Browse the corpus

General lnternal Medicine Eating Disorders Diagnosis Anorexia nervosa consists of two types: o restricting, in which patients restrict intake . binge eating/purging, in which patients binge and purge to control weight Diagnostic clues for the restricting type of anorexia include: . low BMI . fear of weight gain r distorted body image . amenorrhea The medical complications include anemia, osteopenia, hypotension, electroll.te abnormalities, and arrhl.thmias. During the flrst few weeks of eating, patients are at risk for the refeeding syndrome, which can include cardiac arrest and delirium caused by exacerbation of hypophosphatemia and hypokalemia. Diagnostic clues for bulimia nervosa are episodes of binging with loss of control followed by purging (vomiting, diuretic or laxa- tive abuse), fasting, or excessive exercise. Patients usually have normal weight. Medical complications may be the presenting problem and can include acid-induced dental disease, esophageal tears, electrolyte derangements (low chloride and potas- sium), and metabolic alkalosis. Treatment For anorexia nervosa, psychotherapy is considered first line treatment. Psychotropic drugs do not work. Patients with bulimia respond to CBT; antidepressants may be beneficial. DOI{'T BE TRICKED r Do not choose bupropion for eating disorders because ofthe increased incidence ofseizures. TESTYOURSETF A24 year old woman has reflux esophagitis, recurrent sore throat, and a dry cough. She exercises regularly and is 'always dieting" because of her "weight problem." BMI is 25. On physical examination, the posterior pharynx and soft palate are injected without exudate. The tooth enamel is eroded. ANSWER: For diagnosis, choose bulimia nervosa. For management, choose CBT with or without fluoxetine. Schizophrenia Diagnosis The following usually begin in mid to late adolescence: . unusual perceptual experiences . false beliefs . illogical thoughts 139