiveness ≠ identification
© AMSP
4/31
Alcohol Use Disorders Are Common
© AMSP
%/yr
(Lifetime)
Hazardous 25
Abuse5
(15)
Dependence5
(10)
5/31
Mortality/Morbidity of EDs & AUDs
© AMSP
EDs - ↑ mortality rate of all psychiatric ds
AN - most deadly psychiatric illness
BN - electrolyte disturbance
AUDs - 3-4X ↑ in early death Health related (stroke, cancer, heart ds) Accidents Suicide
6/31
This Lecture Reviews
Definitions
Relationships
Screening & identification
Treatment & management
© AMSP
What are Eating Disorders?
© AMSP7/31
http://www.youtube.com/watch?v=QSqtVDIwnHo
8/31
Anorexia Nervosa (AN)
Weight - refusal to keep weight ~ 85% expected
Amenorrhea
Fear of gaining weight
Evaluation of self - influenced by weight/shape
* 30% cross over to BN over time
© AMSP
9/31
Bulimia Nervosa (BN)
Binge eating – recurrently
Inappropriate compensation
Compensation - 2X/wk x 3 mo’s
Evaluation of self - influenced by body image
Not occurring during AN
* Rarely cross-over to AN
© AMSP
10/31
Eating Disorder – NOS (ED-NOS)
Sub-threshold AN or BN
Binge eating disorder (BED) Eating large amounts of food in <2hrs
Distress from lack of control while eating
Eating when not hungry
Guilt from overeating
No compensatory behaviors
Occurs ≥ 2X/wk x 3 mo’s© AMSP
11/31
Alcohol Abuse / Dependence
© AMSP
Dependence12-months of 3: - Tolerance - Withdrawal - use - ↓ ability to quit - time using alcohol - ↓ social activities - Continued use
Abuse
12-months of 1:
- ↓ obligations
- Hazardous situations
- Legal problems
- Interpersonal problems
- Not alcohol dependence
12/31
This Lecture Reviews
Definitions √
Relationships
Screening & identification
Treatment & management
© AMSP
13/31
Can EDs + AUDs Co-Occur?
2X ↑ risk of AUD w/ BN, not AN (only in ♀)
Alcohol related problems > alcohol use
♀ BN & risk of AUD 50% - ED before AUD 40% - AUD before ED 10% onset of AUD & ED at the same time
© AMSP
14/31
ED + AUD Comorbidity
Anxiety → ↑ risk AUDs & EDs
↑ risk of BN + AUD in ♀= impulsivity, novelty seeking, immature defenses
Comorbid AUD + ED = worse outcome? Only in AN
© AMSP
Sociocultural Model for EDs Sociocultural Model for EDs
Pressure to be thin
Thin-idealinternalization
Body dissatisfaction
Dieting (restraint)
Negative affect Exercise
Binge/purge
Low self-esteem
Neuroticism
© AMSP 15/31
Depression
16/31
Food Addiction = Motivation & Reward
© AMSP
↓ Dopamine- DRD2 A1 allele
↑ Opiate- Mu G allele- Kappa 1 long allele
Ventral
17/31
Genetic & Environmental Risk Factors
Genetic +/-
Environment +/-
© AMSP
18/31
This Lecture Reviews
Definitions √
Relationships √
Screening & identification
Treatment & management
© AMSP
19/31
Patient Health Questionnaire (PHQ)
16 sets of questions Sections 6-8: (9 questions) - ED Sections 9-10: (7 questions) - AUD
“Feel you can’t control what or how much you eat?”
“Do you ever vomit?”
Overall accuracy - 85% Sensitivity to detect - 75% Specificity for the illness - 90%
© AMSP
20/31
Eating Disorder Examination (EDE-Q)
28 item questionnaire (6-pt scale)
“Trying to limit food to influence shape/weight?”
“In the past month, lose control over eating?”
Sensitivity - 80% Specificity - 80%
© AMSP
21/31
AUDIT – Alcoholism Screening
10-item questionnaire (5-pt scale)
1. How often do you have a drink of alcohol?
2. How many drinks of alcohol in one occasion?
3. Do you ever have 6 or more on a given day?
Score of > 8/50 = hazardous drinking
Sensitivity to detect: ~ 80%
Specificity for disease: 80%© AMSP
22/31
ED Complaints & Findings
Physical findings: Emaciated appearance Enlarged salivary/parotid glands
Complaints: Constipation Gastroesophageal reflux disease Dental caries/broken teeth Menstrual irregularity
© AMSP
23/31
Laboratory Findings - EDs
↓ potassium
↑ amylase
↑ ALT/AST
↓ white blood count
↓ bone density
© AMSP
24/31
This Lecture Reviews
Definitions √
Relationships √
Screening & identification √
Treatment & management
© AMSP
25/31
Stages of Treatment
© AMSP
Identification
Intervention - brief intervention - motivational interviewing
Inpatient - detoxification - weight stabilization - break binge/purge cycle
Day treatment/outpatient - rehabilitation - psychopharmacology - cognitive behavioral tx
Outpatient - relapse prevention
26/31
Initial Intervention
Directive brief interventions
Motivational interviewing Feed back on risks Responsibility for change Advice Menu of treatment options Empathetic interaction Self-efficacy enhancement
© AMSP
27/31
Meds for ED - Limited Efficacy
© AMSP
Fluoxetine
(Prozac)
Topiramate
(Topamax)
Cognitive Behavioral
Therapy
↓ purge √ √
↓ binge √ √ √
↓ weight √ √
↑ abstinence
(>12 mos)
√
28/31
Meds for AUDs - Limited Efficacy
© AMSP
Naltrexone Acamprosate Topiramate
↓ urges √ √ √
↓ drinks √ √ √
↓ relapse √ √ √
↑ abstinence
(>12 mos)
√ √ √
29/31
Meds for Combined ED + AUD
Naltraxone Inconsistent findings
Acamprosate ↓ cravings for food & alcohol in AUD
Topiramate ↓ heavy drinking days by 50% in AUD ↓ weight in BED by 7lbs - 21 wks ↓ weight by 5kg in 16 wks
© AMSP
30/31
Psychotherapeutic Interventions
Family therapy for AN in adolescents
Cognitive behavioral therapy (CBT) Improves outcome in EDs Improves outcome in AUDs
Group therapy/support groups
© AMSP
31/31
Summary
Definitions √
Relationships √
Screening & identification √
Treatment & management √
© AMSP