Revision - Anorexia, Personality Disorders, Anxiety Disorders, Learning Disabilities & Affective Disorders

Question 1

What BMI anorexia nervosa (AN)?

Answer 1

<17.5

Question 2

What metabolic disturbance is typically seen in AN?

Answer 2

Metabolic alkalosis

Question 3

Blood test results in AN?

Answer 3

1) Low sex hormones

2) Hypercholesterolaemia

3) Metabolic alkalosis

4) Raised GH & cortisol

5) Deranged electrolytes – typically low calcium, magnesium, phosphate and potassium

6) Leukopenia

Question 4

What drug can be administered as a preventative method for refeeding sydrome?

Answer 4

Pabrinex

Question 5

What 2 ECG signs are seen in AN?

Answer 5

1) bradycardia

2) prolonged QTc

Question 6

What age at presentation is a negative prognostic marker for AN?

Answer 6

> 20

Question 7

1st line mx of BN?

Answer 7

CBT

Question 8

How is age of menarche implicated in EDs?

Answer 8

Younger age of menarche linked to increased risk

Question 9

What are the 3 clusters of personality disorders?

Answer 9

A, B & C

Question 10

What typically defines a Type A personality disorder?

Answer 10

Odd or eccentric behaviours

You find it difficult to relate to other people.

Question 11

What are the 3 types of Type A personality disorder?

Answer 11

1) paranoid

2) schizoid

3) schizotypal

Question 12

What characterises a paranoid personality disorder?

Answer 12

Irrational suspicion & mistrust of others

Hypersensitivity to criticism

Reluctance to confide in others due to fear of information being used maliciously against them

Preoccupied with unfounded beliefs about perceived conspiracies against themselves

Question 13

What typically defines a Type B personality disorder?

Answer 13

Cluster B personality disorders are grouped based on those who find it difficult to control their emotions. You might be viewed as unpredictable by others.

Characterised by dramatic, emotional, or erratic behaviors

Question 14

What are the 4 types of Type B personality disorders?

Answer 14

1) Antisocial

2) Borderline

3) Histrionic

4) Narcissistic

Question 15

What characterises hisitrionic PD?

Answer 15

Predominantly characterized by attention-seeking behaviors and excessive displays of emotion.

• Individuals may display inappropriate sexual behaviors.
• Their emotional expressions tend to be shallow, dramatic, and often perceived as exaggerated.
• They often perceive relationships as being more intimate than they truly are, reflecting a distorted perception of interpersonal boundaries.

Question 16

Which type of PD features the need to be at the centre of attention and having to perform for others to maintain that attention?

Answer 16

Histrionic

Question 17

Which type of PD features feelings that they are special and need others to recognise this or else they get upset?

Answer 17

Narcissistic

Question 18

What typically defines a Type C personality disorder?

Answer 18

People with cluster C personality disorders have strong feelings of fear or anxiety.

Question 19

What are the 3 types of Type C PD?

Answer 19

1) Dependent

2) Avoidant

3) Obsessive compulsive

Question 20

OCPD vs OCD?

Answer 20

OCPD:
- The patient perceives them as rational and desirable
- Not associated with recurrent, intrusive thoughts or rituals

OCD:
- The symptoms are distressing for the patient
- Is associated with recurrent, intrusive thoughts or rituals

Question 21

What type of PD features unrealistic expectations of how things should be done by themselves and others, and catastrophising about what will happen if these expectations are not met?

Answer 21

OCPD

Question 22

What is ‘trait anxiety’?

Answer 22

Your propensity to experience the anxiety response when exposed to a stressor.

Question 23

What is ‘state anxiety’?

Answer 23

Simply the state of feeling anxious

Question 24

What are 5 processes thought to drive a spiral of anxiety?

Answer 24

1) Avoidance

2) Attentional and cognitive bias

3) Anxious rumination

4) Low self-worth

5) Poor sleep

Question 25

How long must symptoms be present for for a diagnosis of GAD?

Answer 25

6 months

Question 26

What is the key feature of phobic anxiety disorders?

Answer 26

Avoidance of that situation

Question 27

What phobia is concurrent in 30-50% of panic disorder cases?

Answer 27

Agoraphobia

Question 28

Stepwise treatment algorithm for mx of anxiety disordes?

Answer 28

1) Psychoeducation, sleep hygiene, and self-guided cognitive-based therapy (CBT)/ relaxation techniques 2) CBT 3) Pharmacological (equal 1st line with CBT)

Question 29

What drug is 1st line in management of anxiety disorders?

Answer 29

SSRIs

Question 30

4 key features of PTSD?

Answer 30

1) hyperarousal (i.e. heightened perception of threat) 2) re-experiencing/flashbacks 3) avoidance 4) distress

Question 31

Management options for PTSD?

Answer 31

1) Trauma focused CBT 2) Eye-Movement Desensitization and Reprocessing (EMDR) therapy 3) Pharmacological: SSRI or venlafaxine (possible adjunctive antipsychotic)

Question 32

When should you not diagnose panic disorder?

Answer 32

If 2ary to depression

Question 33

How long must symptoms be present for to make a diagnosis of PTSD?

Answer 33

4 weeks

Question 34

What is the SSRI of choice in people with unstable angina or recent myocardial infarction?

Answer 34

Sertraline

Question 35

If CBT or EMDR therapy are ineffective in PTSD, what are the first line drug treatments?

Answer 35

venlafaxine or an SSRI

Question 36

What SSRI is 1st line in GAD?

Answer 36

Sertraline

Question 37

2nd line in GAD if 1st SSRI not effective?

Answer 37

Try another SSRI, or SNRI

Question 38

What are 4 predisposing conditions for autism?

Answer 38

1) Fragile X syndrome 2) Infantile spasms/West syndrome 3) Congenital rubella 4) Tuberous sclerosis

Question 39

What % of people with autism also have ADHD?

Answer 39

50%

Question 40

What IQ defines a learning disability?

Answer 40

<70

Question 41

What is the most common cause of learning disability?

Answer 41

Down's syndrome

Question 42

Potential complications of Down’s Syndrome?

Answer 42

- Abnormalities of internal organs e.g. ASD, VSD, oesophageal atresia – Cataracts – Hypothyroidism – Chest infection – Transient leukaemia – Epilepsy – Alzheimer’s Dementia

Question 43

What is the leading preventable non-genetic cause of LD?

Answer 43

Foetal alcohol syndrome

Question 44

What are the characteristic facial features in FAS?

Answer 44

Low nasal bridge Thin upper lip Flat midface and short nose Short palpebral fissures Epicanthal folds Indistinct/smooth philtrum Micrognathia

Question 45

What is the most common inherited cause of LD?

Answer 45

Fragile X syndrome

Question 46

What genetic mutation is seen in Fragile X syndrome?

Answer 46

CGG trinucleotide repeat on the FMR1 gene on the X chromosome

Question 47

What signs and symptoms are seen in FXS?

Answer 47

Long, narrow face Large, protruding ears Intellectual impairment (mild to profound) Post-pubertal macroorchidism (large testes) Social anxiety Autistic spectrum features Delayed motor milestones Speech and language delay Prominent jaw & forehead Mitral valve prolapse

Question 48

What cardiac defect is seen in Fragile X?

Answer 48

Mirtal valve prolapse

Question 49

What may depressive features in people with LD also indicate the onset of?

Answer 49

Dementia

Question 50

What cancer can notably cause low mood?

Answer 50

Pancreatic cancer

Question 51

If antidepressants alone do not work in severe depression, what can they be augmented with?

Answer 51

Lithium

Question 52

What can a ‘manic switch’ sometimes be induced by?

Answer 52

1) Someone with BAD taking antidepressants to treat a depressive episode 2) Stressful life events 3) Physical illness 4) Illicit substance misuse

Question 53

What is the gold standard medication for bipolar disorder?

Answer 53

Lithium

Question 54

What PHQ-9 score indicates 'more severe' depression?

Answer 54

≥16 --> combination of CBT & antidepressants

Question 55

How can lithium affect WCC?

Answer 55

Can cause a benign leucocytosis

Question 56

1st line mx of 'less severe' depression? (i.e. PHQ-9 <16)

Answer 56

Guided self help interventions (then CBT)

Question 57

Mx of symptoms of hypomania in primary care?

Answer 57

Routine referral to CMHT