Nutritional psychiatry

Question 1

what is malnutrition

Answer 1

a state of nutrition in which deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue and body form and function, and clinical outcome

Question 2

what are the two routes to malnutrition

Answer 2

1. Insufficient or inappropriate food intake
2. normal intake but failures of digestions/ metabolism

Question 3

what are the two main causes of malnutrition?

Answer 3

1. marasmus
2. kwashiorkor

Question 4

what is marasmus

Answer 4

calorie deficiency

Question 5

what is kwashiorkor?

Answer 5

protein deficiency

Question 6

what are the characteristic features of kwashiorkor?

Answer 6

oedema
sparse hair
moon face
little interest in surroundings
flaky skin
swollen abdomen
thin muscles

Question 7

what are the characteristic features of marasmus

Answer 7

normal hair
old man appearance
thin limbs
little muscle or fat
very underweight

Question 8

marasmus and kwashiorkor can overlap, what is this called?

Answer 8

marasmic kwashiorkor

Question 9

what are the classifications of malnutrition?

Answer 9

waterlow criteria and WHO criteria

Question 10

what is the waterlow criteria for malnutrition

Answer 10

measures malnutrition based on weight and height compared to population norms

Question 11

what is the WHO criteria for malnutrition?

Answer 11

the number of standard deviations between observed and expected values for weight and height

Question 12

what is minus two standard deviations from observed and expected values for weight and height

Answer 12

moderate malnutrition

Question 13

what is minus three standard deviations from observed and expected weight and height?

Answer 13

severe malnutrition

Question 14

what is acute malnutrition/ starvation?

Answer 14

CNS is usually among the last body systems to be affected

Question 15

what are the symptoms of acute malnutrition/ starvation?

Answer 15

delirium
encephalopathy
coma

Question 16

what is chronic malnutrition/ starvation?

Answer 16

non fatal malnutrition but associated with a lot of long term problems (most relevant to neuropsychiatry)

Question 17

what is a hx of pyloric stenosis associated with?

Answer 17

short-term memory and attentional deficits

Question 17

what is pyloric stenosis?

Answer 17

a brief period of starvation in early infancy, is unrelated to socioeconomic conditions, and is easily correctable

Question 18

Barbados nutrition study

Answer 18

40 year longitudinal study of individuals with normal birth weight but had experienced a period of protein-energy malnutrition in first year of life

Question 19

When do specific nutritional deficiencies occur?

Answer 19

deficiency of one or more nutrients
deficient micronutrients - vitamins, minerals, trace elements
deficient macronutrients - proteins, fats, carbohydrates

Question 19

what are the key findings of the Barbados nutrition study?

Answer 19

They found that early malnutrition was associated with:
- attentional deficits
- hyperactivity
- lower IQ
- increased prevalence of learning disability
- subtle motor deficits

Question 20

b1 deficiency

Answer 20

thiamine

Question 21

b3 deficiency

Answer 21

niacin

Question 22

b12 deficiency

Answer 22

cobalamin

Question 23

b9 deficiency

Answer 23

folate

Question 24

b6 deficiency

Answer 24

pyridoxine

Question 25

thiamine (b1) deficiency

Answer 25

strong association with alcohol dependence seen in malabsorption syndromes seen in conditions that involve protracted vomiting

Question 26

alcohol dependency

Answer 26

poor diet alcohol compromises the absorption and utilisation of thiamine

Question 27

what % of alcoholics are thiamine deficient

Answer 27

30%

Question 38

what is dry beriberi

Answer 38

dominated by neurological features e.g. peripheral nerve damage which leads to sensory and motor deficits and muscle wasting

Question 38

what % of survivors of wernicke's progress to korsakoffs

Answer 38

85%

Question 38

effect of nitrous oxide on B12

Answer 38

nitrous oxide inactivates B12

Question 38

what is beriberi

Answer 38

caused by thiamine deficiency

Question 38

which foods are high in B1

Answer 38

green peas squash spinach black beans macadamia nuts tomatoes brussel sprouts sunflower seeds

Question 38

what are the two types of beriberi

Answer 38

wet and dry

Question 38

features of beriberi

Answer 38

weakness lassitude (lack of energy) myalgia cardia problems

Question 38

what is wet beriberi

Answer 38

dominated by cardiac failure

Question 38

what brain regions are affected in wernicke's

Answer 38

**mamillary bodies** Thalamus Superior colliculi Walls of the third ventricle Pons, medulla, brainstem Cerebellar vermis

Question 38

what is the classic triad of Wernicke's encephalopathy

Answer 38

confusion cerebellar ataxia ophthalmoplegia

Question 38

tx for wernicke's encephalopathy

Answer 38

treat with high dose parenteral thiamine

Question 38

is korsakoff's reversible with thiamine

Answer 38

NO

Question 38

what is korsakoff's

Answer 38

a chronic amnestic state characterised by confabulation

Question 38

in what % of korsakoff's pt show atrophy in the mamillary bodies

Answer 38

80%

Question 38

features of niacin (b3) deficiency or pellagra

Answer 38

dermatitis diarrhoea dementia death

Question 39

which foods are rick in vitamin b3

Answer 39

poultry meat mushrooms tomatoes potatoes liver fish peanuts spinach

Question 39

solution to vitamin b3 deficiency

Answer 39

niacin fortified foods

Question 39

what is b12 involved in

Answer 39

the production of myelin

Question 39

what is pellagra (b3) linked to

Answer 39

maize based diets

Question 39

what is the most common b vitamin deficiency

Answer 39

B9 (folate)

Question 39

folate deficiency

Answer 39

folate combined with B12 supports metabolism Neural tube defects in fetus

Question 39

sx of b12 deficiency

Answer 39

Loss of vibration sense Subacute combined degeneration of the spinal cord

Question 39

what is subacute combined degeneration of the cord

Answer 39

Affects dorsal and lateral columns of the cord Causes sensory disturbance Untreated, progresses to motor deficits Potentially reversible with B12

Question 39

what is cerebral folate deficiency?

Answer 39

normally concentration of folate in the CNS is higher than in the blood via active transport impaired active transport causes CFD

Question 39

what is cerebral folate deficiency defined by

Answer 39

low CSF 5-MTHF

Question 39

clinical features of cerebral folate deficiency

Answer 39

Pyramidal spasticity, cerebellar movement disorders and intellectual disability most common clinical features

Question 39

features of vitamin c deficiency

Answer 39

Poor wound healing Severe joint and muscle pain Dental avulsion Oedema Spontaneous haemorrhage fatigue weakness extrapyramidal sx SCURVY

Question 39

what conditions is vit d deficiency associated with

Answer 39

depression schizophrenia parkinsonism dementia

Question 39

where do we naturally get vitamin d

Answer 39

synthesis in skin under sunlight oily fish meat eggs

Question 39

main risk factor for vit d deficiency

Answer 39

lack of sunlight

Question 40

calcium deficiency features

Answer 40

poor development of bones and teeth brittle bones and teeth poor healing of fracture depression acute confusional state

Question 41

what is the neuromuscular hyperexcitability triad?

Answer 41

spasm tetany hyperreflexia