Adult Psychiatry 2.1 Flashcards
(168 cards)
1
Q
What types of ED are recognised in ICD 10?
A
Anorexia
Bulimia
EDNOS
2
Q
What does Binge eating disorder fall under in ICD 10?
A
EDNOS
3
Q
How many patients with bulimia have a hx of anorexia?
A
1/4 - 1/3
4
Q
Which criteria for anorexia has been eliminated in DSM V?
A
Amenorrhoea
5
Q
Diagnostic criterion for bulimia for DSM V?
A
Once-weekly frequency of binge eating and inappropriate compensatory behaviour
6
Q
Which types of patients with ED engage with treatment better and why?
A
Bulimia, due to feelings of loss of control
7
Q
Onset of anorexia?
A
Adolescence
8
Q
Onset of bulimia?
A
Young adults
9
Q
Class distribution of bulimia?
A
Even distribution
10
Q
Prevalence of anorexia in teenage girls
A
0.5-1%
11
Q
Prevalence of bulimia in 16-35?
A
1-2%
12
Q
Prevalence of anorexia in females per year
A
19/100,000
13
Q
Prevalence of bulimia in females per year
A
29/100,000
14
Q
Comorbid psychiatric disorders in patients with anorexia?
A
65% have depression
34% have social phobia
26% have OCD
15
Q
What personality traits are associated with bulimia?
A
Substance use in families
16
Q
What personality traits are associated with anorexia?
A
Obsessional and perfectionist in families
17
Q
MZ vs DZ rates of anorexia
A
55% MZ
5% DZ
18
Q
MZ vs DZ rates of bulimia
A
33% MZ
30% DZ
19
Q
Heritablility of ED?
A
Significant heritability for anorexia
Not for bulimia
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)
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
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.
23
Q
How many patients seeking treatment for binge eating disorder are obese?
A
5-10%
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
25
Treatment for binge eating disorder?
Self-help
Behavioural weight loss programmes
CBT/IPT
26
Physical sx of ED
```
Increased sensitivity to cold
GI sx - constipation, bloating
Dizziness and syncope
Amenorrhoea, low sexual appetite, infertility
Poor sleep with early morning wakening
```
27
Physical signs of ED
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
28
When does orange discolouration of skin occur in ED?
In hypercarotenaemia
29
What is Perimylolysis?
Erosion of inner surface of teeth
30
Endocrinel abnormalities in ED
```
Low LH, FSH and oestradiol
Low T3, T4, Normal TSH
Increase in plasma cortisol
Raised GH
Hypoglycaemia
Low leptim
```
31
Cardiovascular abnormalities in ED
ECG abnormalities; conduction defects, prolonged QT
| Myopathy and fatal cardiomypathy can be caused by ipecac (emetic substance) which contains emetine (an alkaloid)
32
GI signs of ED
Delayed gastric emptying
Decreased colonic motility secondary to laxative misuse
Acute gastric dilatation secondary to binge eating or excessive re-feeding
33
Haematological abnormalities in ED
Moderate normocytic normochomric anaemia
Mild leucopenia with relative lymphocytosis
Thrombocytopenia
34
Metabolic abnormalities in ED
Hypercholesterolaemia
Raised seum carotene
Low phosphate (refreeding)
Dehydration
35
Metabolic abnormalities due to vomiting
Metabolic alkalosis
| Hypokalaemia
36
Metabolic abnormalities due to laxativ misuse
Metabolic acidosis
Hyponatraemia
Hypokalaemia
37
Other abnormalities of ED
Osteopenia and osteoporosis; increased fracture risk
| Enlarged cerebral ventricles and external CSF spaces (pseudo-atrophy)
38
Effects of ED on preganncy
```
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
```
39
In which ED is there food evidence of antidepressants?
Bulimia
40
In which ED does cognitive analytic therapy (CAT) not work?
Bulimia
41
In which ED is there good evidence for CBT?
Bulimia
42
In which ED is there no evidence for family-based therapy for adolescence?
Bulimia
43
In which ED is there no evidence for interpersonal psychotherapy?
Anorexia
44
Most effective treatment for bulimia?
CBT
45
How long is CBT for bulimia?
20 individual sessions voer 5 months
46
Recovery rate for bulimia with CBT
33-50% make full recovery
47
How do antidepressants help in bulimia?
Rapid decline in frequency of binge eating and purging
| Improvement in moood
48
Problem with antidepressant therapy in bulimia?
Effect not sustained
49
Therapeutic goals for anorexia?
Engagement
Weight restoration
Psychological therapy - cognitive restructuring
If needed, use of compulsion
50
When does OP therapy for anorexia have best chance?
Illness present for <6 months
No bingeing or vomiting
Having parents who cooperate and are willing to participate in family therapy
51
Guidance re medications for anorexia?
Should never be used as primary treatment
52
What therapies should be considered for anorexia?
CBT/CAT
Interpersonal psychotherapy
Focal dynamic therapy
Family interventions focused on ED
53
What is helpful for adolescents with ED?
Family interventions that directly address the ED
54
First line treatment for bulimia
Self-help programmes and/or antidepressants
55
First line SSRI for bulimia
Fluoxetine 60mg OD
56
Therapy for buimia
Specifically adapted CBT; 16-20 sessions over 4-5 months
| or Interpersonal psychotherapy but can take 8-12 months for results
57
Which psychiatric disorders are most frequently treated by psychiatrists?
PD
58
Prevalence of PD?
5-13%
59
Most prevalent PD in psychiatric settings
BPD
60
In which group of psychiatric inpatients is prevalence of PD high?
Those with drug and alcohol misuse
| ED
61
Prevalence of PD in those with ED, alcohol or drug misuse
>70%
62
Most common PD in prison?
Dissocial
63
Prevalence of any PD in prison?
78% for male on remand
64% for male sentenced
50% for females
64
Prevalence of PD in prisons
53% of male remand
49% of sentenced
31% of female prisoners
65
Prevalence of antisocial PD in UK
0.6%
66
Male vs female prevalence of PD in UK
Males have 5x prevalence compared to women.
Males 1%
Females 0.2%
67
Prevalence of PD and geographical areas?
Higher rates in urban areas
68
Median prevalence rate per 1000 of paranoid PD
6
69
Median prevalence rate per 1000 of schizoid PD
4
70
Median prevalence rate per 1000 of schizotypal
6
71
Median prevalence rate per 1000 of antisocial
19
72
Median prevalence rate per 1000 of BPD
16
73
Median prevalence rate per 1000 of histrionic
20
74
Median prevalence rate per 1000 of narcissistic
2
75
Median prevalence rate per 1000 of anankastic
17
76
Median prevalence rate per 1000 of avoidant
7
77
Median prevalence rate per 1000 of dependent
7
78
Median prevalence rate per 1000 of passive aggressive
17
79
Prevalence in psychiatric OP sample per 1000 of paranoid PD
42
80
Prevalence in psychiatric OP sample per 1000 of schizoid
14
81
Prevalence in psychiatric OP sample per 1000 of schizotypal
6
82
Prevalence in psychiatric OP sample per 1000 of antisocial
36
83
Prevalence in psychiatric OP sample per 1000 of BPD
93
84
Prevalence in psychiatric OP sample per 1000 of histrionic
10
85
Prevalence in psychiatric OP sample per 1000 of narcissistic
24
86
Prevalence in psychiatric OP sample per 1000 of anakastic
87
87
Prevalence in psychiatric OP sample per 1000 of avoidant
147
88
Prevalence in psychiatric OP sample per 1000 of dependent
14
89
% prevalence of Cluster A PD in community
1.6%
90
% prevalence of cluster B PD in community
1.2%
91
% prevalence of cluster C PD in community
2.6%
92
% prevalence of any PD in community
4.4$
93
% prevalence of any PD in psych OP
46%
94
% prevalence of cluster A PD in psych OP
6%
95
% prevalence of cluster B PD in psych OP
13%
96
% prevalence of cluster C PD in psych OP
22%
97
Prevalence of BPD in general population
2%
98
Prevalence of BPD in Psych OP
10%
99
Prevalence of BPD in psych IP
15-20%
100
Female:male ratio of BPD?
3:1
101
Prevalence of BPD in patients with first-degree relative who has BPD?
5 times more common
102
What are the important longitudinal studies of BPD?
McLean
| CLPDS
103
What did McLean Study of Adult Development show re BPD?
Prevalence of five core BPD sx declines with rapidity; quasi-psychotic thought, self-mutilation, help-seeking suicide efforts, treatment regressions and countertransference problems
104
Most stable sx of BPD?
Depression
Anger
Emptiness/loneliness
105
What did 10 year follow-up of McLean study show re BPD?
Symptoms of chronic dysphoria, intense anger, nondelusional paranoia and impulsivity remained common after 10 years with other features abated
106
What did the Collaborative Longitudinal Personality Disorders Study show re BPD?
Least stable sx of BPD were abandonment fears & physically self-destructive acts
107
What do epidemiological studies show re sx of PD?
J-shaped relation between PD and age; initial decrease followed by an increase in some PD in older people
108
What was Seivewright & Tyrer's study into PD?
12 year follow-up where 178 out of 202 patients were reassessed for their personality status.
109
What did Seivewright & Tyrer's study show?
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
Remission rate of BPD according to McLean Study?
40% after 2 years
| 88% after 10 years
111
What is schizotypal PD classified as in ICD 10?
Schizophrenia?
112
Cluster A PDs?
Paranoid
Schizoid
Schizotypal (in DSM)
113
Features of Paranoid PD
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
Features of schizoid PD
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
Features of schizotypal PD
```
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
Cluster B PDs
Antisocial
BPD
Histrionic
Narcissistic
117
Features of antisocial PD
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
Features of BPD
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
Features of histrionic PD
```
Extreme/over-dramatic behaviour
Quick relationships but demanding
Attention-seeking
Appear self-centred
Shallow emotions
Inappropriately sexually provocative
```
120
Features of narcissistic PD
```
Exaggerated sense of own importance
Self-centred
Intolerant of others
Grandiose ideas and plans
Craving for attention and admiration
```
121
Cluster C PDs
Avoidant
Dependent
OCD
122
Prevalence of OCD PD
1-2%
123
Features of avoidant PD
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
Features of dependent PD
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
Features of OCD PD
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
ICD 10 schizotypal disorder characteristics
Occasional transient quasipsychotic episodes with intense illusions, hallucinations and delusion-like ideas usually occurring without external provocation
127
Efficacy of Flupenthixol for PD
Some efficacy for self-harm behaviour
128
Efficacy of antipsychotics for PD
Low dosage may be effective in schizotypal and BPD
129
Efficacy of antidepressants for PD
Reduce aggressive, impulsive and angry behaviours in antisocial and VPD
130
Efficacy of anticonvulsants and lithium on PD
Effective against affective dysregulation in BPD and aggressive outburts in Cluster B PDs
131
NICE guidelines re pharmacotherapy for PDs?
Not recommended for PD, but for co-morbid illness such as depression or OCD
132
Drug treatment for cognitive/perceptual symptoms of PD
Antipsychotics
133
Drug treatment for affective dysregulation in PD
SSRIs
134
Drug treatment for impulsive-behavioural dyscontrol in PDS?
SSRIs
| Mood stabilisers
135
Mood changes in Bipolar vs BPD
Bipolar: observable, spontaneous mood changes, last for days/weeks
BPD: not observable, change precipitated by internal/exernal events, last for hours
136
What type of mood is common in bipolar but rare in BPD?
Elated
137
Differences in impulsivity in bipolar vs BPD
Bipolar: episodic impulsivity
BPD: chronic impulsivity
138
Suicide attempts in bipolar vs BPD
Bipolar: related to depressive episodes
BPD: recurrent suicidal gestures
139
What did Richardson & Tracy (2015) highlight in PDs?
Six core illness-differentiating themes influencing patient perspectives on bipolar & BPD
140
What were Richardson and Tracy (2015)'s findings re patient perspectives on bipolar vs BPD?
```
Public information
Delivery of diagnosis
Illness causes
Illness management
Stigma and blame
Relationship with others
```
141
What do patients find different re public information in bipolar vs BPD?
For bipolar greater public awareness, positive celeb exposure, more support groups
142
What do patients find re delivery of diagnosis in bipolar vs BPD?
Bipolar perceived to be taken more seriously and given more time by staff than BPD
143
What do patients find re illness causes in bipolar vs BPD?
Bipolar perceived to be more genetic and neurochemical than BPD
144
What do patients find re illness management in bipolar vs BPD?
More medication-orientated in bipolar and better established protocols compared to BPD
145
What do patients find re stigma & blame in bipolar vs BPD?
Greater stigma for BPD accompanied with staff hopelessness and self-blame
146
What do patients find re relationships with others in bipolar vs BPD?
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
Where are sexual dysfunctions coded in ICD 10?
F50
148
What are sexual dysfunctions classified into?
```
Sexual desire disorders
Sexual arousal disorders
Orgasmic disorders
Sexual pain disorders
Other
```
149
What are sexual desire disorders?
Sexual aversion
| Hypoactive sexual desire
150
What are sexual arousal disorders?
Female sexual arousal disorder
| Male erectile disorder
151
What are orgasmic disorders?
Female and male orgasmic disorder
| Premature ejaculation
152
What are sexual pain disorders?
Dyspaeenia
| Vaginismus
153
What is included in 'other' in sexual dysfunctions?
General medical and substance misuse disorders
154
What is the most common female sexual dysfunction?
Hypoactive sexual desire
155
Which sexual dysfunction is most difficult to treat?
Hypoactive sexual desire
156
What has been trialled for treatment for hypoactive sexual desire in both males and females?
Testosterone; modest effects due to side effects
157
DSM-V specified paraphilic disorders
```
Voyeurism
Exhibitionism
Frotteurism
Sexual masochism
Sexual sadism
Pedophilia
Fetishism
Transvestic disorders
```
158
What is included in 'other specified paraphilic disorders' in DSM V?
```
Zoophilia
Scatalogia
Necrophilia
Coprophilia
Klismaphilia
Urophilia
```
159
What is exhibitionism?
Deliberately exposing ones genitals
160
What is frotteurism?
Deliberately rubbing against a non-consenting individual
161
What is sexual masochism?
Choosing to undergo humiliation, bondage or suffering for sexual arousal
162
What is sexual sadism?
Choosing to inflict humiliation, bondage or suffering to achieve sexual arousal
163
What is fetishism?
Use of objects or focussing on non-genital body parts to achieve sexual arousal
164
What is transvestic disorder?
Engaging in sexually arousing cross-dressing
165
What is scatalogia?
Obscene phone calls
166
What is coprophilia?
Faeces
167
What is Klismaphilia?
Enemas
168
What is Urophilia?
Urine
