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Clin Med- P > Psych Eating DOs/Abuse/Dementia > Flashcards

Psych Eating DOs/Abuse/Dementia Flashcards

1
Q

what is the definition of obesity

A

BMI 30 kg/m2 or greater OR body weight 20%> over the ideal weight

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2
Q

about 50% of patients with obesity experience what?

A

binge eating episodes

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3
Q

what are the four different management options for obesity?

A

1) . behavior modification
2) . medical therapy: depends on condition, i.e. antidepressants if underlying depression
3) . anti-obesity meds: ORLISTAT or LORCASERIN
4) . surgical options

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4
Q

how does orlistat work?

A

decreases GI fat digestion

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5
Q

how does Lorcaserin work?

A

serotonin agonist

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6
Q

obesity screening guidelines

A

screen all adults and children age 6 years and older

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7
Q

what is bulimia nervosa?

A

eating disorder characterized by frequent binge eating combined with compensatory behaviors to prevent weight gain

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8
Q

patients with bulimia usually maintain a __________ weight and compensatory behaviors are ________

A

normal weight

ego-dystonic = troublesome to the patient

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9
Q

3 possible signs on exam for a pt with bulimia

A

1) . Teeth pitting or enamel erosion (from vomiting)
2) . russell’s sign: calluses on the dorsum of the hand from self-inducing vomiting
3) . parotid gland hypertrophy

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10
Q

what is a lab finding indicative of bulimia?

A 
increased amylase (salivary gland hypertrophy and vomiting)
*maybe metabolic alkalosis from vomiting
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11
Q

diagnostic criteria for bulimia (3)

A

1). recurrent episodes of someone eating more than a normal person would in 2 hr period- occurs AT LEAST WEEKLY FOR 3 MOs

2). purging vs non-purging:
purging: self-induced vomiting, diuretic/laxative abuse
non-purging: reduced calorie intake, dieting, fasting

3). perception of self-worth is excessively influenced by shape and body weight

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12
Q

management of bulimia

A
  • psychotherapy + pharm

- pharm: FLUOXETINE/PROZAC (reduces binge-purge cycle)

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13
Q

definition of anorexia

A

failure to maintain a normal body weight, fear and preoccupation with body weight/image
**BMI <17.5 OR body weight <85% of ideal weight

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14
Q

which psych DO has the highest mortality rate?

A

Anorexia

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15
Q

people with anorexia are often at a ________ weight and behavior is ________

A

low weight

ego-syntonic: behaviors are acceptable to them and in harmony with self-image

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16
Q

what are the two main types of anorexia?

A

1) . restrictive type: strict, reduced calories, dieting, fasting
2) . binge eating/purging: self induced vomiting and diuretic/laxative abuse

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17
Q

PE signs of anorexia

A

emaciation, hypotension, bradycardia, skin or hair chages, dry skin, salivary gland hypertrophy, amenorrhea, ostepenia

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18
Q

3 diagnostic criteria for anorexia

A

1) . restriction of calorie intake leading to significantly low body weight
2) . intense fear of fatness or gaining weight
3) . distorted body image

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19
Q

4 ways to manage anorexia

A

1) . medical stabilization: hospitalization for <75% expected body weight or pts with medical complications
2) . nutritional rehab: refeeding syndrome can occur with this (LOW Phosphorus)
3) . psychotherapy
4) . pharmacotherapy: if depressed, SSRIs (may also help with weight gain)

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20
Q

what is child neglect? signs of it?

A

failure to provide the basic needs of a child (supervision, food, shelter, affection, education)
-signs: malnutrition, withdrawal, poor hygiene, and failure to thrive

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21
Q

how many females under 18 have experience sexual abuse?

A

1/4-1/3 of female children

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22
Q

what is the normal age range for sexual abuse?

A

9-12

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23
Q

who are the most common perpetrators for sexual abuse?

A

most commonly males and most are relatives to the child or known to child

24
Q

signs of child abuse

A

children that exhibit sexual knowledge, initiate sex acts with peers, show knowledge of sexual acts or injury to genital areas

25
Q

what is Munchhausen by proxy?

A

mental health problem in which a caregiver makes up or causes an illness or injury in a person under his or her care, such as a child, an elderly adult, or a person who has a disability

The caregiver with MSBP may lie about the child’s symptoms, change test results to make a child appear to be ill, or physically harm the child to produce symptoms.

26
Q

what percent of women and men will experience intimate partner violence?

A

1/4 for women and 1/7 for men

27
Q

a women who leaves an abusive partner has a ____% greater risk of being killed by the abuser compared to staying

A

70%

28
Q

management of intimate partner violence

A

screening for it in healthcare facilities
assessing patients
referring patients for violence if the patient ACCEPTS help

29
Q

what is delirium?

A

acute, abrupt TRANSIENT confused state due to an IDENTIFIABLE cause
* usually a full recovery within 1 week

30
Q

what are some causes of delirium

A

I- infections

W- Withdrawal
A- acute metabolic
T- trauma
C- CNS injury
H- hypoxia
D- deficiencies
E- endocrine
A- Acute vascular
T- Toxins/Drugs
H- heavy metals
31
Q

most common type of dementia and risk factors for it

A

ALZHEIMER’S

risk factors: AGE, family hx, genetics

32
Q

pathophys for alzheimers

A

UNKNOWN- some theories

  • amyloid protein deposition
  • neurofibrillary tangles (tau proteins)
  • ACh deficiency
33
Q

S/S of alzheimers

A

short term memory loss appears first
progresses to long term memory loss and cognitive deficits: disorientation, behavior and personality changes, language difficulties, loss of motor skills

34
Q

how to diagnose alzheimers

A

CLINICAL

  • do workup to rule out other causes
  • MRI is PREFERRED neuroimaging (medial temporal lobe atrophy)
35
Q

Medications for Alzheimers

A

Acetylcholinesterase inhibitors for improving memory and symptom relief: donepezil, tacrine, rivastigmine, galantamine

In moderate to severe dz, monotherapy or in adjunct: MEMANTINE (NMDA antagonist- blocks receptor, inhibiting excitatory glutamate receptor that normally causes cell death)

36
Q

what causes vascular dementia?

A

brain disease due to chronic ischemia and multiple infarctions (LACUNAR INFARCTS)

37
Q

what is the most important risk factor for vascular dementia?

A

HTN

38
Q

how do symptoms present in vascular dementia?

A

SUDDEN decline in functions with a stepwise progression of symptoms

39
Q

how to diagnose vascular dementia?

A

CLINICAL
workup similar to alzheimer’s
can do MRI- white matter lesions, cortical or subcortical infarcts

40
Q

how do you prevent vascular dementia?

A

strict BP control

41
Q

what is frontotemporal dementia?

A

“Pick’s Disease”

localized brain degeneration of the frontotemporal lobes

42
Q

symptoms of frontotemporal dementia

A
  • marked changed in social behavior, personality, and language are early signs
  • executive and memory dysfunction are advanced disease
  • behavioral changes: DISINHIBITION or SOCIALLY inappropriate behaviors, apathy, hyperorality
43
Q

when is average onset for frontotemporal dementia?

A

EARLIER than alzheimers (usually 6th decade)

44
Q

what skill is preserved in frontotemporal dementia

A

visuospatial skills

45
Q

what is typically seen on histology for frontoemporal dementia?

A

Pick bodies (round or oval aggregates of Tau protein

46
Q

what is Lewy body dementia?

A

PROGRESSIVE dementia characterized by DIFFUSE presence of lewy bodies (abnormal neuronal protein deposits), compared to parkinsons where lewy bodies are LOCALIZED

47
Q

symptoms of lewy body dementia

A

Early: visual hallucinations, episodic delirium, Parkinsonism and REM sleep DO
Late: Dementia
Also, autonomic dysfunction

48
Q

management of lewy body dementia

A

tx of parkinsonism symptoms MAY WORSEN the neuropsychiatric symptoms

49
Q

what is Parkinson’s disease?

A

movement disorder due to idiopathic loss of dopaminergic neurons in the substantia nigra

50
Q

pathophys for parkinson’s

A

loss of dopaminergic neurons leads to failure of ACh inhibition in the basal ganglia (ACh is excitatory)
*also affects dopamine’s ability to initiate movement

51
Q

average age range for symptom onset

A

45-65 yo

52
Q

Clinical triad for parkinson’s

A

resting tremor: often the first sign, “pill-rolling”, WORSE at rest, IMPROVES with voluntary movement
bradykinesia: slowness of voluntary movement and decreased automatic movements
muscle ridgidity: increased resistance to passive movement (“cogwheeling”)

53
Q

what kind of facial features appear in parkinsons?

A

fixed facial expressions
Myerson’s sign: tapping the bridge of the nose repeatedly causes a sustained blink
seborrhea of the skin common

54
Q

how to diagnose parkinson’s and what is found on post mortem histology?

A

CLINICAL dx

histology: LOCALIZED lewy bodies and loss of pigment cells in substantia nigra

55
Q

what is the most effective medication for parkinsons?

A

Levodopa-carbidopa

56
Q

what medications for parkinson’s are 2nd line? when are these used versus Levodopa?

A 
Dopamine agonists (Bromocriptine, Pramipexole, Ropinirole)
*have less motor ADRs than Levodopa, but not as effective; use these drugs in younger patients to delay use of Levodopa
57
Q

when are anticholnergics used to tx parkinson’s?

A

when the patient is under 70 yo and TREMOR is the predominant symptom, use this as MONOTHERAPY
*may worsen glaucoma or BPH

Clin Med- P (124 decks)

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