Psychology in GI disorders Flashcards Preview

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Flashcards in Psychology in GI disorders Deck (17)
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1
Q

Learning Points:

A
  • Psychological factors arise in many GI disorders and may be secondary to an organic disease.
  • They may also complicate and drive functional disorders such as IBS
  • Psychiatric conditions can trigger gut symptoms, e.g. depression, anxiety and eating disorders
  • Even if the precise cause of a persons symptoms isnt clear keep them safe and nutritioned
  • REMEMBER REFEEDING SYNDROME
2
Q

What are the psychological aspects of an organic disease?

A
  • Patient fears/confusions

- Prejudices against having stoma, IBS/D or anything visibly GI.

3
Q

Examples of functional GI disease?

A
Reflux
Functional dyspepsia (Non-ulcer Dyspepsia)
Nausea Vomiting syndromes
IBS
Sphincter of Oddi Dysfunction
4
Q

How do we explain a functional disorder to a patinet?

A

The hardware/software is a good analogy.

Remember to stress that its a real diagnosis and the symptoms are genuine.

5
Q

Whats the aetiology of functional GI disorder?

A

Multifactorial:

  • Motility
  • Hormones
  • Microbiota
  • Diet
  • Psychological Factors
  • Altered Visceral Sensation e.g. gut hyperawareness
6
Q

How do we assess someone with a suspected functional disorder?

A

Histroy
Exam
Investigate to exclude organic disorders
Nutritional and mental state assessments, thinking about eating disorders

7
Q

What kind of psychological problems can arise from a GI disorder?

A
  • Loss of appetite
  • Stress/anxiety/depression
  • Sexual problems
  • Conditioning
8
Q

What kind of psychological problems can present with GI manifestations

A

Stress
Anxiety
Depression
Eating Disorders

This is called somatization, the manifestation of psychological stress as a bodily symptom

9
Q

Define Reefeeding syndrom

A

Normal feeding after a period of starvation causes massive electrolyte shifts that can lead to MI & other deaths

10
Q

How does refeeding syndrome occur?

A

Adaptive starvation = Low energy use, atrophied gut, heart and muscles, low micronutrient reserves and low intracellular phosphate.

Example:
Carb refeeding –> Rapid insulin spike -> Rapid ATP generation –> Phosphate moves into cells for use –> Hypophosphataemia.

However many such imbalances occur during refeeding that can cause harm.

11
Q

How do we determine if some is at risk of refeeding syndrome?

A

One of:

  • BMI <16
  • unintentional 15% weight loss in 3-6 months
  • Low K, phosphate or Mg.

OR Two or more of:

  • BMI<18.5
  • 10% unintentional weight loss in 3-6 months
  • Little -> no nutritional intake in 5 days
  • History of alcohol or drug abuse, chemo, antacids or diuretics.
12
Q

How do you treat someone to avoid refeeding syndrome?

A
  • Start slowly by correcting the fluid depletion
  • Replace their low micronutrients e.g. K, phosphate, Mg, Thiamine
  • Feed 5-10Kcal/Kg over 24 hours, gradually raising to normal over a week.
13
Q

List some eating disorders

A

Binge eating disorders
Bulimia nervosa
Anorexia

14
Q

Explain the difference between binge eating disorders and bulimia nervosa

A

Binge eating disorders involves binging on food and not compensating so they gain weight.

Bulimia involves binging and compensating by vomiting out of fear of gaining weight. So they tend to maintain a normalish body weight.

15
Q

Explain anorexia nervosa

A

The patient has an obsessive fear of gaining weight so restricts food and uses other measures to control weight.

They have body dysmorphia i.e. see themselves differently to how they are.

They often have SIDMA (Significatnly Impaired Decision making) specific to their weight, they may be very intelligent in every other respect.

Due to tiny weight they may have amenorrhoea (lack of menstruation)

16
Q

What other behaviours come with weight loss disorders such as anorexia?

A
Self starvation
Self induced vomiting
Compulsive activity/exercise
Exposure to cold
Laxative/diet pill/herbal meds
17
Q

How should we approach treatment of an eating disorder?

A
  • Be Firm and consistent
  • Externalize - i.e. explain you understand its the illness not their fault they’re not eating or whatever
  • Take a united team approach
  • They may require NG feeding but beware of refeeding syndrome
  • Specialist help including experts in eating disorders, dieticians and psychiatrists