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MRCPsych Part B - Al-Rashid Hospital > Adult Psychiatry 2.1 > Flashcards

Adult Psychiatry 2.1 Flashcards

1
Q

What types of ED are recognised in ICD 10?

A

Anorexia
Bulimia
EDNOS

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2
Q

What does Binge eating disorder fall under in ICD 10?

A

EDNOS

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3
Q

How many patients with bulimia have a hx of anorexia?

A

1/4 - 1/3

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4
Q

Which criteria for anorexia has been eliminated in DSM V?

A

Amenorrhoea

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5
Q

Diagnostic criterion for bulimia for DSM V?

A

Once-weekly frequency of binge eating and inappropriate compensatory behaviour

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6
Q

Which types of patients with ED engage with treatment better and why?

A

Bulimia, due to feelings of loss of control

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7
Q

Onset of anorexia?

A

Adolescence

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8
Q

Onset of bulimia?

A

Young adults

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9
Q

Class distribution of bulimia?

A

Even distribution

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10
Q

Prevalence of anorexia in teenage girls

A

0.5-1%

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11
Q

Prevalence of bulimia in 16-35?

A

1-2%

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12
Q

Prevalence of anorexia in females per year

A

19/100,000

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13
Q

Prevalence of bulimia in females per year

A

29/100,000

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14
Q

Comorbid psychiatric disorders in patients with anorexia?

A

65% have depression
34% have social phobia
26% have OCD

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15
Q

What personality traits are associated with bulimia?

A

Substance use in families

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16
Q

What personality traits are associated with anorexia?

A

Obsessional and perfectionist in families

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17
Q

MZ vs DZ rates of anorexia

A

55% MZ

5% DZ

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18
Q

MZ vs DZ rates of bulimia

A

33% MZ

30% DZ

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19
Q

Heritablility of ED?

A

Significant heritability for anorexia

Not for bulimia

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20
Q

Risk factors for ED

A

Female, adolescence and early adulthood
Western cultural adaptation
FHx of ED, depression, substance misuse (EtOH and obesity for bulimia)
Adverse parenting
Occupational and recreational pressure to be slim
Low self-esteem, perfectionism (in anorexia)
Hx of obesity (bulimia)
Early menarche (bulimia)

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21
Q

What type of parenting is related to ED?

A

Low contact, high expectations, parental discord
Childhood abuse
Critical comments re eating and weight

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22
Q

What characterises binge eating disorder?

A

Recurrent episodes of binge eating in absence of extreme weight control behaviour.
Background of tendency to overeat.

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23
Q

How many patients seeking treatment for binge eating disorder are obese?

A

5-10%

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24
Q

Typical characteristics of patients with Binge eating disorder?

A

Present in 40s
Male (25% male)
High degree of spontaneous remission
Stress associated overeating

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25
Q

Treatment for binge eating disorder?

A

Self-help
Behavioural weight loss programmes
CBT/IPT

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26
Q

Physical sx of ED

A 
Increased sensitivity to cold
GI sx - constipation, bloating
Dizziness and syncope
Amenorrhoea, low sexual appetite, infertility
Poor sleep with early morning wakening
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27
Q

Physical signs of ED

A

Emaciation, stunted growth and failure of breast development if pre-pubertal
Lanugo on back, forearms and side of face
Russels sign
Swelling of parotid and submandibular glands in bulimia
Perimylolysis
Hypothermia
Bradycardia, orthostatic hypotension, cardiac arrhythmias
Dependent oedema
Week proximal muscles

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28
Q

When does orange discolouration of skin occur in ED?

A

In hypercarotenaemia

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29
Q

What is Perimylolysis?

A

Erosion of inner surface of teeth

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30
Q

Endocrinel abnormalities in ED

A 
Low LH, FSH and oestradiol
Low T3, T4, Normal TSH
Increase in plasma cortisol
Raised GH
Hypoglycaemia
Low leptim
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31
Q

Cardiovascular abnormalities in ED

A

ECG abnormalities; conduction defects, prolonged QT

Myopathy and fatal cardiomypathy can be caused by ipecac (emetic substance) which contains emetine (an alkaloid)

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32
Q

GI signs of ED

A

Delayed gastric emptying
Decreased colonic motility secondary to laxative misuse
Acute gastric dilatation secondary to binge eating or excessive re-feeding

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33
Q

Haematological abnormalities in ED

A

Moderate normocytic normochomric anaemia
Mild leucopenia with relative lymphocytosis
Thrombocytopenia

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34
Q

Metabolic abnormalities in ED

A

Hypercholesterolaemia
Raised seum carotene
Low phosphate (refreeding)
Dehydration

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35
Q

Metabolic abnormalities due to vomiting

A

Metabolic alkalosis

Hypokalaemia

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36
Q

Metabolic abnormalities due to laxativ misuse

A

Metabolic acidosis
Hyponatraemia
Hypokalaemia

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37
Q

Other abnormalities of ED

A

Osteopenia and osteoporosis; increased fracture risk

Enlarged cerebral ventricles and external CSF spaces (pseudo-atrophy)

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38
Q

Effects of ED on preganncy

A 
Decreased fertility
More abortions
Higher rates of hyperemesis gravidarum, anaemia, impaired weight gain
Compromised intrauterine fetal growth
Premature delivery
Post-partum depression
Low birth weight, microcephaly, low APGAR
Hypoglycaemic neonate
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39
Q

In which ED is there food evidence of antidepressants?

A

Bulimia

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40
Q

In which ED does cognitive analytic therapy (CAT) not work?

A

Bulimia

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41
Q

In which ED is there good evidence for CBT?

A

Bulimia

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42
Q

In which ED is there no evidence for family-based therapy for adolescence?

A

Bulimia

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43
Q

In which ED is there no evidence for interpersonal psychotherapy?

A

Anorexia

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44
Q

Most effective treatment for bulimia?

A

CBT

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45
Q

How long is CBT for bulimia?

A

20 individual sessions voer 5 months

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46
Q

Recovery rate for bulimia with CBT

A

33-50% make full recovery

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47
Q

How do antidepressants help in bulimia?

A

Rapid decline in frequency of binge eating and purging

Improvement in moood

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48
Q

Problem with antidepressant therapy in bulimia?

A

Effect not sustained

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49
Q

Therapeutic goals for anorexia?

A

Engagement
Weight restoration
Psychological therapy - cognitive restructuring
If needed, use of compulsion

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50
Q

When does OP therapy for anorexia have best chance?

A

Illness present for <6 months
No bingeing or vomiting
Having parents who cooperate and are willing to participate in family therapy

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51
Q

Guidance re medications for anorexia?

A

Should never be used as primary treatment

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52
Q

What therapies should be considered for anorexia?

A

CBT/CAT
Interpersonal psychotherapy
Focal dynamic therapy
Family interventions focused on ED

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53
Q

What is helpful for adolescents with ED?

A

Family interventions that directly address the ED

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54
Q

First line treatment for bulimia

A

Self-help programmes and/or antidepressants

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55
Q

First line SSRI for bulimia

A

Fluoxetine 60mg OD

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56
Q

Therapy for buimia

A

Specifically adapted CBT; 16-20 sessions over 4-5 months

or Interpersonal psychotherapy but can take 8-12 months for results

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57
Q

Which psychiatric disorders are most frequently treated by psychiatrists?

A

PD

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58
Q

Prevalence of PD?

A

5-13%

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59
Q

Most prevalent PD in psychiatric settings

A

BPD

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60
Q

In which group of psychiatric inpatients is prevalence of PD high?

A

Those with drug and alcohol misuse

ED

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61
Q

Prevalence of PD in those with ED, alcohol or drug misuse

A

> 70%

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62
Q

Most common PD in prison?

A

Dissocial

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63
Q

Prevalence of any PD in prison?

A

78% for male on remand
64% for male sentenced
50% for females

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64
Q

Prevalence of PD in prisons

A

53% of male remand
49% of sentenced
31% of female prisoners

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65
Q

Prevalence of antisocial PD in UK

A

0.6%

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66
Q

Male vs female prevalence of PD in UK

A

Males have 5x prevalence compared to women.
Males 1%
Females 0.2%

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67
Q

Prevalence of PD and geographical areas?

A

Higher rates in urban areas

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68
Q

Median prevalence rate per 1000 of paranoid PD

69
Q

Median prevalence rate per 1000 of schizoid PD

70
Q

Median prevalence rate per 1000 of schizotypal

71
Q

Median prevalence rate per 1000 of antisocial

72
Q

Median prevalence rate per 1000 of BPD

73
Q

Median prevalence rate per 1000 of histrionic

74
Q

Median prevalence rate per 1000 of narcissistic

75
Q

Median prevalence rate per 1000 of anankastic

76
Q

Median prevalence rate per 1000 of avoidant

77
Q

Median prevalence rate per 1000 of dependent

78
Q

Median prevalence rate per 1000 of passive aggressive

79
Q

Prevalence in psychiatric OP sample per 1000 of paranoid PD

80
Q

Prevalence in psychiatric OP sample per 1000 of schizoid

81
Q

Prevalence in psychiatric OP sample per 1000 of schizotypal

82
Q

Prevalence in psychiatric OP sample per 1000 of antisocial

83
Q

Prevalence in psychiatric OP sample per 1000 of BPD

84
Q

Prevalence in psychiatric OP sample per 1000 of histrionic

85
Q

Prevalence in psychiatric OP sample per 1000 of narcissistic

86
Q

Prevalence in psychiatric OP sample per 1000 of anakastic

87
Q

Prevalence in psychiatric OP sample per 1000 of avoidant

88
Q

Prevalence in psychiatric OP sample per 1000 of dependent

89
Q

% prevalence of Cluster A PD in community

90
Q

% prevalence of cluster B PD in community

91
Q

% prevalence of cluster C PD in community

92
Q

% prevalence of any PD in community

93
Q

% prevalence of any PD in psych OP

94
Q

% prevalence of cluster A PD in psych OP

95
Q

% prevalence of cluster B PD in psych OP

96
Q

% prevalence of cluster C PD in psych OP

97
Q

Prevalence of BPD in general population

98
Q

Prevalence of BPD in Psych OP

99
Q

Prevalence of BPD in psych IP

100
Q

Female:male ratio of BPD?

101
Q

Prevalence of BPD in patients with first-degree relative who has BPD?

A

5 times more common

102
Q

What are the important longitudinal studies of BPD?

A

McLean

CLPDS

103
Q

What did McLean Study of Adult Development show re BPD?

A

Prevalence of five core BPD sx declines with rapidity; quasi-psychotic thought, self-mutilation, help-seeking suicide efforts, treatment regressions and countertransference problems

104
Q

Most stable sx of BPD?

A

Depression
Anger
Emptiness/loneliness

105
Q

What did 10 year follow-up of McLean study show re BPD?

A

Symptoms of chronic dysphoria, intense anger, nondelusional paranoia and impulsivity remained common after 10 years with other features abated

106
Q

What did the Collaborative Longitudinal Personality Disorders Study show re BPD?

A

Least stable sx of BPD were abandonment fears & physically self-destructive acts

107
Q

What do epidemiological studies show re sx of PD?

A

J-shaped relation between PD and age; initial decrease followed by an increase in some PD in older people

108
Q

What was Seivewright & Tyrer’s study into PD?

A

12 year follow-up where 178 out of 202 patients were reassessed for their personality status.

109
Q

What did Seivewright & Tyrer’s study show?

A

Personality traits of patients with Cluster B PD became significantly less pronounced after 12 years.
Those with Cluster A and C became more pronounced.

110
Q

Remission rate of BPD according to McLean Study?

A

40% after 2 years

88% after 10 years

111
Q

What is schizotypal PD classified as in ICD 10?

A

Schizophrenia?

112
Q

Cluster A PDs?

A

Paranoid
Schizoid
Schizotypal (in DSM)

113
Q

Features of Paranoid PD

A

Suspicious of other people and their motives
Longstanding grudges
Believe others are not trustworthy
Emotionally detached
Feel other people are threatening, deceiving or making plans against them

114
Q

Features of schizoid PD

A

Prefer loneliness
Difficulty in expressing emotions, particularly around warmth and tenderness
Aloof/remote
Difficulties in developing or maintaining social relationships
Unaware of social trends
Unresponsive to praise or criticism

115
Q

Features of schizotypal PD

A 
Odd/eccentric
Illusions, magical thinking
Obsessions without resistance
Members of quais-cultural groups
Thought disorders or paranoia
Believe in clairvoyance etc
May have transient psychotic features
116
Q

Cluster B PDs

A

Antisocial
BPD
Histrionic
Narcissistic

117
Q

Features of antisocial PD

A

Lack of regard for rights or feelings of others
Lack of remorse for actions that may hurt others
Ignore social norms about acceptable behaviour
May disregard rules and break the law
Make relations easily but break easily
Small proportion may be psychopathic

118
Q

Features of BPD

A

Poor self-image
Unstable personal relationships
Impulsive behaviour e.g. personal safety, substance misuse
May self-harm, feel suicidal and act on feelings
Experience instability of mood
Episodes of micro-psychosis
Feelings of chronic emptiness
Fears of abandonment - rejection sensitivity hence form intense but short lasting relations

119
Q

Features of histrionic PD

A 
Extreme/over-dramatic behaviour
Quick relationships but demanding
Attention-seeking
Appear self-centred
Shallow emotions
Inappropriately sexually provocative
120
Q

Features of narcissistic PD

A 
Exaggerated sense of own importance
Self-centred
Intolerant of others
Grandiose ideas and plans
Craving for attention and admiration
121
Q

Cluster C PDs

A

Avoidant
Dependent
OCD

122
Q

Prevalence of OCD PD

123
Q

Features of avoidant PD

A

Fear of being judged negatively by others
Discomfort in groups or social settings
Socially withdrawn
Low self-esteem
Crave affection but overwhelming fear of rejection

124
Q

Features of dependent PD

A

Assumes position of passivity
Allow others to assume responsibility for most areas of their daily life
Lack self-confidence
Feel unable to function independently of another preson
Feels own needs are of secondary importance

125
Q

Features of OCD PD

A

Difficulties in expressing warm or tender emotions to others
Perfectionists
Lack clarity in seeing other perpectives or ways of doing things
Rigid attention to detail may prevent them from completing tasks
Some may be hoarders, scrupulous with money
May not be able to delegate tasks; workaholics

126
Q

ICD 10 schizotypal disorder characteristics

A

Occasional transient quasipsychotic episodes with intense illusions, hallucinations and delusion-like ideas usually occurring without external provocation

127
Q

Efficacy of Flupenthixol for PD

A

Some efficacy for self-harm behaviour

128
Q

Efficacy of antipsychotics for PD

A

Low dosage may be effective in schizotypal and BPD

129
Q

Efficacy of antidepressants for PD

A

Reduce aggressive, impulsive and angry behaviours in antisocial and VPD

130
Q

Efficacy of anticonvulsants and lithium on PD

A

Effective against affective dysregulation in BPD and aggressive outburts in Cluster B PDs

131
Q

NICE guidelines re pharmacotherapy for PDs?

A

Not recommended for PD, but for co-morbid illness such as depression or OCD

132
Q

Drug treatment for cognitive/perceptual symptoms of PD

A

Antipsychotics

133
Q

Drug treatment for affective dysregulation in PD

134
Q

Drug treatment for impulsive-behavioural dyscontrol in PDS?

A

SSRIs

Mood stabilisers

135
Q

Mood changes in Bipolar vs BPD

A

Bipolar: observable, spontaneous mood changes, last for days/weeks

BPD: not observable, change precipitated by internal/exernal events, last for hours

136
Q

What type of mood is common in bipolar but rare in BPD?

137
Q

Differences in impulsivity in bipolar vs BPD

A

Bipolar: episodic impulsivity

BPD: chronic impulsivity

138
Q

Suicide attempts in bipolar vs BPD

A

Bipolar: related to depressive episodes

BPD: recurrent suicidal gestures

139
Q

What did Richardson & Tracy (2015) highlight in PDs?

A

Six core illness-differentiating themes influencing patient perspectives on bipolar & BPD

140
Q

What were Richardson and Tracy (2015)’s findings re patient perspectives on bipolar vs BPD?

A 
Public information
Delivery of diagnosis
Illness causes
Illness management
Stigma and blame
Relationship with others
141
Q

What do patients find different re public information in bipolar vs BPD?

A

For bipolar greater public awareness, positive celeb exposure, more support groups

142
Q

What do patients find re delivery of diagnosis in bipolar vs BPD?

A

Bipolar perceived to be taken more seriously and given more time by staff than BPD

143
Q

What do patients find re illness causes in bipolar vs BPD?

A

Bipolar perceived to be more genetic and neurochemical than BPD

144
Q

What do patients find re illness management in bipolar vs BPD?

A

More medication-orientated in bipolar and better established protocols compared to BPD

145
Q

What do patients find re stigma & blame in bipolar vs BPD?

A

Greater stigma for BPD accompanied with staff hopelessness and self-blame

146
Q

What do patients find re relationships with others in bipolar vs BPD?

A

Diagnosis of bipolar accompanied with greater support from family and friends. Its infrequent nature makes it less troublesome and easier to conceal.
BPD associated with insidious destruction and sabotage of relationships, felt to be ever-present and cannot be concealed from relationships

147
Q

Where are sexual dysfunctions coded in ICD 10?

148
Q

What are sexual dysfunctions classified into?

A 
Sexual desire disorders
Sexual arousal disorders
Orgasmic disorders
Sexual pain disorders
Other
149
Q

What are sexual desire disorders?

A

Sexual aversion

Hypoactive sexual desire

150
Q

What are sexual arousal disorders?

A

Female sexual arousal disorder

Male erectile disorder

151
Q

What are orgasmic disorders?

A

Female and male orgasmic disorder

Premature ejaculation

152
Q

What are sexual pain disorders?

A

Dyspaeenia

Vaginismus

153
Q

What is included in ‘other’ in sexual dysfunctions?

A

General medical and substance misuse disorders

154
Q

What is the most common female sexual dysfunction?

A

Hypoactive sexual desire

155
Q

Which sexual dysfunction is most difficult to treat?

A

Hypoactive sexual desire

156
Q

What has been trialled for treatment for hypoactive sexual desire in both males and females?

A

Testosterone; modest effects due to side effects

157
Q

DSM-V specified paraphilic disorders

A 
Voyeurism
Exhibitionism
Frotteurism
Sexual masochism
Sexual sadism
Pedophilia
Fetishism
Transvestic disorders
158
Q

What is included in ‘other specified paraphilic disorders’ in DSM V?

A 
Zoophilia 
Scatalogia
Necrophilia
Coprophilia
Klismaphilia
Urophilia
159
Q

What is exhibitionism?

A

Deliberately exposing ones genitals

160
Q

What is frotteurism?

A

Deliberately rubbing against a non-consenting individual

161
Q

What is sexual masochism?

A

Choosing to undergo humiliation, bondage or suffering for sexual arousal

162
Q

What is sexual sadism?

A

Choosing to inflict humiliation, bondage or suffering to achieve sexual arousal

163
Q

What is fetishism?

A

Use of objects or focussing on non-genital body parts to achieve sexual arousal

164
Q

What is transvestic disorder?

A

Engaging in sexually arousing cross-dressing

165
Q

What is scatalogia?

A

Obscene phone calls

166
Q

What is coprophilia?

167
Q

What is Klismaphilia?

168
Q

What is Urophilia?

MRCPsych Part B - Al-Rashid Hospital (64 decks)

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