<prompt> False regarding Anorexia Nervosa :Evident psychosisVigor exceeding physical ill beingWeight lossDecreased appetite  <response>: D. i.e. Decreased appetite. Although all features i.e. self perception of being fat, under weight, amenorrhoea and binge eating may be present in anorexia nervosa. It is binge eating that is least common present only in 25-50 cases ; whereas other 3 features are present in 100 cases. However, it is impoant to mention that binge eating i.e. consuming large amount of food in sho period of time a feeling that the eating is out of control followed by inappropriate behaviour to compensate it i.e. self induced vomiting, purging, diuretic use, missing insulin etc. is a characteristic essential feature required for diagnosis of bulimia nervosa. Features Anorexia nervosa Bulimia nervosa Onset Mid adolescence Late adolescence early adulthood Female : Male 10 : 1 10 :1 Lifetime 1 1 - 3 prevalence in -- 5 per decade Low women Markedly decreasedQ Usually normalQ Moality height Weight Menstruation Absent2 Amenorrhea 100Q required for diagnosis; this criteria is met if Usually normal absence of atleast 3 menstrual period occurs only following hormone eg. Present in 50 consecutive menstrual cycles estrogen administration, or OCP Body image - There is self perception of being too fat, with an There is self perception of being too fat, disturbance intrusive dread of fatnessQ, which lit a self with an intrusive dread of fatnessQ. imposed low weight threshold. included in both included in ICD- 10 only DSM - IV ICD- 10 criteria Self evaluation is undualy influenced - Despite objectively low weight, patient feels that over concerned by body weight and their body as a whole, or some pa of it is too fat; shape DSM-IV undue influence of body weight or shape on self evaluation; or denying or minimizing the seriousness of low weight DSM - IV Method of weight - By drastically reducing total food intakeQ, with a - By recurrent inappropriate compensatory control dispropoionate decrease in high - carbohydrate self induced purging vomiting laxative and fatty foods, mostly abuseQ in 80 - Ritualistic exercising, extensive cycling, walking, - Fasting, excessive exercise, use of appetite jogging, running are common suppressants and thyroxine and omission - Purging with or without binging is less common of insulin in 20 Pecaliliar behaviour about PresentQ in form of - Hiding food all over house AbsentQ food - Carrying large amount of candies with them - Cutting meat into very small pieces spending a great deal of time rearranging pieces on their plate. Confronted with their peculiar behaviour , they often deny that it is unusual or flatly refuse to discuss it Hunger Anorexia - Term anorexia is a misnomer because loss of Irresistable craving for food with episodes of appetite is usually rareQ until late Kaplan. binge eating often followed by post binge However they rarely complain of hunger or fatigue. anguish depression - As weight loss progresses, thoughts of food dominate mental life idiosyncratic rules develop around eating. Evidence that patients are thinking constantly about food is their passion for collecting recipes, and for preparing elaborate meal for others, and be drawn to food related occupations. Subtypes 1. Food Restricting type more common : During 1. Purging type more common: during current episode, the person is not regulary engaged current episode, the person is regularly in binge- eating or purging behaviour. These often engaged in self induced purging have obscessive compulsive traits. vomiting, misuse of laxative, diuretics, 2. Binge- eatingpurging type less common : or enemas. These are more likely to be during current episode, the person is regularly associated with substance abuse alcohol, engaged in binge eating purging. These are more drug, impulse control disorder stealing, likely to be associated with substance abuse alcohol, shopping, antisocial behaviour, personality drug, impulse control disorders, stealing personality disorder, suicide attempts sexual disorder, risk of suicide sexual promiscuity promiscuity. 2. Non purging type less common: during current episode, the person has used other inappropriate compensatory behaviour eg. fasting or excessive exercise. Binge Eating i.e eating definitely a large amount of food in 25 - 50 100, Required for diagnosisQ sho period than most people would eat in same period At least twice a week over under similar circumstance; and a sense of lack of control over eating. period of 3 months. Recurrent inappropriate compensatory behaviour eg. self Uncommon 100, Required for diagnosisQ induced vomiting, purging, diuretic useQ in 80. 25- 50 Omission of insulin, fasting or excessive exercise, use of appetite suppressants thyroid preparations in 20 At least twice a week for 3 months Features secondary to purging vomiting laxative abuse Uncommon; and persent Common - Enamel erosion dental decay cariesQ only in binge eating - Salivary gland pancreatic inflammation purging subtype of hyperophyQ with increase in serum amylase anorexia nervosa. - Esophageal gastric erosion, bowel dysfunction with haustral dilation - Electrolyte abnormalities esp. hypokalemic, hypochloremic akalosis, dt vomitingQ; hypomagnesemia; metabolic acidosis dt laxative abuse - Seizures dt electrolyte imbalance, mild neuropathies, weakness, fatigue, cognitive disorder. Features secondary to excessive weight loss Present Absent mostly - Cachexia, cold intolerance, hypothermia - Lanugo fine baby like hair over body, edema, acrocyanosis - Leucopenia, anemia normocytic normochromic, thrombocytopenia, increased BUN creatinine, and hypokalemia, hypoglycemia, hypophosphatemia, hyper chlosterolaemia, hypercarotenemia yellow palm skin - Low estrogen testosterone LH FSH thyroid metabolism T3; increased coisol - Osteopenia, osteoporosis - Hypotension, bradycardia, prolonged HIS bundle transmission prolonged QT interval, small hea, cardiac arrhythmias atrial ventricular premature contractions, ventricular tachycardia, sudden death. - Abnormal taste sensation Zn def. Sexual Orientation other disorders - Have poor sexual - Most are sexually active adjustment, delayed - More oftenly associated psychosocial sexual development and a markedly decreased with anxiety disorders, bipolar I disorder, dissociate disorders interest in sex and tend to become socially withdrawn. sexual abuse. - Are perfectionist rigid. Prognosis Poor Better 