Eating Disorders | Anatomy2Medicine
Eating Disorders

Eating Disorders

Anorexia Nervosa,

        • Profound disturbance of body image and there lentless pursuit of thinness, often to the point of starvation
        • Occurs most commonly in females between the ages of 12 and 21 years but may occur in older women and men.
        • Patient has intense fear of becoming obese which does not diminish as weight loss progresses.
        • Although appetite may not decrease initially but later on, it does decrease, and decreased intake of food may cause weight loss.
        • The patient claims to feel fat even when emaciated.
        • A loss of 25 percent of original weight may occur.

 

  • Weight loss leading to maintenance of body weight less than 85% of that expected

 

      • Binge eating followed by vomiting may also be present.
      • No known physical illness accounts for the weight loss.
      • There is refusal to maintain body weight over a minimal normal weight for age and height.
      • Medical complications of Anorexia Nervosa

 

 

  • Amenorrhea
  • Baby like lanugo hairs over the body
  • Cold Intolerance
  • delayed gastric emptying, bloating, constipation, and abdominal pain.

 

        • Psychiatric therapy in a hospital is usually required if patient refuses to eat.

 

  • The patient may need to be fed parenterally.
  • Depression may be the accompanying feature

 

        • Imipramine is considered to be drug of choice.
      • “Bulimia Nervosa” is characterized
        • Adolescents commonly affected
        • Binge pattern of eating
        • Craving for food
        • Bulimics frequently attempt to counteract the effects of overeating by either of the following:

 

  • Self induced vomiting
  • Purgative/laxative abuse

 

        • Use of appetite suppressants
        • Intermittent starving

 

  • Classical clinical vignette of Bulimia Nervosa

 

          • Padma19-year-old, unmarried girl was brought to psychiatry OPD by her mother with complaints that she has started remaining fearful of becoming obese, and thus would starve 3-4 days. Then she would eat more than her normal meal followed by induced vomiting. This is continuing for the last 8-9 months.
        • Differential diagnoses of Bulimia Nervosa

 

  • Anorexia Nervosa
  • Kliiver-Bucy Syndrome
  • Kleine Levin Syndrone
  • Kliiver-Bucy Syndrome

 

          • It is characterized by visual agnosia, compulsive licking and biting, examination of objects by mouth, inability to ignore any stimulus, placidity, hypersexuality and hyperphagia
        • Kleine-Levin Syndrome.
        • Periodic hypersomnia lasting for 2-3 weeks and hyperphagia.
        • Onset is usually during adolescence.

 

  • More common in men than in women.

 

      • The drug of choice in weight reduction programme is Diethylpropion
    • Drugs are used in treatment of obesity

 

  • Phendimetrazine
  • Perfluoroctyl

 

        • Perfluoroctyl Bromide coats the gastrointestinal tract and inhibits fat absorption.

 

  • Orlistat

 

      • Orlistat. A non-systemic pancreatic lipase inhibitor which decreases the amount of fat absorbed by 30 percent.

 

  • Triphasic K-complexes are seen in Stage II NREM phase of sleep:

 

Sleep Disorders

    • Characteristic changes in sleep physiology:
      • Waking Electroencephalogram (EEG): alpha (a) waves of 8-12 Hz. low voltage activity of mixed frequency

 

  • Non-rapid eye movement (NREM) sleep
  • Stage 1

 

        • occurs mostly in the beginning of sleep, with slow eye movement.
        • This state is sometimes referred to as relaxed wakefulness.
        • Alpha waves disappear and the theta wave appears.
        • People aroused from this stage often believe that they have been fully awake. During the transition into stage-1 sleep, it is common to experience hypnic jerks
      • Stage 2
        • no eye movement occurs, and dreaming is very rare.
        • The sleeper is quite easily awakened.
        • EEG recordings tend to show characteristic “sleep spindles”, which are short bursts of high frequency brain activity, and “K-complexes” during this stage.

 

  • Stage 3

 

      • previously divided into stages 3 and 4, is deep sleep, slow-wave sleep (SWS).

 

  • delta waves dominated in stage 4
  • In 2007, these were combined into just stage 3 for all of deep sleep

 

      • Dreaming is more common in this stage than in other stages of NREM sleep though not as common as in REM sleep.
      • The content of SWS dreams tends to be disconnected, less vivid, and less memorable than those that occur during REM sleep
      • This is also the stage during which parasomnias most commonly occur

 

  • It is the Non-REM sleep stages 3 and 4, that, if people are aroused, i.e. 1/2 to 1 hour after sleep onset, they are disoriented, and their thinking is disorganized.

 

 

Stage1 Sleep. EEG highlighted by red box.

 

Stage 2 Sleep. EEG highlighted by red box. Sleep spindles highlighted by red line.

Stage 4 Sleep. EEG highlighted by red box.

 

    • REM sleep:
      • After 90 minutes of sleep onset, first REM episode

of the night occurs

        • Characterized by a high level of brain activity
        • Depression may shorten REM latency
      • High level of brain activity similar to those in wakefulness
      • REM sleep is “paradoxical” because of its similarities to wakefulness.
      • Although the body is paralyzed, the brain acts somewhat awake. Electroencephalography during REM sleep usually reveals fast, desynchronized, low-amplitude “brainwaves” (neural oscillations), which differ from the slow δ (delta) waves of deep sleep but resemble patterns seen during wakefulness
      • An important element of these is the θ (theta) rhythm in the hippocampus.
      • The cortex shows 40–60 Hz gamma waves as it does in waking.
      • The cortical and thalamic neurons of the waking or paradoxically sleeping brain are more depolarized—i.e., can “fire” more readily—than in the deeply sleeping brain
      • The right and left hemispheres of the brain are more coherent in REM sleep, especially during lucid dreams.
        • REM sleep is punctuated and immediately preceded by PGO (ponto-geniculo-occipital waves) waves, bursts of electrical activity originating in the brain stem.
        • These waves occur in clusters about every 6 seconds for 1–2 minutes during the transition from deep to paradoxical sleep.
        • They exhibit their highest amplitude upon moving into the visual cortex and are a cause of the “rapid eye movements” in paradoxical sleep
      • A very High yield MCQ for PG Medical entrance
        • Somnanbulism occurs Stage IV of NREM
        • Nocturnal penile tumescence occurs REM sleep
        • Nocturnal Enuresis is a feature seen in Stage 4 of NREM sleep
        • “Night Terrors” are features of Stage IV of NREM sleep
        • “Nightmares” occur in REM sleep
      • The “drug of choice” for treating night terrors is Clonazepam
      • “Circadian Rhythm” is controlled by Suprachiasmatic Nucleus of Hypothalamus

 

  • Causes of Insomnia,
  • Aging
  • Brain stem lesions
  • Circadian rhythm sleep disorders
  • Narcolepsy,
  • A chronic ailment consisting of recurrent attacks of drowsiness and sleep.

 

          • The patient is unable to control these spells of sleep but is easily awakened.
          • Association with HLA-DQB1

 

  • Cataplexy
  • Sleep paralysis

 

          • Except for frequent sleep patterns, the electroencephalogram is normal.

 

  • Symptomatically treated with drugs such as amphetamine and methylphenidate.
  • Cataplexy.

 

        • The brief, sudden loss of muscle control, such as jaw drop, head drop, weakness of the knees, or paralysis of all skeletal muscles with collapse, brought on by strong emotion or emotional response such as hearty laugh, excitement, surprise, or anger.
        • Patient remains awake and fully conscious.
        • The episodes may last from a few seconds to as much or two minutes. Once the condition begins, it usually continues but may be less severe with age.

 

  • About 70 percent of patients with narcolepsy have cataplexy.
  • Sleep paralysis.
  • Most often occurs on awakening in morning in norcolepsy patients. During the episode, patients are apparently awake and conscious, but unable to move a muscle.
  • The attack usually is of short duration, but, to the patient, the elapsed time may seem like hours
  • “Sleep Talking” is known as Somniloquy

 

      • Bruxism=Tooth grinding.
      • Jactatio Capitis Nocturna’, i.e. Sleep related head banging.
      • “Pavor Nocturnus” is a Sleep terror

 

  • Sleep Apnoea,

 

      • cessation of breathing during sleep.
      • In order to be so classified, the apnoea should last for at least 10 seconds, and should occur 30 or more times during a 7 hour period of sleep.
    • Most common sleep disorder is Insomnia