W03 - PSYCH: Child & Adol. Psych; Eating Disorders; Personality Disorder Flashcards
(21 cards)
Distinguish between the different eating disorders as well as between eating disorders and ‘feeding disorders’, and demonstrate awareness of the range of symptoms and behaviours involved.
- highest mortality rate amongst psychiatric symptoms
- all share features of pre-occupations
BULIMIA NERVOSA
* eating large amounts of food with a loss of control over the eating — and then purge, trying to get rid of the extra calories in an unhealthy way.
* purging Vs non-purging
ANOREXIA NERVOSA
* Relies on compulsive compensatory behaviours when food cannot be avoided, Self induced vomiting, laxative abuse, excessive exercise, abuse of appetite suppressants / diuretics.
BINGE EATING DISORDERS
* repetitive cycles, similar to bulimia nervosa with nil purging, ‘buzzed’ after eating
- Other specified feeding or eating disorder (OSFED)
*Avoidant Restrictive Food intake disorder. ( ARFID)
Analyse the predisposing, precipitating and perpetuating factors contributing to the onset of eating disorders.
*obsessive fear of fatness, avoidance food and sources of calories
PREDISPOSING:
high risk obsessionality
genetic
perinatal
PRECIPITATING:
life events - trauma
puberty
dieting
exercise
PERPETUATING:
consequences of starvation syndrome
- delayed gastric emptying
- narrowing focus
- obsessionality
- high emotional expression: families, school, clinic staff
Describe evidence-based treatments for the management of the different disorders
- specialist centres associated with lower mortality rates
- Average time for recovery from anorexia nervosa – where this occurs – has been estimated at 6 – 7 years.
> Re-feeding = vital in ensuring good response to medication and psych. support and intervention
> Psych. Support & Rx.
CBT-ED
MANTRA
SSCM
CBT + self-help
> IPT, fluoxetine
> Olanzapine
> Family work
+ Dietary advice and education
+ Medicine for psychological symptoms
+ bone health
- follow-upss
Demonstrate the use of motivational approaches and the technique of ‘externalising the disorder’.
*motivational and open approach to combat feeling of isolation.
*controlling impulses => from EXTERNALISING DISORDERS (vs INTERNALISED)
- Externalizing disorders are often specifically referred to as disruptive behavior disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder) or conduct problems which occur in childhood. Externalizing disorders, however, are also manifested in adulthood. For example, alcohol- and substance-related disorders and antisocial personality disorder are adult externalizing disorders.
Manage risk of death and of irreversible physical damage appropriately in patients with severe eating disorders
- assessment of risk of profound electrolyte disturbance
- severe wt loss
- <40bpm
- severe dehydration; fluid refusal
- hypothermic
- prolonged QT complex
Prioritise nutritional concerns in the management of the mental and physical health of all patients, whether or not they have formal eating disorders
> Re-feeding = vital in ensuring good response to medication and psych. support and intervention
TIDE
DM with eating disorder
- insulin omission
*food restricition A/nervosa variant
- CHO avoidance/restriction
- binging/bulimic variant
- intentional insulin omission
= ketoacidosis high risk - Diabetes Eating Disorder Survey – Revised DEPS- R . 16 item questionnaire, diabetes specific , self-reported measure of disordered eating
Anx. Nervosa Signs & Symptoms
cold intolerance: peripheral wasting, dt cardiac muscle weakening = maintenance of core.
blue hands feet
GI bloating / constipation
delayed puberty, Primary or secondary
amenorrhea
dry skin
fainting
fatigue, weakness
haair symptoms
Osteopenia & osteoporosis
Bulimia Nervosa Signs & Symptoms
Pharyngeal trauma
esoph rupture
dental caries, mouth sores
Heartburn, chest pain
impulsivity
Muscle cramps
Weakness
Bloody diarrhoea
Irregular periods
Fainting
Swollen parotid glands
hypotension
*K+ loss = cardiac arrhythmia risk
Link to anorexia nervosa and reynauds
some may come in to mask their anorexia nervosa = low wt, peripheral wasting
To be able to discuss the impact of genetics, family and the wider social environment on the development and maintenance of psychiatric disorder in young people.
*early life hx, genogram significance, personal hx etc.
+ temperment, likes/dislikes
+ in-utero stress = LT dmg
+ collateral hx
PREDISPOSING
* genetics, toxic in-utero, birth compl., insult
PRECIPITATING
* iatrogenic rection, substance misuse
* new stress
* school/home changes = stress
PERPETUTATING
* poor response to meds, pain, illness
* personality, coping, self-belief, world outlook
PROTECTIVE
* diet, sleep, genes, exercise, intelligence
* cognitive strategies, coping, psychologically minded
* faith, community, family
To recognise the features of the common psychiatric disorders that affect young people.
a
To be aware of the impact that child psychiatric disorder may have on normal developmental processes, the family and later adult life.
a
ADHD features and mgmt
- 6 months inattention and/or hyperactivitity-impulsivity
- present before 12, M>F
- hyperactive-impusive symptoms recede vs persisting inattention
= functional negative impact
- Conners index
(1)
> parent training programme
+ school adjustments
(1)
> Methylphenidate
2. >Lisdexamphetamine
3. >Atomoxetine (non-stimulants)
- monitor growth, baaseline obs, cardiac events hx
Autism Spectrum Disorder features and mgmt
- IMPAIRMENTS IN RECIPROCAL SOCIAL INTERACTIONS
- DIFFICULTIES WITH SOCIAL COMM
- RESTRICTED, REPETITIVE, INFLEXIBLE PATTERNS OF INTEREST / BEHAVIOUR
*early childhood
= impaired functioning
+ impaired functionl language, intellectual dev.
M>F
Psychometrics for anxiety in children
The Revised Child Anxiety and Depression Scale (RCADS)
CHILDREN’S YALE-BROWN OBSESSIVE COMPULSIVE SCALE (CY-BOCS)
Mgmt for Anxiety in Children
> School based intervention frequently
> CBT, Graded exposure, Exposure response prevention, SLT, OT, Physio as appropriate
> SSRI can be considered if inadequate response
Mediating mechanisms vs Moderating mechanisms
Mediating mechanisms = processes accounting for familial factors that attribute to child’s risk for psychopath.
Moderating mechanisms = who and when is the greatest risk..ID populations at risk and can focus on.
To understand the nature and epidemiology of personality disorder
Lifelong, persistent, deeply ingrained maladaptive behaviour that:
- characterizes an individual
- deviates markedly from culturally expected or accepted ‘normal’ range
- Onset in late childhood or early adolescence
affecting: cognition, affectivity, social conduct, impulse/gratification control, interpersonal function
To have an understanding of therapeutic options
Biopsychosocial approach
Assessment for full diagnostic picture, including co-occurring mood and addictive disorders
Diagnostic formulation, risk management planning, and setting of treatment goals and realistic ways of meeting them
Judicious use of medication
Specific psychological treatments
Social interventions
> Antipsychotics – cognitive symptoms, impulsivity and intense angry affect
> Monoamine Oxidase Inhibitors – borderline PD to alleviate abnormal mood
> Carbamazepine and lithium – episodic behavioural dyscontrol and aggression
Borderline Pattern
A pattern of unstable and intense interpersonal relationships, typically characterized by alternating between extremes of idealization and devaluation. Identity disturbance, manifested in markedly and persistently unstable self-image or sense of self.
