Adol & Psych Cram Flashcards
Lifetime prevalence of eating disorders?
7%
Risk of anorexia/bulimia if first degree relative affected?
6-10x greater
Biggest risk factor for development of an eating disorder?
Previous dieting
Signs of abnormal dieting behaviours?
Successive weight goals Increasing body self-criticism Social isolation Loss of menstruation/failure to start menstruation Vomiting
Criteria for dx of anorexia nervosa?
Restriction of energy intake relative to requirements leading to significantly low body weight
Intense fear of gaining weight or becoming fat, or persistent behaviour
Disturbance in the way in which one’s body weight or shape is experienced
*** loss of menstruation no longer considered
Criteria for dx of bulimia nervosa?
Eating an amount of food that is definitely larger than most would eat in a similar situation and time period + a sense of lack of control during episodes
Inappropriate compensatory behaviour (vomiting, excessive laxatives, exercising)
>1 per week for 1 month
Criteria for dx of binge eating disorder?
Binges associated with: rapid eating/ feeling uncomfortably full / eating when not hungry/ eating alone/ feeling disgusted after
Occur at least once a week for 3 months
Atypical AN?
Features of AN however normal or high body weight
Co-morbidities of anorexia?
OCD
Social phobia
Which complication of AN does not resolve with weight restoration?
Bone density
Healthy children = gain 45-60% BMD in second decade
Orofacial complications of AN?
Caries
Parotid enlargement
Submandibular adenopathy
Cardiovascular complications of AN?
Bradycardia: due to increased vagal tone, decreased metabolic rate
Postural hypotension
Decreased cardiac output: reduced exercise capacity, attenuated BP response to exercise
Decreased cardiac mass and myocardial fibrosis
Mitral valve prolapse in p to 20%
Pericardial effusions
May get small volume ST/ T wave changes and prolonged QT
Endocrine complications of AN?
Decreased estradiol, FSH, LH, testosterone
Amenorrhoea (due to decreased pulsatility of GnRH)
Hypogonadotrophic hypogonadism
sick euthyroid (↓T3/T4, normal or low TSH)
Increased cortisol
Renal complications of AN?
↑ urea (dehydration, ↓ GFR), low urea if malnutrition
Mild proteinuria, haematuria, pyuria
Renal calculi
Neurological complications of AN?
Brain pseudoatrophy
Ventricular enlargement
Reduced basal blood flow to brain, increased flow to medial temporal lobe areas (seen in psychosis)
Peripheral neuropathy
Hypothalamic dysfunction: thermoregulation, satiety , sleep
GI complications of AN?
Gastroparesis / Constipation
Esophagitis
Elevated LFTS + amylase
SMA syndrome (rare) = reduction of fatty tissue that separates superior mesentery artery and aorta leads to compression of duodenum between these two vessels resulting in small bowel obstruction
Treatment goals for AN?
Resume growth and puberty
Return to menstruation
Normalise eating
Treat underlying psychological conditions
Mortality rate in AN?
12x higher than all other causes in female adlescents
5% per decade
50% due to cardiovascular complications, 50% due to suicide
Average length of illness in AN?
5-7 years
Risk factors for poor outcome in AN?
Onset <11 years of age, or onset in adulthood Psychiatric and somatic comorbidities Obsessionality and impulsivity Purging and binging behaviour More significant weight loss Family dysfunction Longer duration of illness
Risk factors for good outcome in AN?
Early age at onset/ adolescent onset (<14 years, but must be >11 years)
Good relationship with family
Shorter duration of illness
Treatment modality with best outcome for AN?
Family based therapy
Suitable for children with anorexia up to 19 years of age with less than 3 years duration
50-70% more effective than individual therapy
Phases of family based therapy?
1: intensive refeeding, parents take all control & siblings role is to support distress only
2: transition to adolescent control - completed at weight restoration/return of menses
3: return to adolescent control
Core principles of FBT?
- Causes of AN are NOT the focus of treatment; causes of AN are unknown
- Separate client from the anorexia
- Through separation parents encouraged to take action against the illness NOT child
- Hospitalisation is temporary solution
- The therapist only challenges the structural elements of the family that interfere with weight gain
- Development of strong parental alliance, sibling sub-system and fostering open communication
Medical safety takes precedence
Management of bulimia?
- Psychoeducation/CBT
- Dietary management, regular meals, DELAY purging (less likely to vomit if delayed by > 30 minutes), distraction
- High dose SSRI: Fluoxetine
Cause of melanosis coli?
Senna based laxatives (anthraquinones)
Paracetamol overdose dosages?
Single ingestion >200mg/kg
150mg/kg (or 6g) per 24hr period over the previous 48 hours
100mg/kg (or 4g) per 24hr period for more than 48 hours who also have symptoms
Risk factors for hepatic injury in paracetamol overdose?
Chronic alcohol use
Use of enzyme-inducing drugs
Dehydration and prolonged
Glutathione deficiency from regular panadol dosing
Indications for NAC prior to confirming paracetamol level?
Presentation > 8 hours since toxic ingestion (>200 mg/kg)
Symptoms (RUQ tenderness or pain, N+V)
Slow release paracetamol >200 mg/kg or 10g
Side effects of NAC?
rash, bronchospasm, hypotension
Predictors of mortality/need for liver transplant?
Grade III encephalopathy – or any change in mentation
Acute kidney injury
Progressive increase in INR
Degree of ALT elevation is not considered a prognostic factor - is used to guide NAC duration
Paranoia Increase HR Increased BP Dilated pupils Increased temperature
Cocaine
Increase HR Increased BP Dilated pupils Seizures Cardiac arrhythmia Hyperthermia Rhabdomyolysis Acute renal failure
Amphetamines
Low HR
Low BP
Decreased resp rate
Pinpoint pupils
Opiates
Major depressive disorder criteria
2 weeks of depressed/irritable mood and loss of pleasure AND Feelings of worthlessness/guilt Weight change Sleep change Psychomotor agitation/retardation Reduced concentration/decisiveness Suicidal ideation AND Impairment of function No other organic cause
Comorbidity in depression?
Anxiety (50%) ADHD (10%) conduct disorder ODD substance abuse
Treatment of depression?
CBT & SSRI
Beware: Paroxetine – higher suicide rates than others
Generalised Anxiety Disorder criteria?
Excessive anxiety and worry occurring more days than not for the last 6 months. Difficult to control the worry
Restlessness or feeling keyed up /on edge
Being easily fatigued
Difficulty concentrating/ mind going blank
Irritability
Muscle tension
Sleep disturbance
AND
Impairment of function
Not due to organic cause
Treatment of generalised anxiety disorder?
CBT
Risk factors for anxiety disorders?
Parent with anxiety disorder
Parent with substance abuse disorder
Most heritable psychiatric disorder?
Bipolar
Most common comorbidity in ADHD?
ODD
Learning disorder 2nd most
Anxiety
Depression
Most common comorbidity in selective mutism?
Speech/language disorders
MRI B changes in anorexia?
Increased activation of amygdala
Mechanism of NAC in paracetamol overdose?
Inactivation of NAPQI by glutathione
Echolalia associations?
Catatonia
Autism
Tourettes
Fragile X
Risk factors for suicide?
Male Family Hx of suicide Previous attempt Lethality of method Mental health condition - depression, substance abuse, conduct disorder
Mental changes - agitation, delerium
Autonomic instability - tachycardia, labile BP, diaphoresis, flushing, hyperthermia
Tremor, rigidity, hyperreflexia
Serotonin Syndrome
Delirium Fever Muscle rigidity Autonomic instability High CK metabolic acidosis
Neuroleptic Malignant Syndrome
Serotonin Syndrome VS Neuroleptic Malignant Syndrome
Serotonin Syndrome
- Serotonergic Agents (SSRIs, triptans, metoclopramide)
- Short onset (<12hrs)
- HypERreflexia, clonus and DILATED pupils
NMS
- Dopamine antagonists (risperidone, chlorpromazine, quetiapine)
- 1-3 days onset
- High CK
- HypOreflexia and normal pupils
Conversion disorder VS somatic symptom disorder?
Conversion disorder
- nervous system symptoms
Somatic symptom disorders
- physical symptoms (pain/irritation)
Atomoxetine mechanism?
Noradrenergic
Risperidone mechanism?
Dopamine antagnoist
Nightmares VS Night terrors?
Night terrors
- NREM sleep (first 1/2 of night)
- Unrousable
- Amnesia
- FHx
Nightmares
- REM sleep, second 1/2 night
- Easily roused
- Remembered
Contraindications for stimulant medication use in ADHD?
Anxiety Tics/Tourettes FHx cardiac disease/sudden cardiac death Glaucoma Hyperthyroidism
SCD has been associated with stim use in children with underlying cardiac abnormalities
