Flashcards in Psychiatry in other medical settings (including eating disorders) Deck (35):
What is the psychopathology in anorexia nervosa (AN) and bulimia nervosa (BN)?
An overvalued idea
What are the two measures used to diagnose anorexia nervosa (AN)?
1) Body weight maintained at least 15% below normal
2) A BMI below 17.5kg/m2
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.
What body weight change is there in BN?
Pts usually have a normal weight
How do BN pts purge?
Vomiting, laxatives and diuretic use.
What is Russell's sign?
Calluses on the back of hands when the hand has been used to induce vomiting.
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)
What is the ICD-10 criteria for BN?
All of the below:
1) Binge eating
2) Methods to counteract weight gain
3) Overvalued idea
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.
What is the F:M ratio for BN and AN?
They are both 10:1 F:M
What is the prevelance of AN and BN?
AN = 1%
BN = 4%
What are the ages of onset of AN and BN?
AN --> mid to late adolescence
BN -->late adolescence to early adulthood
Which social classes are more at risk of BN and AN?
Social economic class is no longer thought to play a large role.
Which neurotransmitter is thought to play a part in AN and BN?
High serotonin (thought to reduce appetite)
Is AN and BN thought to have genetic causes?
Yes (shown by monozygotic twin studies)
What family traits are thought to be linked to AN and BN?
2) over involved
3) avoid conflict
4) resistant to change
What is the first line treatment in AN?
Psychoeducation about diet and nutrition.
What is the best outpatient treatment for AN?
Brief outpatient psychotherapy with the encouragement of family involvement which involves:
What the reasons for hospitalisation for AN?
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
What treatments are the used in BN?
2) TCAs and SSRIs
What % of AN pts return to normal?
What fraction of pts fail to recover from anorexia?
What is the psychiatric disorder with the highest mortality? (what is the mortality %?)
AN with >10% mortality
What % of AN pts go on to develop healthy weight BN?
What % of BN pts make a full recovery within 5 years?
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.
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
What types of psychotherapy are used in BN?
What are the drug therapies used in BN and what symptoms do they reduce?
SSRIs (fluoxetine 60mg)
have been shown to reduce bingeing and purging behaviours
Describe dissociative amnesia?
memory loss of recent events
ranging from hours to years
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
Describe dissociative stupor?
lack of movement
Describe dissociative convulsions?
pseudo seizures i.e. not real seizures