14bc Personality eating disorders

Question 0

Defense mechanisms

Answer 0

unconscious mental process that the ego uses to resolve conflicts. (i want to punch him but I know I shouldnt)

Question 1

Personality parts

Answer 1

• 50% temperament “nature”
• Character
• Development- negative repeated childhood events can have negative effects
• Psyche- self awareness and ability to learn, adapt, and change

Question 2

Immature defense mechanisms

Answer 2

Acting out
dissociation- drastic temporary change in personality etc.
Denial
Displacement- husband yells at wife- wife yells at child
fixation
identification- modeling behavior after someone more powerful
Isolation- separating feelings from ideas or events
Projection-projecting your own unacceptable impulses 2 someone else
Rationalization
Reactio formation- think of sex join monestary
regression- toilet trained child wets bed
Repression- involuntary witholding ffelings or thoughts from consciousness
splitting- all good or all bad- no inbetween

Question 3

Mature defenses

Answer 3

Altruism- alleviating guilt by helping others
Humor- i.e. making a joke about Step 1
Sublimation- replace impulse with more acceptable one- angry at dad- take out frustrations scoring goals in soccer
Suppression- intentionally witholding thought or idea from consciousness- choosing not to worry because there are other things to do right now.

Question 4

Personality disorder

Answer 4

• Ingrained.inflexible
• Gets in the way of realtionships or functioning
• Stays stable
• distresses people around them

Question 5

Personality disorders stats

Answer 5

10-18% of population
30-50% psychiatric outpatient populations
>50% inpatient
34% of Axis 1 disorder patients

Question 6

Cluster A

Answer 6

Detached and eccentric

• Schizoid
• schizotypal
• paranoid

Question 7

Schizoid PD

Answer 7

Emotionally detached
doesnt want relationships
SchizoiD --> Distant
*M>f
*No positive symptoms of Schizophrenia

Question 8

SchizoTypal PD

Answer 8

Eccentric/ awkward
magical Thinking
*genetic predisposition
“I dont like your vibe man”

Question 9

Paranoid PD

Answer 9

pervasive distrust
M>F
No hallucnations or thought disorder

Question 10

Cluster B personality disorders

Answer 10

Dramatic and imulsive

Antisocial
Borderline
Histrionic
Narcisistic

Question 11

Borderline PD

Answer 11

• Frantic fear of abandonment
• Unstable and intense relationships- Idealization or devaluation
• mood swings (minutes to hours, not days like bipolar)
• suicide and self mutilation common
• F>M
• Familial- associated with MDD and substence abuse

Question 12

Antisocial PD

Answer 12

Sociopath
criminal, deceitful, impulsive
Aggressive, irritable
Irresponsible
-M>F
-very genetic

Question 13

Histrionic PD

Answer 13

Paris hilton
sexually provocative, attention seeking, emotional and excitable
F>M

Question 14

Narcissistic PD

Answer 14

*Self-important grandiosity- lack of empathy
*Success, pwer, brilliance, beauty, love
*arrogant, entitled, envious
*require admiration, take advantage of others
rages at criticism

Question 15

Cluster C personalities

Answer 15

Cowardly, clingy, compulsive

• avoidant
• Obsessive compulsive
• Dependent

Question 16

OCPD

Answer 16

*Fixated on details- lose scope
*Perfectionism that interferes
*Inflexible values that are unattainable
M>F
rationalize, intellectualize, reactionary, controlling
EGO SYNTONIC

Question 17

Avoidant PD

Answer 17

• Extreme sensitivity to rejection with withdrawl

* Shy but desire relationships

Question 18

Dependent PD

Answer 18

*subordinate needs to others
*indecisive- no self confidence
*doesnt speak up because of fear
*Cant be alone
F>M

Question 19

PD treatments

Answer 19

*Psychodynamic treatment- change defenses
*supportive if patient unstable or unable to see problems
*Behavioral if behavior self destructive
Meds for symptoms

Question 20

Anorexia nervosa

Answer 20

MOST LETHAL PSYCH DISORDER
-intense weight loss and fear of obesity
-Disturbed body image
-medical signs and symptoms of starvation
(May require inpatient)
Dx Criteria
*less than 85% of ideal weight
*intense fear of gaining weight
*Body image distortion
*(amenorrhea)

Question 21

Anorexia classifications

Answer 21

Purging/restricting

Severity
Mild BMI>17
Moderate 16-16.99
Severe 15-15.99
Extree <15

Question 22

Signs of starvation

Answer 22

Hypotension
Bradycardia
Hypothermia

• bradycardia, syncope, EKG changes, arrhythmias and suddendeath
• skeletal: osteopenia porosis
• Endocrine: decreased sex hormones, cold intolerance hypothermia, decr libido and amenorrhea
• Derm- dry skin, alopecia, lanugo
• Heme- pancytopenia
• GI- delayed gastric emptying constipation
• Neuro- fatigue, weakness, brain mass volume loss and cognative deterioration

Question 23

Anorexia epidemiology

Answer 23

• 10:1 females to males
• Mid teens
• 1% population, 5% subclinical
• higher socioeconomic status
• Multifactorial, dieting common
• Genetic predisposition

Question 24

Eating disorder psychological factors

Answer 24

* Temperment: perfectionism, harm avoidant, high achieving * Control issues: feeling helpless, or controlled * Maturation fears: doesnt want to be full woman * demands to increase independence * Greedy/unacceptable moral desires

Question 25

Eating disorder social factors

Answer 25

``` Media Obesity ed Family weight concerns Teasing about weight dieting info performance pressures ``` *interfamily conflicts: hostile, chaotic, isolative, controlling, not nuturing, not empathetic

Question 26

AN treatment

Answer 26

* Hospitalization- slow refeeding * Therapy - family (maudsley -parents control at start then give to patient) - individual - CBT and DBT - group therapy * STABALIZE AND IMPROVE RELATIONSHIPS Prognosis: 75% good to moderate improvement, 1/4 complete recovery, 1/2 still issues but functiong, waxing and waning Poor prognosis- persisting food obsessions, bulimia, low albumin/low weight *7-18% mortal

Question 27

Bulimia Nervosa

Answer 27

* Binging and compensatory * clinical S/Sx Dx Criteria * Recurrent binging and inappropriate compensatory behavior * twice (once in V) per week for 3 months * Body image distortion and self worth dependent on body image

Question 28

BN severity

Answer 28

Mild 1-3 episodes of compensation Moderate 4-7 Severe 8-13 Extreme 14+

Question 29

BN SSx

Answer 29

* Swollen parotid, MCP caluses (russels sign), Dental erosions and caries * fluid and electrolyte imbalance * GERD, Carices, melanosis coli * CV arrhythmias and myopathies * ENDO: menstrual abnormalitiees * Neuro: neuropathy, fatigue, cognative slowing, seizure

Question 30

BN labs

Answer 30

*Vomting and diuretic: Metabolic alkylosis: lowK, low NA,high bicarb Hypochloremic *Laxatives: Hyperchloremic metabolic acidosis: Low K, high Cl, Low bicarb Low Mg, ^serum amylase

Question 31

BN Epidemiology

Answer 31

1-3% of population Late adolescence early adulthood *genetic predisposition - associated with mood and impulse disorders *more responsive to serotonin changes

Question 32

BN Psychological and social

Answer 32

Overachiever, secretive, ego-dystonic, self critical, outgoing, angry, impulsive *associated with depression, substance abuse, PDs, emotional lability, anxiety, dissociative disorders, abuse history *media influence, anti-obesity education, weight teasing, family conflict:les close, control issues, neglect/rejection

Question 33

BN Tx

Answer 33

Same as AN but also fluoxetine NOT BUPROPRION- lowers seizure threshold. Prognosis: Great as long as no substance abuse Untreated remains chronic

Question 34

BED

Answer 34

3-5% population * recurrent binging with distress * 1X per week>3 months (1-3 mild, 4-7 moderate, 8-13 severe, 14+ extreme)

Question 35

Avoidant/restrictive food intake disorder

Answer 35

* Fails to meet nutritional needs * no body image distortion * Not AN or BN

Question 36

Obesity

Answer 36

BMI >30 | 2/3 overweight or obese, 1/3 obese

Question 37

Orlistat

Answer 37

Lipase inhibitor for obesity | 5-10 lbd weight loss in 6 months

Question 38

Phentermine

Answer 38

Sympathomimetic decreases appetite

Question 39

Lorcasein HCL

Answer 39

Belviq | BMI>30 or >27 with co morbid condition

Question 40

Reasonable weight loss

Answer 40

Adults: 1-2 lbs/ week or 10% weight loss over 6 months cut calories 500-1000 calories per day Kids: slow weight gain by exercising to fall back on curve if obese: maintain for 3 months then 1lb/mo weightloss

Question 41

Exercise recommendations

Answer 41

150 mins moderate aerobic weekly | 2+ days muscle strengthening

Question 42

PD Tx

Answer 42

Schizotypal, paranoid, and borderline PD benefit from 1/10 dose of antipsychotics