Anxiety Disorders Flashcards
% of EDs that are men / boys
15 to 20
BMI of bulaemia
normal / above normal
BMI of binge eating disorder
above normal
BMI of anorexia
low
what common belief do eating disorders have
individuals judge their self worth in terms of their shape / weight / eating / ability to control these features
EDs have highest rate of mortality of any mental illness. true or false?
TRUE - pre pandemic for sure but likely now
ED with the highest mortality rate
anorexia
why does anorexia have the highest mortality rate
physical decline & suicide
sex ratio of AN
1:10 F:M
age on onset for AN usually
16 to 17
diagnostic for AN
15% below expected or BMI under 17.5
behaviours of AN
self induced weight loss
avoidance ofcertain foods / resitriction
vomitting / purging / xs exercise / appetite suppresants / laxatives
thoughts of AN
body image distortion
dread of fatness
overvalued ideas
imposed low weight threshold
endocrine disorders of AN
HPA axis
amonorhoea
reduced libido / impotence
raised GH levels
altered TFTs
abnormal insulin secretion
delayed / arrested puberty
causes of EDs
genetics, personality, cultural enviroment, reaction to traumatic life event
physiological risk factors
lack of adaptive coping strategies
easily anxious / shy
personality traits: perfectionist / rigidity / impulsive
low self esteem
feelings of inadequacy / lack of control in life
depression, anxiety, anger, lonely
overlap of AN with other mental health disorders
depression - Sx of depression are Sx of starvation too
anxiety / OCD / social phobia - obsessions / compulsions related to food / exercise / weight
maintaining factors of AN
starvation –> difficulty concentrating / infelxible thinking / low mood / bloating makes ppl feel they lose control / guilt and denial
affected loved ones –> unhelpful, conflict, anger, carers can be lulled in false sense of security, intelligence masks it, splitting of family
how can you think of ED
like a food phobia
dental and renal consequences of ED
dental caries
renal calculi
blood issues of AN
anaemia, leucopaenia, thrombocytopaenia
neuro signs of AN
peripheral neuropathy, loss of brain volume
reproductive issues of AN
infertility, low birth weight infant
endocrine issues of AN
low K/Na/sugar/Ca/body temp
amenorrhoea, osteoporosis, high cortisol
russels sign?
callused skin over interpharangeal joints due to xs vomitting
hypercaratonaemia?
orange tint to skin like jaundice but spares sclera
heart and tummy issues of AN
low BP, porlonged QT, arrhytmias, cardiomyopathy
delayed gastric emptyingd
derm issues of AN
dry scal skin, brittle hair, lanugo hair
screening questionaire of AN
SCOFF
what is included in SCOFF Qs
do you make yourself sick when you feel full
*****
other features to look for in AN
overvalued ideas about shape / weight
body image disturbance
hormonal disturbance - no periods etc
emotionally labile
hide behaviours
Ix of AN
full psych history
SCOFF questionnaire to screen
current ED Sx - vomiting, laxatives, exercise, periods
bio/ psycho / social factors
collateral history from family - also to see fmaily dynamics
blood tests for AN
FBC - high HB in dehydration
ESR - organic cause
U&Es - urea/creaitnine/K/Pi/Mg - low
CK - raised in exercising
Amylase - raised = vomitting
glucose
LFTs - elevated
TFT
albumin
cholesterol - elevated
hypercortisolaemia, raised GH, low LH/FSH, low E/P
why would Na be low in AN
ppl drink lots and lots of water to gain weight for weigh ins
why check Mg/Pi
refeeding syndrome
Mx of AN
early referral to EDU
rest, food, warmth
CBT / family intervention
dietician gives nutritional education
?MHA assessment if needed / refusing –> contact seniors
what drug may be used in AN
olanzapine - will cause them to gain weight too
key difficulty in Mx of AN
how to introduce food whilst maintaining the relationship with patient
guidelines for Mx of acute physical deterioration of AN
marzipan guidelines
how to assess the physically unwell AN patient
marzipan guidelines
looks at BMI, vital signs, clinical signs, blood tests
inpatient may be necessary
reasons for inpatient admission for AN
rapid weight loss
severe electrolute imbalnace
marked chaneg in mental state
psychosis / suicide
failure of outpatient Tx
physiological complications - bradycardia, low BP
refeeding diet content & why
low fibre, phosphate rich diet (milk)
- reduce refeeding syndrome
process of refeeding syndrome
in starvation, main source from carbs –> fatty acids / amino acids so reduced insulin secretion
refeeding = insulin secretion resumes, so increased glycogen, fat, protein synthesis - uses up Mg/K
–> cardiac abnormalities
what should happen if the patient deteriorates
consents –> use MCA to check if they can consent
not consent –> MHA and can give food under this
bulaemia nervosa diagnostic criteria
preoccupation with eating
craving for food
binges
attempts to counyer the fattening effects of food by vomitting / laxatives
co-morbidities of BN
anxiety / mood disorder
cutting / overdose
Tx of BN
fluoxetine
CBT / family therapy
key features of how to talk to patient with ED
collaborative approach - agree a care plan with them
avoid conflict / anxiety
facilitate their motivation to change
compassion and understanding - EDs are lonely
support family
MDT approach
what is anxiety
fight or flight respons due to adrenal hypothalamocortical axis is overran in an unhelpful well
perception of threat / reaction is unnecessarily high
psychological sx of anxiety
feeling worried
poor concentration
irritable
depersonalised / derealised
difficulty falling asleep
physical sx of anxiety
fast heart rate / palpitations
chest discomfort
tremore
headache
restlessness
dry mouth
indigestion / farting
hyperventilating
dizziness
ED / increased urinary freq
define phobia
fear out of proportion to the situation
can’t be reasoned away
not rationalised
beyond voluntary control
avoidance of fear
epidemiology of phobias
lifetime prevalance 5-10%
sex distribution of phobia
F>M 2:1
age peak of phobias
presents age 5-9
signs of phobias
avoidance, fear, disability
aetiology of phobias
3/4 have 1st degree relative with same phobia
phobias develop through modelling or conditioning
what is agorophobia
a fear of being in situations where escape might be difficult or that help wouldn’t be avilable if things go wrong eg open/confined spaces
sex distribution of agorophobia
social phobia?
f>m 4:1
f>m 3:2
what is social phobia
marked fear of being the focus of attention, or fear of behaving in a way that will be embarrassing / humiliating
Mx for phobias
CBT with exposure therapy
meds used would be SSRI / venlafaxine, beta blockers
drugs of choice for social phobia
SSRI
what drug should be avoided in phobias
benzodiazepine
define panic disorder
intermittent intense anxiety NOT triggered by a specific stimulus
unpredictable
are panic attacks panic disorder?
NO - they have a specific stimulus so they are more a phobia
sx of panic disorder
the panic attack sx
fear of dying
hyperventiliating
sweating, dizziness
palpitations
chest discomfort
desire to flee
Mx for panic disorder
CBT / relaxation techniques
SSRIs
not benzos
what is GAD
generalised anxiety disorder
excessive and uncontrolled anxiety, NOT triggered by a specific stimulus
continuous (most days over 6 months)
sx of GAD
motor tension, restlessness, irritability, somatic Sx
comorbid depression / OCD / panic disorder
are all anxiety disorders more common in women
all except OCD, which is even
risk factors of GAD
history of trauma
low socioeconomic status
substance abuse
chronic illness
Ix and Mx for GAD
rating scales eg GAD-7
Mx
1 = educate and monitor
2 = CBT
3 = high intensitiy CBT +/- drugs
4 = speciialist intervention
meds for GAD
SSRIs, SNRI, pregabalin
define OCD
obsessions are recurrent, unwanted and intrusive thoughts/images/impulses in ones mind, despite attempts to resit
compulsions are repeated and seemingly purposeful rituals that are carried out
diagnostic for OCD
Sx present on most days for at least 2 successive weeks and be the source of distress or interference with activities
most common OCD types
checking compulsions 63%
washing 50%
fears of contamination 45%
obsessive doubts 42%
aetiology of OCD
FHx - 35% of 1st degree relative
tics 20%
anakastic personality
stress
basal ganglia defects
Mx of OCD
CBT - ERP
SSRIs - high dose or clomipramine (TCA)
prognosis of OCD
70% respond to Tx but can be chronic
better if mild sx / short prognosis
what is in the GAD 7
define PTSD
an event of exceptionally threatening or catastrophic nature likely to cause pervasive distress in anyone
3 key sx of PTSD
reliving trauma - flashbacks, recurrent nightmares
hyperarousal / vigilance
avoidance due to perceived fear of re-exposure
prevalence of PTSD
lifetime = 6.8%
aetiology of PTSD
10% of people who have experienced severe trauma
predisposing traits = neuroticism, FHx of psych, child abuse, poor early attachment, survivor guilt
mx of PTSD
psychological - CBT (trauma focused) or EMDR (eye movement desenistisation and reprocessing)
pharmacological - mirtazipine / SSRI / venlafaxine
MDMA - 80% cure rate at 12 weeks
prognosis of PTSD
majority recover
chronic cases can change personality
sx precipitated by anniversaries of trauma
