306 Personality, eating, and anxiety disorders Flashcards
What does EUPD stand for?
Emotionally unstable personality disorder
What is EUPD?
Emotional instability/affective dysregulation – very intense, changeable and uncontrollable emotions
Disturbed patterns of thinking or perception – cognitive distortions or perceptual distortions
Impulsive behaviour
Intense but unstable relationships with others
Attachment seeking behaviour
-may harm themselves in attempts to get their needs met
What is schizophrenia?
A loss of connection to reality so they don’t have much insight
Where in the brain do people with EUPD show neurological changes?
-Orbitofrontal cortex (planning, decision making)
-Amygdala (intensity and reactivity of emotions)
-Hippocampus (behavioural regulation)
-Neurotransmitter abnormalities (especially serotonin)
What is the most common type of personality disorder?
Antisocial personality disorder
What are the features of antisocial personality disorder?
-Exploits, manipulates other for personal gain
-Lacks concern for other people/their distress
-Disregards normal social behaviour
-Anger outbursts
-Trouble sustaining long term relationships
-Lacks guilt
-Blames others for problems in their lives
-Repeatedly breaks the law
What are some different types of personality disorder?
Paranoid – suspiciousness, misconstrue friendly or neutral actions of others as hostile, tenacious sense of personal rights, preoccupation with unsubstantiated “conspiracies”
Schizoid – withdrawal from social contacts with preference for solitary activities, fantasy. Limited capacity to express feelings and feel pleasure
Anankastic (Obsessive Compulsive) – feelings of doubt, perfectionism, excessive conscientiousness, rigidity, and preoccupation with details
Dependent – pervasive passive reliance on others to make one’s life decisions. Feelings of helplessness and incompetence. Fear of abandonment
Avoidant – extreme shyness, social inhibition, feelings of inadequacy, sensitivity to rejection and criticism from others.
Histrionic – shallow, labile affect, self-dramatization, theatricality, exaggerated expression of emotion, lack of consideration for others, easily hurt feelings
What are some features of PTSD?
Flashbacks - re-experiencing phenomena
Avoidance of anything that may be triggering
Hypervigilance due to anxiety
What is depersonalisations?
Feeling like your not real
What is derealisation?
Feeling like things around you aren’t real
Name some continuous anxiety disorders
Generalised Anxiety Disorder (GAD)
PTSD
Name some episodic anxiety disorders
Panic Disorder
Specific Phobia
Social Phobia
Agoraphobia
OCD
BDD
Acute Stress Reaction
What are some organic causes of anxiety?
-Phaeochromocytoma
-Hyperthyroidism
-Hypoparathyroidism
-Caffeine
-Substance use
Acute intoxication (eg stimulants) and withdrawal (eg alcohol, benzos)
-Medication
Eg. Asthma drugs (Salbutamol, Theophylline) and steroids
What is Agoraphobia?
Fear of situation in which escape might be difficult or help might not be available
Examples:
Fear of entering shops
Public places (shops, cinemas, theatres)
Using public transport
Being in crowds
Being outside the home alone
What is EMDR?
Eye Movement Desensitization and Reprocessing
Used to treat PTSD
What is the SCOFF questionnaire?
A group of questions used to screen for an eating disorder
Sick: ‘Do you ever make yourself sick because you feel uncomfortably full?’
Control: ‘Do you worry that you have lost control over how much you eat?’
One: ‘Have you recently lost more than one stone in a 3-month period?’
Fat: ‘Do you believe yourself to be fat when others say you are too thin?’
Food ‘Would you say that food dominates your life?’
What does the SUSS test measure?
Sit Up, Squat, and Stand Test
Measures muscle strength
0: unstable
1: able only using hands to help
2: able to with noticeable difficulty
3: No difficulty
2 or less is a red flag
What are some differentials for weight loss?
GI: coeliac, IBD, peptic ulcer, malignancy
Drug or alcohol
Endocrine/metabolic – Diabetes, hyperthyroidism
Autoimmune
What are some differentials of amenorrhoea?
Pregnancy
Polycystic ovary syndrome
Hypothalamic
What are some differential mental health conditions for eating disorder?
Depression
Anxiety
OCD
Substance misuse
Name some eating disorders
-Anorexia nervosa
-Bulimia nervosa
-Binge eating disorder(BED)
-Other specified feeding or eating disorders (OSFED): almost half of patients with eating disorders will actually have OSFED. This accounts for a variety of eating disorders that don’t quite fit into diagnostic criteria for the disorders above
What is diabulimia?
A media coined, not in diagnostic criteria type of eating disorder
A condition associated with type 1 diabetes when a person reduces or stops taking their insulin in order to lose weight
What are some clinical features of anorexia nervosa?
-Significantly low BMI
-Persistent pattern of behaviours to prevent restoration of normal weight
-Compensatory behaviours aimed at reducing energy intake (restricted eating), purging behaviours (e.g. self-induced vomiting, misuse of laxatives), and behaviours aimed at increasing energy expenditure (e.g. excessive exercise)
-Intense fear of gaining weight
-Incorrectly perceived weight
What are the features of bulimia nervosa?
-Frequent, recurrent episodes of binge eating
-Subjective loss of control of eating
-Repeated inappropriate compensatory behaviours aimed at preventing weight gain (e.g. self-induced vomiting, misuse of laxatives or enemas, strenuous exercise, continuing attempts to restrict intake)
-Preoccupation with weight
-Distress about the pattern of binge eating and inappropriate compensatory behaviour or significant impairment in psychosocial function
-BMI may be normal or above
What are some dermatological complications of eating disorders?
-Acrocyanosis
-Jaundice
-lanugo hair
-Dry skin
What is Acrocyanosis?
Persistent abnormally cyanotic discoloration of skin over extremities
What is Lanugo hair?
Fine hair due to malnourishment
What are some dental complications of eating disorders?
-Dental erosions if induced vomiting
-Salivary gland enlargement
What are some metabolic/endocrine complications of eating disorders?
Bone loss,
Oedema
euthyroid sick syndrome (low T4)
suppression HPA axis
hypothermia
hypoglycaemia
What are some renal complications of eating disorders?
Kidney stones
hypokalaemia
renal impairment
What are some obstetric and gynaecological complications of eating disorders?
Amenorrhoea, infertility, miscarriage
What are some neurological complications of eating disorders?
Fainting, headaches, fatigue, poor concentration
What are some Cardiovascular complications of eating disorders?
Low cardiac output and hypotension
Poor circulation
bradycardia
anaemia
Arrhythmias
What are some Gastrointestinal complications of eating disorders?
Constipation
bloating
gastro-oesophageal reflux
slow gastric emptying
What are some Musculoskeletal complications of eating disorders?
Muscle weakness
swollen joints
osteoporosis/osteopaenia
When would you refer patient to specialist services?
Rapid weight loss (>1kg/week)
BMI <15
Other concerns/medical complications/risk factors
Severe psychiatric comorbidity
What is re-feeding syndrome?
A dangerous and potentially fatal complication of eating disorders
Occurs 1-5 days after eating is reinstated following period of starvation
Rapid shifts of electrolytes back into cells from which they had, during starvation, been leached out
Electrolytes affected: phosphate, potassium, magnesium, calcium, thiamine
