Adol & Psych Cram Flashcards by Olivia Wells

Lifetime prevalence of eating disorders?

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Risk of anorexia/bulimia if first degree relative affected?

6-10x greater

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Biggest risk factor for development of an eating disorder?

Previous dieting

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Signs of abnormal dieting behaviours?

Successive weight goals
Increasing body self-criticism 
Social isolation
Loss of menstruation/failure to start menstruation
Vomiting

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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

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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

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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

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Atypical AN?

Features of AN however normal or high body weight

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Co-morbidities of anorexia?

OCD

Social phobia

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Which complication of AN does not resolve with weight restoration?

Bone density

Healthy children = gain 45-60% BMD in second decade

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Orofacial complications of AN?

Caries
Parotid enlargement
Submandibular adenopathy

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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

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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

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Renal complications of AN?

↑ urea (dehydration, ↓ GFR), low urea if malnutrition
Mild proteinuria, haematuria, pyuria
Renal calculi

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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

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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

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Treatment goals for AN?

Resume growth and puberty
Return to menstruation
Normalise eating
Treat underlying psychological conditions

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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

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Average length of illness in AN?

5-7 years

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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

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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

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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

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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***