Mental Health

Question 1

Whenever reviewing someone who has presented with weight loss, what is it important to do?

Answer 1

Carry out a full history.

Weight loss could in be caused by many different things and so it is important to take a full history

Question 2

What conditions can cause rapid weight loss other than Anorexia Nervosa?

Answer 2

Coeliac disease

Type 1 diabetes mellitus

Hyperthyroidism

Malignancy

Inflammatory bowel disease

Oesphageal problems eg achalasia

Severe depression/OCD/autism

Juvenile arthritis

Addisons

Question 3

What is lanugo hair?

Answer 3

This is hair that develops when the body experiences rapid weight loss. It is a way of keeping the body warm following the rapid loss of fat insultation.

Question 4

What is the short term management for a patient with Anorexia Nervosa?

Answer 4

Measure weight for height ratio (bit different to BMI)

• if this is less than 75%, start Thiamine, Vitamin B complex and Multivitamins

Diet plans (to help gain weight), monitor bloods, repeat ECGS

Only discharge when stable

Question 5

Who is part of the MDT for children with Anorexia Nervosa and what does each do?

Answer 5

Psychiatrist - to help diagnose the underlying mental illness

Prescribe medications to treat underlying mental illness or comorbidities

Paediatrician - Also to monitor health, using different scans and tests

Dietician - help with weight gain journey

Therapists - to help with thought processes

Question 6

What are the two most common eating disorders in adolescents?

Answer 6

Anorexia Nervosa and Bulimia

Question 7

What is the Weight-for-Height Ratio?

Answer 7

A method of calculating whether a childs weight is appropriate for their height. This is used instead of BMI in younger people.

Question 8

What are the clinical features of Anorexia Nervosa?

Answer 8

Wearing oversized clothing OR wearing fitted clothing to exaggerate appearances

Lanugo hair

Rough or scaly skin

Bradycardia and hypothermia

Decreased BMI - underweight

Acrocyanosis of the hands and the teeth

Question 9

What are the risk factors of Anorexia Nervosa?

Answer 9

Familial

Personality traits

Previously overweight

Affective disorders

Psychiatric disease

Question 10

What can help with the diagnosis of Anorexia Nervosa?

Answer 10

The patient could demonstrate any of the below diagnostic criteria:

1. Intense fear of gaining weight despite being incredibly underweight.
2. Denial of the seriousness of the low body weight—a disturbance in the way in which one’s body weight or shape is experienced
3. Amenorrhoea in postmenarche females
4. Refusal to maintain body weight at or above a minimally normal weight for age and height - this means they want to be thinner or smaller than the smallest expected amount for the height and weight of their age.

Question 11

What is Thiamine used for?

Answer 11

B1 deficiency in children with Anorexia Nervosa

(Unrelated!! but also those with Wernicke’s Encephalopathy in Alcohol Withdrawal)

Question 12

What questions should you consider in a child who is presenting with Behavioural Issues?

Answer 12

Ask about members of the family and if the px gets on with the others?

What is giving the impression that the px has behavioural problems?

TED and SOCRATES - e.g. onset of the problems, describe the problems, what makes it worse or better, when is it seen most, how much is it affecting every everyone?

Stresses around the start of the problems or current stresses?

ICE - from guardians and px themselves

Development and Progression

Question 13

What is the clinical diagnosis of Autism Spectrum Disorder?

Answer 13

It is impaired social interaction and communication, seen with stereotyped behaviours, interests and activities.

Question 14

How many times more likely are males to get Autism in comparison to females?

Answer 14

4 times more likely

Question 15

Which 4 mental conditions all come under the general umbrella of Autism Spectrum Disorder?

Answer 15

Autism

Aspergers Syndrome

Childhood Disintegrative Disorder

Pervasive Developmental Disorder

Question 16

At what age is Autism Spectrum Disorder expected to be seen in children?

Answer 16

<5 years old

Question 17

What is the main aetiological factor of Autism Spectrum Disorder (ASD)?

Answer 17

Genetics

Question 18

What are the clinical features of Autism Spectrum Disorder?

Answer 18

Markedly impaired social interaction and social communication

Delays in responding to social cues like smiling and speaking

Continuous repetitive behaviours, interests and activities

Meltdowns

ADHD - in some cases

Some have learnign disabilities; others are genuises

Question 19

How is Autism Spectrum Disorder investigated?

Answer 19

ASD screening programmes

• CARS, CAST and MChAT

Question 20

How is Autism Spectrum Disorder treated/managed?

Answer 20

Improving their ability to function independently

Using pharmacology to treat the mental conditions that surface as a result of the disease

Non-pharmacological treatment - education and early behavioural interventions

Question 21

What is Attention Deficit Hyperactivity Disorder (ADHD)?

Answer 21

Chronic neurobehavioral disorder characterised by inattention, hyperactivity, impulsivity, or a combination of these symptoms.

Question 22

At what age is ADHD usually identified?

Answer 22

Between 3 - 7 years old

Question 23

Which three clinical features are characteristic of ADHD?

Answer 23

Inattention

Hyperactivity

Impulsiveness

Question 24

How is ADHD diagnosed?

Answer 24

It is usually diagnosed based on clinical history taking and reports from the childs parents, guardians and teachers.

Question 25

What is the Connor's Rating Scale?

Answer 25

A questionnaire assessing academic, behavioural & social issues in young people (6-18 years old

Question 26

What are some differentials for inattention and hyperactivity?

Answer 26

Hyperthyroidism Sleep disorders Seizure disorder Substances Use Genetic Disorders - Digeorge syndrome and Neurofibromatosis

Question 27

How long is the "wait and watch" phase after a positive diagnosis of ADHD in a child?

Answer 27

10 weeks

Question 28

Are medications used to treat children with ADHD?

Answer 28

It is not advised to use medication in children unless it is the last resort and the child is older than 5 years old

Question 29

What are the pharamcological treatments of ADHD? (*when meds are actually used*)

Answer 29

Methylphenidate and Amphetamines Methylphenidate is also known as **Ritalin**

Question 30

What is the MAIN side effect to look out for in medications for ADHD?

Answer 30

***Cardiotoxicity*** - make sure to get an ECG before starting the medications. Refer the px to Cardiology if there is a past medical hx or family hx of heart disease

Question 31

What are the important things to look out for in a Mental State Exam?

Answer 31

**Appearance** - clothing, weight, scars, objects **Behaviour** - engagement and rapport, eye contact, facial expressions **Speech** - rate, quanity, tone etc **Mood and Affect** **Thoughts** **Perceptions** and **Cognitions** **Insight and Judgement**

Question 32

How do you assess suicidal thoughts in a person?

Answer 32

Ask directly about suicidal thoughts have they attempted? If they have, what prevented them from going through with it If they haven't, whats stopping them from wanting to? How often do they have suicidal thoughts?

Question 33

What is Conduct Disorder?

Answer 33

A repetitive and persistent pattern of dissocial, aggressive or defiant behaviour.

Question 34

What is Somatisation?

Answer 34

The manifestation of psychological distress by the presentation of physical symptoms.