Psychiatry in other medical settings (including eating disorders) Flashcards Preview

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Flashcards in Psychiatry in other medical settings (including eating disorders) Deck (35):
1

What is the psychopathology in anorexia nervosa (AN) and bulimia nervosa (BN)?

An overvalued idea

2

What are the two measures used to diagnose anorexia nervosa (AN)?

1) Body weight maintained at least 15% below normal
OR
2) A BMI below 17.5kg/m2

3

What endocrine disturbances can occur in AN?

1) Amenorrhoea in post-menarchal women
2) Loss of sexual interest
3) Raised GH
4) Raised cortisol
5) Reduced T3.
6) Pubertal events delayed or arrested in certain age groups.

4

What body weight change is there in BN?

Pts usually have a normal weight

5

How do BN pts purge?

Vomiting, laxatives and diuretic use.

6

What is Russell's sign?

Calluses on the back of hands when the hand has been used to induce vomiting.

7

What is the ICD-10 criteria for AN?

All of the below:
1) Low body weight (BMI)
2) Self-induced weight loss
3) Overvalued idea
4) Endocrine disturbances (failure to make expected development if prepubertal)

8

What is the ICD-10 criteria for BN?

All of the below:
1) Binge eating
2) Methods to counteract weight gain
3) Overvalued idea

9

What is an important s/e of BN?

Hypokalaemia with repeated vomiting which can be life threatening. This should be treated gradually and the patient should be encouraged to eat potassium rich foods i.e. bananas.

10

What is the F:M ratio for BN and AN?

They are both 10:1 F:M

11

What is the prevelance of AN and BN?

AN = 1%
BN = 4%

12

What are the ages of onset of AN and BN?

AN --> mid to late adolescence
BN -->late adolescence to early adulthood

13

Which social classes are more at risk of BN and AN?

Social economic class is no longer thought to play a large role.

14

Which neurotransmitter is thought to play a part in AN and BN?

High serotonin (thought to reduce appetite)

15

Is AN and BN thought to have genetic causes?

Yes (shown by monozygotic twin studies)

16

What family traits are thought to be linked to AN and BN?

1) overprotective
2) over involved
3) avoid conflict
4) resistant to change

17

What is the first line treatment in AN?

Psychoeducation about diet and nutrition.

18

What is the best outpatient treatment for AN?

Brief outpatient psychotherapy with the encouragement of family involvement which involves:
1) CBT
2) IPT
and others

19

What the reasons for hospitalisation for AN?

1) BMI

20

What medication is used in AN?

The use of medication is limited and special care should be taken in patients with a very low weight. Fluoxetine may be helpful in maintaining weight gain and preventing relaps

21

What treatments are the used in BN?

1) Psychotherapy
2) TCAs and SSRIs

22

What % of AN pts return to normal?

50%

23

What fraction of pts fail to recover from anorexia?

1/3

24

What is the psychiatric disorder with the highest mortality? (what is the mortality %?)

AN with >10% mortality

25

What % of AN pts go on to develop healthy weight BN?

25%

26

What % of BN pts make a full recovery within 5 years?

60%

27

What are dissociation disorders?

Disorders that describe a disruption in the integration between

consciousness, memory, identity, perception and movement

and is where a person’s behaviour and personality become separated.

28

Give 4 examples of dissociation disorder.

1) Dissociative amnesia (memory loss of recent events)
2) Dissociative fugue – purposeful sudden travel beyond a person’s normal range where self care and normal social interactions are maintained
3) Dissociative stupor – psychomotor retardation, unresponsiveness, mutism, lack of movement
4) Dissociative convulsions – pseudo seizures i.e. not real seizures

29

What types of psychotherapy are used in BN?

Psychoeducation,

CBT,

etc

30

What are the drug therapies used in BN and what symptoms do they reduce?

TCAs and

SSRIs (fluoxetine 60mg)

have been shown to reduce bingeing and purging behaviours

31

Describe dissociative amnesia?

memory loss of recent events

ranging from hours to years

32

Describe dissociative fugue?

purposeful sudden travel

beyond a person’s normal range

where self care

and normal social interactions are maintained

Some degree of amnesia with

no understanding or knowledge of the reason for the flight

33

Describe dissociative stupor?

psychomotor retardation,

unresponsiveness,

mutism,

lack of movement

34

Describe dissociative convulsions?

pseudo seizures i.e. not real seizures

35

What does ICD-10 require there to be evidence of in dissociation disorders?

ICD-10 requires there to be some evidence of psychological causation

in association with the

onset of dissociative symptoms.