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Psychiatry > Anxiety And Eating Disorders > Flashcards

Anxiety And Eating Disorders Flashcards

1
Q

Biological aetiology of anorexia nervosa

A

MZ twin concordance higher than DZ twins
Neuro / endocrine changes (disturbance of hypothalamic function, increased serotonin levels, brain atrophy)
Changes in brain normalise when weight is restored though regular balanced diet

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2
Q

Psychological aetiology of anorexia nervosa

A

Perfectionism
Low self esteem
Sexual development
History of abuse
Personality disorder

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3
Q

Social aetiology of anorexia nervosa

A

Parental overprotection
Family enmeshment

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4
Q

Biological aetiology of bulimia nervosa

A

Changes in serotonin levels
MZ and DZ twin concordance rates broadly similar

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5
Q

Psychological aetiology of bulimia nervosa

A

Low self esteem
History of abuse / self harm
Impulsive personality traits
Personality disorder
High value placed on food and eating behaviour
History of being overweight

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6
Q

Social aetiology of bulimia nervosa

A

Exposure to diet culture
Family culture of categorising food as good or bad

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7
Q

Hair and skin effects of anorexia

A

Can become dry and brittle
Hair can thin and drop out
Lanugo hair may grow over the skin on face and body aiming to aid warmth

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8
Q

Psychiatric effects of anorexia

A

Difficult to make decisions
Poor concentration
Obsessions - difficulty being spontaneous
Interests become centred around food
Irritated mood
Flattened affect

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9
Q

Heart effects of anorexia

A

BP drops
Pulse declines
Increased risk of arrhythmia
Risk of heart failure

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10
Q

Reproductive system effects of anorexia

A

Lack of sex drive
Lack of function
Amenorrhoea in females
Low testosterone in males
Function usually returns with weight restoration

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11
Q

CNS effects of bulimia nervosa

A

Poor concentration
Irritability
Seizures

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12
Q

Oral effects of bulimia nervosa

A

Tooth decay / erosion
Hoarse voice
Bleeding from the mouth or throat
Swollen parotid glands

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13
Q

Heart effects of bulimia nervosa

A

K+ is crucial to heart function
Hyopkalaemia can cause arrhythmias and can be fatal
This is caused by the use of diuretics, D&V and laxative use

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14
Q

Hand effects of bulimia nervosa

A

Russell sign - callosities, scarring and abrasion on the dorsal surface of index and long fingers as a result of self induced vomiting

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15
Q

Define generalised anxiety disorder

A

Anxiety to the point that it severely impairs a patients day to day functioning
Thoughts of being apprehensive / nervous as well as the awareness of a physical reaction to anxiety
Often leads to behavioural changes to try and avoid the threat

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16
Q

Organic causes of anxiety

A

Any condition causing dyspnoea or increased sympathetic outflow
Drug intoxication
Withdrawal symptoms
Medication side effects

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17
Q

Epidemiology of anxiety

A

3-4% prevalence
2:1 F:M
Commonly seen with co-morbid depression or phobic disorders

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18
Q

Biological aetiology of anxiety

A

Genetic links (overlaps with depression)
Amygdala hyperactivation
Evidence on neurotransmitter imbalances is conflicting

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19
Q

Psychological aetiology of anxiety

A

Negative cognitive biases
Personality factors (neuroticism)

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20
Q

Social aetiology of anxiety

A

Increased negative / traumatic childhood events

21
Q

Clinical features of anxiety

A

Not episodic
Not associated with any specific external threat
Characterised by excessive worry about normal events

22
Q

What is paroxysmal anxiety

A

Abrupt onset episodes
Termed panic disorder at its most severe

23
Q

Biological Symptoms of anxiety

A

Autonomic overactivity:
- heart racing
- sweating
- hyperventilation
- restlessness
- fidgeting
- tension headaches
- sleep disturbances

24
Q

Psychological symptoms of anxiety

A

Persistent worrisome thoughts
Apprehension about future
Poor concentration

25
Q

Psychological management of anxiety

A

CBT is first line
Identify and challenge cognitive biases such as catastrophic thinking, and recognise learnt behaviours based upon such biases
Relaxation therapy can also be used

26
Q

Biological management of anxiety

A

SSRIs
- 1st line for moderate severe symptoms only
- 2nd line is an alternate SSRI, or SNRI
- drugs generally take longer to work and need to be titration to higher doses to be effective in anxiety disorders

Benzodiazepines
- potentiate GABA - effective in rapidly reducing anxiety symptoms
- rapid tolerance and dependence syndrome so avoided where possible

Non selective beta blockers
- can be used prn to dampen symptoms of autonomic arousal

27
Q

Social management of anxiety

A

Ensure social support structures are in place
Reduce alcohol / illicit drug use

28
Q

Prognosis of generalised anxiety disorder

A

Chronic, fluctuating course

29
Q

Define phobia

A

An intense, irrational fear of an activity or situation

30
Q

Epidemiology of phobias

A

Prevalence of all phobias is around 8%

31
Q

Aetiology of phobias

A

Specific phobias can often be traced back to childhood exposures
- genetic predisposition for some objects to evoke fear and behavioural conditioning can re-enforce this fear
Agoraphobia and social phobias are poorly understood

All involve some level of amygdala dysregulation

32
Q

Clinical features of phobias

A

Intense symptoms of anxiety related to a discernible object / situation
Can manifest as panic attacks at their most severe

33
Q

Features of agoraphobia

A

Fear of public places (crowds, queues, public transport)
Can become housebound
Classically a fear of a lack of a clear exit
More common in females

34
Q

Features of social phobia

A

Fear of social situations in which they may be exposed to scrutiny eg fear of eating in public
Can progress to almost all social situations
- patients describe fear of going mad or vomiting in public
More commonly seen in males (most comfortable when alone)
Linked to alcohol abuse

35
Q

Describe management of phobias

A

1st line is psychotherapy (CBT)
- involved graded exposure (desensitisation)
SSRIs can be useful for agoraphobia / social phobia

Benzodiazepines are occasionally used for rarely occurring situations eg flying

36
Q

Prognosis of phobias

A

Specific phobias held from childhood are unlikely to remit
Social phobias are usually chronic but may have periods of remission

37
Q

Describe the characteristics of the obsessions in OCD

A
  • involuntary thoughts, images or impulses that are recurrent, intrusive and unpleasant
  • enter the mind against conscious resistance and are recognised as being the produce of their own mind
  • patients generally have insight into the fact that the thoughts are irrational
38
Q

Describe the characteristics of the compulsions in OCD

A

Repetitive mental operations eg counting, praying or physical acts eg checking, hand washing
- patient feels compelled to perform this act in response to their own obsessions or irrationally defined rules
The acts are performed to reduce anxiety through the belief that they will stop a dreaded event from occurring
Resisting a compulsion can lead to increased anxiety

39
Q

Describe the aetiology and epidemiology of OCD

A

Epi: prevalence of 2%, equal M:F
Aeti: genetic predisposition to develop symptoms
Symptoms common in childhood
Mean time from onset of symptoms to diagnosis is 9yrs

40
Q

Which conditions frequently co-exist with OCD

A

Schizophrenia, Tourette’s or depression

41
Q

Describe the pathophysiology of OCD

A
  1. Damage to the cortico-striato-thalamo-cortical circuits following neurological injury eg stroke can invoke symptoms of OCD
  2. Neurosurgical interruption of these circuits has also been shown to induce response in OCD patients resistant to all other treatments
42
Q

What is the diagnostic criteria for OCD

A

Obsessions or compulsions present for at least 2 successive weeks
Source of distress and / or interfere with the patients functioning
They are acknowledged as coming from the patients own mind
Obsessions are unpleasantly repetitive
At least one thought / act is resisted unsuccessfully
A compulsive act is not in itself pleasurable

43
Q

Psychological management of OCD

A

CBT is 1st line, involving exposure response prevention
Aims to break the cycle of behaviour by exposing the patient to their obsession but preventing the compulsive response

44
Q

Biological management of OCD

A

SSRIs considered for moderate - severe symptoms

45
Q

Social management of OCD

A

Optimise social support structures, screen for substance abuse

46
Q

Prognosis of OCD

A

Mainly chronic fluctuating course, with around 15% showing a progressive decline in functioning

47
Q

Aetiology / epidemiology of adjustment disorder

A

Most common in children and adolescents but can happen in any age
Around 1% prevalence equal M:F
More common in those with mental health history and low social support

48
Q

Diagnostic criteria of adjustment disorder

A
  • maladaptive reaction to psychosocial stressors, causing an impairment of function
  • must develop within 3 months of a stressful life event
  • symptoms do not generally last >6 months
49
Q

What is the difference between acute stress disorder and PTSD

A

Acute stress disorder is an acute stress reaction that occurs in the 4 weeks after a traumatic event as opposed to PTSD which is diagnosed after 4 weeks

Psychiatry (6 decks)

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