0071643192.pdf

PSYCHOBEHAVIORAL DISORDERS

■ Outpatient therapy includes psychotherapy (both individual and group)
and antidepressants.

Bulimia

SYMPTOMS/EXAM/DIAGNOSIS

■ Minimum of two episodes of binge eating per week for at least 3 months
■ Feeling of lack of control over behavior during eating binges
■ Regular self-induced vomiting, use of laxatives, strict dieting, fasting, vigorous
exercising
■ Persistent overconcern with body shape and weight
■ Physical exam significant for parotid and submandibular gland enlarge-
ment, dental enamel erosion, Russell sign(calluses over the dorsal aspect
of the fingers), posterior pharyngeal abrasions, facial petechiae, scleral
hemorrhage, stress fractures

TREATMENT

Same as for anorexia

Eating Disorder, Not Otherwise Specified (NOS)

DIAGNOSIS

■ All criteria for anorexia except the patient is still menstruating and has
normal weight
■ All criteria for bulimia but decreased in frequency or duration
■ Binge eating disorder, chewing/spitting out of food, eating large amounts
of food

TREATMENT

Same as for anorexia/bulimia

VIOLENCE/ABUSE/NEGLECT

Child Abuse

RISKFACTORS

Domestic violence, poverty, child’s medical condition, mental illness, history
of abuse and substance abuse in parent

SYMPTOMS/EXAM

■ Look for cutaneous manifestations such as bruises that are not over bony
prominences; area of erythema in specific shapes, cigarette burns, bites,
immersion burns on buttocks and legs. (See Figures 16.2 and 16.3.)
■ Shaken baby syndrome: Usually children <2 years presenting with lethargy,
vomiting; exam shows retinal hemorrhages, skeletal fractures
■ Sexual abuse: Look for perianal tears or fissures, acute tears of hymen,
vaginal petechiae, or hematomas.

DIFFERENTIAL

Mongolian spots, coagulopathy, coining/cupping, impetigo, toxic epidermal
necrolysis, herpes simplex virus, osteogenesis imperfecta, accidental trauma,
urethral prolapse, priapism

SSRIs are the antidepressants

of choice for eating disorders,

particularly bulimia.

A sexually transmitted disease

(STD) in a prepubescent child

is highly suspicious for sexual

abuse!