RDA; Lecture 4, 5 and 6 - Adolescent psychological development, Depression, Anorexia and Conduct Disorder; Ageing Flashcards

Question

# RDA What is anorexia nervosa (ICD10 criteria)?

Answer 1

ICD10 criteria = Body wt at least 15% below expected (\<17.5 BMI) Avoidance of “fattening” foods (may also be self-induced vomiting, purgative abuse, alternating periods of starvation, drugs eg appetite suppressants, laxatives) Psychopathology-morbid dread of fatness, aims for wt lower than premorbid or healthy Endocrine disturbance (amenorrhea in women and men lose sexual interest) May also be other wt loss behaviours.

Answer 2

Persistent preoccupation with eating, and an irresistible craving for food, succumbs to episodes of eating large amounts of food in short periods of time binges Wt losing behaviours: Purging: by vomiting, taking a laxative, diuretic, or stimulant, &/or excessive exercise Psychopathology- morbid dread of fatness, aims for wt lower than premorbid or healthy

Answer 3

Influence of media/fashion Hard to prove direction of causality Models/mannequins getting slimmer last 50 years Slimmer body shapes attractive

Answer 4

Earlier pubertal maturation and higher body fat; concurrent psychological problem. Dieting (severe level) can lead to 16x more probability to have eating difficulties

Answer 5

Puberty starting earlier

Answer 6

MULTIFACTORIAL!!!! Traumatic event; genetic predisposition, perfectionist temperament, specific subcultures, childhood abuse and adversities, perhaps higher social class

Answer 7

Association anorexia nervosa and ASD Weak central coherence in ED’s Global processing difficulties [review] Poorer global processing -\> Weak central coherence (limited ability to understand context or to "see the big picture")

Answer 8

Family interview, individual interview with child/adolescnet, physical exam and investigations and data on growth

Answer 9

\*Physical Gastro-intestinal disorder e.g.. Crohns disease Metabolic e.g. diabetes Pituitary \*Psychiatric Bulimia nervosa Depression Psychosis Obsessive compulsive disorder (OCD)

Answer 10

Admission for weight restoration in a minority of cases - Family therapy - Nutritional counselling - Cognitive behaviour therapy (CBT) - Treatment of persistent depression etc.

Answer 11

TREATMENT OF CHOICE 1) Initial focus of adolescents need to eat Parents/carers to take charge/supervise 2) Adolescent gradually assumes more control of eating Graded improvement in social function 3) Address other developmental/ relationship/life cycle issues

Answer 12

Mortality at 20y follow up is 15-20%

Answer 13

Cognitive/emotional changes, family, peers and biology

Answer 14

* Best treatment: \*\*prevention\*\* * Cognitive problem solving skills: * Adolescents with CD may have distorted attributions of aggressive intentions in other people. * Techniques to develop more accurate perceptions. * Teaching of problem-solving skills including range of options and their consequences.

Answer 15

i) Play and good times together ii) Praise and recognition for good behaviour iii) Clearly expressed expectations iv) Consistent & calm consequences for misbehaviour v) planning ahead to avoid trouble

Answer 16

Increase of symptoms -\> increase of impairment. Degree of depression determined by: * not depressed (\< 4 symptoms) * mild depression (4 symptoms) * moderate depression (5 to 6 symptoms) * severe depression (7 or \> symptoms, with or without psychotic symptoms). Symptoms are pervasive, impairing and present for at least 2wks -\> affective (sadness, loss of enjoyment, irritability), biological (disturbed sleep, reduced appetite), cognitive (self blame, hopelessness, guilt)

Answer 17

Increased risk of self-harm Association with anxiety disorders; eating disorders [females]; conduct problems Familial aggregation (genetic and learning);

Answer 18

Persistent and pervasive; Relatively unresponsive to pleasurable activities, interactions and attention from other people Functional impairment is an important distinguishing factor from the normal mood fluctuations of childhood

Answer 19

‘Normal adolescent angst’: Mastering the tasks of development physical, cognitive, social, emotional, moral Psychiatric disorder: Symptoms -\> Serious suffering/impairment personal, family, peers, education/work

Answer 20

Irritability instead of sadness/low mood Especially in boys Somatic complaints and social withdrawal are common Psychotic symptoms rare before mid-adolescence

Answer 21

FHx of major affective disorders usually depression exist

Answer 22

Suggests that depression results from hypo-activity of monoamine NT reward systems

Answer 23

Endocrine changes, changes in family relationships, peers, responsibility and hassles

Answer 24

Conceptualises depression as occurring within an interpersonal matrix and targets resolution of interpersonal stress that seem to be associated with it. Starts by taking an interpersonal inventory of important relationships.

Answer 25

No difference between TCA (Tricyclic AD) and placebo Several studies have demonstrated efficacy with selective serotonin reuptake inhibitors (SSRI) Esp. using fluoxetine This may be reflective of an overall developmental difference in so far as adolescents and younger adults may respond better to serotonergic agents

Answer 26

Higher levels of irritability

Answer 27

Process of growing older -\> biological, psychological/cognitive and social

Answer 28

Statistical measure of how long a person can expect to live -\> increasing, with popn getting older overall, led by falling fertility rates and people living longer overall

Answer 29

Programmed ageing - genetic, Hayflick limit (cells appear to be able to count, reaching a certain number of divisions and then stopping - thought to be enough to allow organism to reach maturity and reproduce, reducing risk of Cancer); damage/error theories -\>Free radical-oxidative stess due to reactive oxygen species exceeding antioxidant capacity - mitochondria remain source of radicals, but also come from macrophages, peroxisomes, cytochrome P450, supported by people with chronic inflammation/infections clinically age more rapidly; DNA damage -\> frequent damage to DNA whilst it is being transcribed, which DNA polymerase can't always repair, leading to damage accumulation and contributing to eventual cell death

Answer 30

Outdated and ageist beliefs/assumptions Working life/retirement balance Medical system designed for single acute diseases Extending healthy old age not just life expectancy Inadequate or absent services Lack of accessibility for people with disabilities

Answer 31

* Small proportion due to genetic inheritance, most due to ongoing interactions between broader characteristics of individuals and environment (home, enighbourhood and community). sex and ethnicity, occupation, educational attainment, wealth, contributing to social position and ability to access resources

Answer 32

Older people make +ve contributions to society, so health and social care expenditures for them are an investment not a cost

Answer 33

Councils are reducing/freezing the amount they pay care agencies and homes, despite ageing popn

Answer 34

* Loss of biological reserve across multiple organ systems, leading to vulnerability to physiological decompensation and functional decline after a stressor event. * When we have a ‘stressor’ event its fine, we bounce back. * When old frail people have a ‘stressor’ event end up with less functional, in hospital and can’t bounce back fast enough. * Much longer to get back up to a good level, which may not even be the same level that they were previously at * Loss of biological reserve * Cumulative damage * STRESSOR EVENT * Falls and delirium * Functional decline

Answer 35

Increased risk of falls, worsening disability, care home admission, death

Answer 36

Exercise, nutrition and drugs (possibly) -\> prevention better than cure

Answer 37

Instability Immobility Incontinence Intellectual impairment Iatrogenic harm

Answer 38

Older people are less likely to have common, “textbook” symptoms of disease ACS - Less likely to have chest pain PE - Less likely to have pleuritic chest pain Less likely to have haemoptysis More likely to have other symptoms ACS - More likely to have shortness of breath PE - More likely to have syncope

Answer 39

2 or more chronic conditions. Conditions impact on one another Treatment for one condition may impact on another Negative impacts: * Worse QoL, more likely to be depressed * Increased functional impairment * Burden of treatment * Polypharmacy

Answer 40

Comorbidities Guidelines/QOF/NICE Undetected non adherence Infrequent review Poor communication. Up to 405 of prescriptions are inappropriate, associated with bad outcomes -\> falls, increased length of stay, delirium and mortality

Answer 41

Adverse reactions to medications -Nosocomial conditions: Infections Pressure sores Constipation Deconditioning Delirium Malnutrition Incontinence -Falls Pyschological/cognitive damage 2-36% of inpatients, with half probably avoidable

Answer 42

Up to 17% of hospital admissions due to drug reactions -\> more meds taken = greater risk. Drugs most likely to cause hospital admission: NSAID 30% Opioid 6% Warfarin 10% Digoxin 3% Antidepressant 7%

Answer 43

CGA in the community1 Reduce admissions to institutional care Reduce falls Most benefit in mild or moderate frailty CGA for frail inpatients2 Reduces inpatient mortality Reduces functional and cognitive decline Reduces admission to institutional care. Multidisciplinary assessment -\> medical, functional, social, psychological/psychiatric; problem list, plan

Answer 44

To restore/improve funcitonaity, multidisciplinary, rehab alongside acute illness (prevent deconditioning), rehabilitation

Answer 45

White matter reduction; grey matter reduction -\> mainly in size and number of connections between neurones not in neuron number. CSF increases as well, with larger size in ventricles and gaps between major gyr widen

Answer 46

Reduciton in inductive reasoning from 45y, reduction in mental flexibility, ability to generate novel soln to problems and response inhibition from 70y

Answer 47

Decline in all cognitive functions, not just memory Impairment of function Progressive Degenerative Irreversible, chronic West London diagnosis rate is 76%

Answer 48

AMT, MOCA, MMSE, CAM and 4AT

Answer 49

Very orientation focused Orientation can be well preserved in some forms of dementia Assumes cultural knowledge/interest (WW2, PM) Assumes numeracy Monarch or PM could give different results No time limit on 20-1 Person recognition can be difficult in hospital

Answer 50

Most assumes some basic cultural knowledge Most assume numeracy and literacy Depression can masquerade as dementia Ceiling effects in highly educated/intelligent Interpret them in context

Answer 51

Initiates secretion of GnRH at puberty, which triggers release of LH/FSH; encoded by KISS1 gene; it's a G-protein coupled receptor ligand for GPR54

Answer 52

Familial aggregation, effects of family interaction and life events/adversities

Answer 53

Delirium is an acute episode of confusion, usually with clear precipitant such as infection/medication changes; usually resolves but can leave residual problems