In the last post, we saw how:

• There are several changes in patients that have AN also the are many conditions that look like AN
• Among the hair changes that are seen in AN are those of hair loss and in some cases, they may grow abnormal hair called Lanugo hair.
• A patient being evaluated for AN has to be evaluated both psychologically and physically.

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My curls aren’t as defined anymore this is what they don’t tell you about anorexia

— Eris (hospital arc) (@st4revd) November 19, 2022

Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for four consecutive months. This month will be dedicated to Eating Disorders. In the first month, we discussed Depression, and in the subsequent month, anxiety. We just finished with Schizophrenia.

In this post, we are looking at Twitter posts. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.

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Differentials

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Patients who have schizophrenia may express delusions about food but it is hardly ever about the caloric content of the food. They are more likely to be paranoid about the food being poisoned by someone.

In schizophrenia, the preoccupation is hardly about being overweight. They also pay no mind to exercise to increase caloric consumption. The eating habits seen in anorexia are very different from those seen in schizophrenia.

Anorexia is different from bulimia especially the binge and purge type in because the patient will consume large amounts of food and experience depressive symptoms like guilt. The patient will then indulge in self-induced vomiting but they do not lose up to 15% of their body weight.

There is a condition whose aetiology is not known but presents with hyperactivity of the vagal nerve and in this case, the patient also eats heavily and there may be weight loss in some cases. Because the parasympathetic system is overstimulated, it leads to some of the features seen in AN such as bradycardia, hypertension and other features seen in parasympathetic overstimulation.

The patient will feel bloated in this case and the patient doesn’t have the appetite of a patient with AN. This case should be death with anticholinergics.

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Coccygeal pain in Eating Disorders (Reaction post)

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Source

According to several sources online, there appears to be tailbone pain when the weight loss gets very severe. In these instances, it is because of the loss of muscle and fat that usually would prevent contact between the surfaces but with all that the only structure between the tailbone and the surfaces as a person sits is the skin and its limited connective tissue.

In this post, we will discuss a bit about the tailbone, particularly the anatomy given that it is a vestigial organ and it functions almost nil in humans.

The tailbone or coccyx is triangular and it makes up the bottom end of the spine beneath the sacrum. It is the main bony structure of the tail or at least that’s the structure it is in other animals that’s why it is called the tail bone in humans.

Fetal development largely determines the number of bones that can be counted on the coccyx usually it is between 3 to 5 bones which are either fused or are in some way fused. In initial studies of this bone, it was thought that the bone was fused but now it is known that the bone permits movement as little as it may be.

The sacrum is attached to the coccyx through the sacrococcygeal joint and the movement between these bones is usually very minute. TH movements of the tailbone are little flexion and extensions as the lower limb move (pelvic, hips and legs). In the standing position, the pelvic bone will point outward and inward so that the body can be better held and the body can be kept in the proper position.

The coccygeal bone was named the tail bone because that is its function in other animals but it is vestigial in humans meaning it has no function. But if there was any function it would be in sitting as this organ part of the pelvis. The ischium of the pelvis and the coccyx help with stability as a person sits. Some of the pelvic floor muscles are also attached to these bones that make up the coccyx.

The orifice of the pelvic floor is also supported by these bones including the vagina in females and the anus.

Women tend to have more coccygeal injuries than men because of the wider hips they have for delivery. Some studies point out that women are 5 times more likely to have coccydynia than men. Because of the wider hip in women, there is a reduced ability for the hips to rotate and for that reason, the hip is more prone to injury.

There is also the fact that women have more of their upper body weight placed on the coccyx when they sit and this is part of the reason why they tend to be more prone to injury.

During childbirth, the baby's head also presses against this bone as it makes its way through the canal. Women also report coccygeal pain during mensuration.

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Treatment

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A meta-analysis of the effects of cognitive behavioural and Psychodynamic therapy was done by the eating disorder journal. They tried to gather more knowledge about these studies to know how they work and to know who they would work best on based on the patient's comorbidity and the pathological processes ongoing in the patient.

Their method was to analyse search results for the topic. Important details were the rates at which they were able to achieve remission in people in these studies. The studies analyse ED and other psychopathology. The study analyse the data based on the changes that were seen and the diagnosis.

The result was that for CBT there was a 50% remission in patients for other eating disorders it was less than this and it was lowest in patients who had mixed disorders. For PIT the results were not so profound because of limited data. The predictive value for the patient undergoing the PIT is if the patient has comorbidity.

With CBT there was a better result when compared to PIT but even with CBT, there were a good number of people who did not go into remission for ED. From these studies, it was evident that PIT is not very suitable for achieving remission in patients with ED but this could be because a small study group was used.

Some people may need PIT specifically for the fact that they can not function independently and not because they have cognitive decline. More studies need to be conducted to not the best treatment method and will bring about change in behaviour in patients with ED over a long period.

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Questions

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• What did you learn about Eating Diorders?

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Conclusion

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• Schizophrenia may present with eating habits that are abnormal but the main difference is that they are not fixated on the caloric value of what they eat.
• There may be complaints of coxygeal pain in people who have eating disorders.
• PIT is not as effective as CBT in eating disorders

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References

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• Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
• Page demarcations made with Inkscape.org
• Spine-Health
• Biomed Central