Adjustment disorders, somatisation and conversion, eating disorders Flashcards
What is adjustment disorder?
Situational depression - abnormal response to a major life event / stressor
Anxiety, difficulty moving forwards, reckless behaviour, depressed mood - significant impairment of social, occupational functioning
Normal grief reaction?
On average lasting ~6 months
Normal grief symptoms - shock, disbelief, anger, guilt, sadness
Disturbed sleep/appetite
Hearing the voice of the deceased
Abnormal grief reaction
Prolonged (>6 months), or absent (delayed)
Excessive symptoms
pre-occupation with guilt, thoughts of death
psychomotor retardation
prolonged impairment of functionality
hallucinatory experiences
Differences in management of normal vs abnormal grief
Normal - reassure, no treatment, benzos for sleep, support groups
Abnormal - consider antidepressants, support groups
What are somatoform disorders
Somatisation
Conversion
Hypochondrial
Persistent somatoform pain disorder
Features of somatisation disorder?
1 or 2+ distressing symptoms - causing significant disruption to daily life
Typically present for >2yrs (ICD-10)
absence of physical illness, compatible with symptoms
Features of conversion disorder?
Voluntary motor or sensory function deficits
Dissociative amnesia/fugue state/stupor
Features of Anorexia Nervosa (AN)
BMI <17.5
Low body weight + intense fear of gaining weight + body image disturbance + calorific restriction/weight loss practices
What is the SCOFF questionnaire?
S - so you make yourself SICK because you feel full
C - have you lost CONTROL over what you eat
O - have you lost ONE stone in past 3 months
F - Do you think yourself FAT where others think you too thin
F - does FOOD dominate your life
Physical manifestations of AN
Lanugo hair on face, trunk, arms
Scalp hair thinning
Dry skin, cracked nails
Amenorrhoea, infertility
Metabolic disturbances - systemically unwell
Fatigue, weakness, dizzy
Cardiac arrhythmias (hypokalaemia), postural hypotension
4 features of physical risk assessment?
1) Clinical history and physical examination
2) BMI
3) ECG
4) Bloods
Important questions in clinical history and physical examination?
Rapid weight loss - >1kg/week
Excessive exercise, inappropriate use of laxatives, diuretics, vomiting
CVS - hypotension, chest pain, arrhythmias, blackouts
Risk stratification according to BMI
<17.5 = AN <15 = moderate risk <13 = high risk
ECG changes in hypokalaemia
Bradycardia - <40bpm Flattened T waves ST depression Prolonged PR interval Wide, big P wave Prominent U wave
Blood results in AN
Starvation - hypoglycaemia
Vomiting - hypokalaemia
Water-loading - hyponatraemia
Re-feeding syndrome: Hypophosphataemia Hypomagnesaemia Hypocalcaemia Hypokalaemia
