Eating disorders. Anorexia versus bulimia. Anorexics are those really really thin women. They are about 5’8″ and they weigh about 80 pounds. Bulimics are normal weight and sometimes overweight. The anorexics starve themselves, the bulimics binge and purge. They eat all these Twinkies; they eat all these donuts and then the throw it all back up. The anorexics have to weigh like less than 85% of their normal body weight, and they have to have missed three consecutive periods, if they are post-menarche. Bulimics just basically do the eating and then the purging. Now there’s all kinds of funny variations. There’s anorexics who will purge, there’s bulimics who will starve themselves. Sometimes they won’t do the bingeing and purging, sometimes they will use laxatives or diuretics. There’s a thing called Russell’s sign, which is scraping the back of their palm in bulimics. What’s that from? Making yourself throw up. They remove tooth enamel, they become hypokalemic, bulimics do.
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Two zebras: this is important, under eating disorder differential. There’s two zebras, particularly I think for neurologists. One is Klüver-Bucy. When somebody loses their temporal lobes because they had such bad seizures, the neurosurgeon had to take them both out. Or they have something like Herpes encephalitis and they lose a temporal lobe. They get this syndrome where they are hyper-oral, hyper-sexual, constantly masturbating or constantly mounting things. It’s really a tragic disorder. Loss of rage, sometimes loss of memory, very docile. And also Kleine-Levin syndrome. Classically adolescent males with hyper-somnolence and bingeing. The way I tell people to remember it is to think about adolescent males and what they do normally; sleep a lot and eat a lot. Right? Just multiply that tenfold and that’s Kleine-Levin. And there are mental status changes that you will see with that. Patients may also be confused or psychotic.
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Adjustment disorders. An adjustment disorder is having so bad a to a situation that you are suicidal. Post-traumatic stress disorder is the opposite. Post-traumatic stress disorder is you see something that’s not normal. Unfortunately, in some neighborhoods to see a lot of violence and stuff like that. But in post-traumatic stress you see something that would rattle anybody. You are raped, or you are assaulted, or you see combat, or an accident. That would disturb anybody. Adjustment disorder, you have something that everybody has had. You know, loss of a job, something like that. A breakup of a marriage or a relationship or an engagement. Something that’s pretty much part of the normal human experience but it goes beyond normal sadness. Your adjustment to that is terrible. You are suicidal or you are just intensely anxious, more so that your average person would be.
Nov 20
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