Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PSYCHIATRY > Anorexia Nervosa > Flashcards

Anorexia Nervosa Flashcards

1
Q

They can restrict calorie intake. How else may they try to lose weight? - 3

Diagnostic Criteria:

1st:

  • What percentage of predicted weight have they lost?
  • Under what BMI?

2nd:

  • Their thoughts? - 1
  • Behaviour - 1

3rd:

  • Thoughts - 1
  • Endocrine changes in men and women
A 
Vomiting
Intense exercise
Laxative use 
-------------------------------
85%
<17.5 - 14 is severe

Fear of weight gain, or becoming fat, with persistent behaviour that interferes with weight gain

Feeling fat when thin
Amenorrhoea for 3 months, or low libido in men.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Other features:

Mental state:

  • Main symptom without food
  • Why is cognition impaired?
  • Sleep

Sensations:

  • What sensation are they sensitive to?
  • One more

CVD:
- Why do you get arrhythmias? What may it lead to?

Sexual - 2

GI - 1

Skin:

  • What happens to the skin?
  • You get lanugo. What is it?

Bone:

  • Lack of Vit D
  • Teeth

OBS - 3

A

Fatigue
Due to cerebral atrophy
Altered sleep

Cold sensitive
Dizzy

Arrhythmias due to hypokalaemia LEADING to heart failure.

Amenorrhoea
Reduced lipido

Constipation

Dry skin
Fine body hair all over

Osteoporosis
Dental caries - tooth decay

Low temperature, BP and HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors:

What sex is it more common in?

Co-morbid conditions? - 4

Personality traits? - 2

Social pressures? - 2

A

FH

4x commoner in women

Depression
Anxiety
OCD
Substance abuse

Low self-esteem
Perfectionism

TV watching
Image-aware work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Differentials diagnosis:

Psychiatric - 3

GI - 2

Endocrine - 2

A

Eating disorders
Depression
OCD

IBD
Coeliac

Thyrotoxicosis
Hypothalamic tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Investigations:

What screening tool is used?

What needs to be measured?

Bloods and why? - 4

A

SCOFF screening tool

TFT - hypothyroidism
FBC - low blood cells
LFT - mildly raised
Sex hormones reduced - effects of AN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Investigations:

ECG findings?

What scan should be done if amenorrheic?

A

Long QT intervals

DEXA scan - osteopenia and osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Investigations - Metabolic effects:

  • What causes hypokalaemia? - 2
  • Why do you get alkalosis?
  • Why do you get acidosis?
  • How do you get raised urea and creatinine?
  • What electrolytes should be measured?
A

Vomiting or laxatives

Vomiting
Laxatives

Dehydration

Magnesium
Phosphate
Calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Management:

How much weight gain do you aim for per wk?

What should be avoided as much as possible?

A

0.5kg

Admission unless severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Management - Biological:

What should be monitored regularly and why?

What antidepressant can be used if there is a co-morbid depression or OCD?

A

Physical health - weighing

Fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management - Psychological:

1st line

Who needs to be involved?

Enhanced CBT (CBT-E) can be used. What is the aim?

What type of therapy should be used for children?

A

Psychoeducation

Dietician - structured eating plan

To establish regular eating habits
Then to identify and address harmful ideas about body size and eating
As well as triggers and stressors

Family therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management - Social:

What can be done for families?

A

Self-help and support groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management - Inpatient care - Admission:

BMI needed for admission?

You must refeed them with dietician input. How do you start?

How much do you increase their caloric intake by and how often?

A

<14

Start on current intake

Increase by 200 calories every 2 days

0.5 - 1.0 kg/week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management - Inpatient care - Admission:

What may be needed if they are unable to eat orally?

When is the only time TPN should be used?

Why is 1 to 1 observation needed?

What must be used if they want to leave the ward?

A

NG tube

If there is GI dysfunction

To prevent micro exercise (e.g. fidgeting).
Monitoring during meals to ensure food is not hidden.

A wheelchair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Management - Inpatient care - Admission:

What electrolyte usually needs to be replaced?

What can be added to this as well just to make sure?

What can be used instead of laxatives for constipation as laxatives can be used for weight loss?

What is important to remember?

A

Potassium

Multivitamins

Stool softeners

Getting the weight back prevents short-term complications, but remember that this doesn’t;t fix the underlying problem.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management - Inpatient care - Admission:

Monitoring:

What is an emergency that should be looked out for?

How should their weight be monitored? - 4

What daily blood should be done?

What bedside test should also be done daily?

A

Re-feeding syndrome

Same scales
Same clothing
Jewellery removed
Ensure no fluid loading before hand

FBC, LFT, U&E, phosphate, calcium, magnesium, CK, TSH

ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management - Inpatient care - Admission:

What sections of the MHA can be used for compulsory Rx?

Below what BMI are they thought to lack capacity and need to be treated in their best interest?

What about when their weight increases again?

A

Section 2/3

<12.5

The legal framework needs to be reviewed and they may need to be sectioned.

17
Q

Re-feeding syndrome:

What can it happen after?

How long after re-feeding does it tend to happen?

What electrolyte drops?

What else happens leading to multiorgan problems?

A

Re-feeding for anorexia Rx
Malnutrition
GI disease or surgery

5 days

Phosphate + Fluid shifts

18
Q

Re-feeding syndrome:

S+S:

What does low phosphate levels lead to?:

  • muscles
  • heart
  • lungs
  • neurological

What 2 other electrolytes can also drop?

A

Rhabdomyolysis
Respiratory or CV failure, Low BP
Delirium, seizures and coma

Potassium and magnesium

19
Q

Re-feeding syndrome:

Monitoring required?

How can it be prevented?

A

Bloods - looking for drop-in phosphate, magnesium and potassium.

Gradual re-feeding and correction of electrolyte imbalances

https://www.youtube.com/watch?v=HlFr7in3_S8

20
Q

SCOFF screening tool:

What does each one start?

It is used to diagnose eating disorders

> 2

*One point for every “yes”; a score of ≥2 indicates a likely case of anorexia nervosa or bulimia

A

Sick - do you make yourself feel sick because you feel full?

Control - worry you have lost control over how much you eat?

One - have you lost a stone in the last 3 months

Fat - do you believe you’re fat when others say you are thin?

Food - does it dominate your life

21
Q

What score can be used to assess for malnutrition?

A

MUST SCORE:

BMI:

  • Clinical impression – thin, acceptable weight, overweight.
  • Obvious wasting (very thin) and obesity (very overweight) can also be noted.

Unplanned weight loss:

  • Clothes and/or jewellery have become loose fitting (weight loss).
  • History of decreased food intake, reduced appetite or swallowing problems over 3-6 months and underlying disease or psycho-social/physical disabilities likely to cause weight loss.

Acute disease effect:

  • Acutely ill AND no nutritional intake or likelihood of no intake for more than 5 days.
  • If the subject is currently affected by an acute patho-physiological or psychological condition, and there has been no nutritional intake or likelihood of no intake for more than 5 days, they are likely to be at nutritional risk.
  • Such patients include those who are critically ill, those who have swallowing difficulties (e.g. after stroke), or head injuries or are undergoing gastrointestinal surgery.

Determine overall risk of malnutrition:

On the basis of estimated BMI category, unplanned weight loss, and Acute Disease Effect, select the appropriate risk category.

PSYCHIATRY (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions