6. CAH mental health

Question 1

Case 1 - 14y.o female, history of fainting and bp 85/50
background of 6 months central abdominal pain- no change in bowel habit but nausea, bloating, hard stool every 3 days.
Potential differential diagnoses?

Answer 1

• constipation
• anxiety
• anorexia

Question 2

Continued case 1-
Menarche 12 months ago, 4 cycles over 7 mths, no menstruation for 4 mths.
Ask about?

Answer 2

Social context, what she does at home, eating patterns, mood, exercise pattern, body image issues, symptoms of hypothermia/hypotension

Question 3

DSM 5 for anorexia?

Answer 3

A. Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, dev trajectory and physical health
B. Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain, even though already at low weight
C Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

Question 4

Signs of anorexia - CNS, hair, cardiac, blood, muscles, kidney, electrolytes, GIT, hormones, skin

Answer 4

CNS- lack concentration, sad, moddy, fainting
hair- thin, brittle
cardiac - hypotn, slow HR, palpitations, heart failrue
blood - anaemia
muscles- weak, swollen joints, fractures, OP
kidneys - stones, failure
electrolytes- low K,Mg, NA
Intestines: constipation, bleeding
hormones: amennorhea, growth restriction, trouble getting pregnant
skin - bruise easily, dry, lanugo, carotinemia, brittle nails
other -cold intolerance

Question 5

mortality of anorexia due to ?

Answer 5

50% - suicide,

50% cardiovascular compilcations

Question 6

treatment of anorexia?

Answer 6

family based, CBT

Question 7

investigations needed for anorexia

Answer 7

FBE
UEC 
LFT
Ca/Mg/PO4
TFT 
coeliac screen