Adjustment disorders, somatisation and conversion, eating disorders

Question 1

What is adjustment disorder?

Answer 1

Situational depression - abnormal response to a major life event / stressor
Anxiety, difficulty moving forwards, reckless behaviour, depressed mood - significant impairment of social, occupational functioning

Question 2

Normal grief reaction?

Answer 2

On average lasting ~6 months
Normal grief symptoms - shock, disbelief, anger, guilt, sadness
Disturbed sleep/appetite
Hearing the voice of the deceased

Question 3

Abnormal grief reaction

Answer 3

Prolonged (>6 months), or absent (delayed)
Excessive symptoms
pre-occupation with guilt, thoughts of death
psychomotor retardation
prolonged impairment of functionality
hallucinatory experiences

Question 4

Differences in management of normal vs abnormal grief

Answer 4

Normal - reassure, no treatment, benzos for sleep, support groups

Abnormal - consider antidepressants, support groups

Question 5

What are somatoform disorders

Answer 5

Somatisation
Conversion
Hypochondrial
Persistent somatoform pain disorder

Question 6

Features of somatisation disorder?

Answer 6

1 or 2+ distressing symptoms - causing significant disruption to daily life
Typically present for >2yrs (ICD-10)
absence of physical illness, compatible with symptoms

Question 7

Features of conversion disorder?

Answer 7

Voluntary motor or sensory function deficits

Dissociative amnesia/fugue state/stupor

Question 8

Features of Anorexia Nervosa (AN)

Answer 8

BMI <17.5

Low body weight + intense fear of gaining weight + body image disturbance + calorific restriction/weight loss practices

Question 9

What is the SCOFF questionnaire?

Answer 9

S - so you make yourself SICK because you feel full
C - have you lost CONTROL over what you eat
O - have you lost ONE stone in past 3 months
F - Do you think yourself FAT where others think you too thin
F - does FOOD dominate your life

Question 10

Physical manifestations of AN

Answer 10

Lanugo hair on face, trunk, arms
Scalp hair thinning
Dry skin, cracked nails
Amenorrhoea, infertility
Metabolic disturbances - systemically unwell
Fatigue, weakness, dizzy
Cardiac arrhythmias (hypokalaemia), postural hypotension

Question 11

4 features of physical risk assessment?

Answer 11

1) Clinical history and physical examination
2) BMI
3) ECG
4) Bloods

Question 12

Important questions in clinical history and physical examination?

Answer 12

Rapid weight loss - >1kg/week
Excessive exercise, inappropriate use of laxatives, diuretics, vomiting
CVS - hypotension, chest pain, arrhythmias, blackouts

Question 13

Risk stratification according to BMI

Answer 13

<17.5 = AN
<15 = moderate risk
<13 = high risk

Question 14

ECG changes in hypokalaemia

Answer 14

Bradycardia - <40bpm
Flattened T waves
ST depression
Prolonged PR interval
Wide, big P wave
Prominent U wave

Question 15

Blood results in AN

Answer 15

Starvation - hypoglycaemia
Vomiting - hypokalaemia
Water-loading - hyponatraemia

Re-feeding syndrome:
Hypophosphataemia
Hypomagnesaemia
Hypocalcaemia
Hypokalaemia

Question 16

Clinical features of Bulimia Nervosa (BN)

Answer 16

Bingeing at least 1x/week, for at least 3 months
BMI maintained >17.5
Compensatory weight loss behaviours

Question 17

Management of AN

Answer 17

MANTRA
CBT
specialist supportive clinical management (SSCM)

Correction of electrolyte disturbances
Structured eating

Question 18

Management of BN

Answer 18

CBT/IPT
Fluoxetine 60mg
Structured eating