Anxiety Disorders and Eating Disorders Flashcards
Sudden onset of intense fear
-Often occur with no trigger
Panic Attack
Is brief and only lasts minutes to an hour
Panic Attack
Items in room look foggy or unreal. Patient feels like they are in a foreign place despite being at home
-Hallmark of panic attack
Derealization
Classified as an “out of body experience.”
- Detached, looking at self from above
- Also a hallmark of panic attack
Depersonalization
Recurrent, unexpected panic attacks
- Not post-traumatic
- Not responsive to phobia
Panic Disorder
Attacks followed by 1 month or more of persistent concern or worry about panic attacks
Panic Disorder
Median age of onset for panic disorder is
24 years old
If you have a first degree relative with panic disorder, you are at
Increased risk
Chronic, persistent anxiety. Lasts longer than 6 months
Generalized Anxiety Disorder
Fear of a specific object or situation
-Leads to avoidance behavior
Specific Phobias
Specific phobia of social settings with an excessive fear of embarrassment
Social anxiety disorder
Fear of leaving a safe place for a public setting
-Fear of needing to flea with no help available
Agoraphobia
Is NOT fear of scrutiny and embarrassment
Agoraphobia
Imagining exposure to feared stimulus
-Relaxation
Systematic Desensitization
Recurrent, persistent thoughts, urges, or images
-Intrusive and unwanted
Obsessions
Patient attempts to ignore or suppress causes distress
Obsessions
Repetitive behaviors or mental acts
-Done to relieve obsessions
Compulsions
Commonly occurs with schizophrenia or schizoaffective disorder, bipolar disorder, and eating disorders
Obsessive Compulsive Disorder
What are two pharmacological treatments to obsessive compulsive disorder?
SSRIs and Clomipramine (TCA)
What are three forms of treatment for PTSD?
CBT, SSRIs, Prazosin
Alpha-1 blocker that reduces nightmares and improves sleep
-May cause orthostatic hypertension
Prazosin
Exposure to threatened death, injury, or sexual assault can cause
Acute Stress Disorder
Characterized by recurrent, intrusive memories and lasts less than one month
Acute stress disorder
Abnormal eating patterns that disrupt or psychosocial functioning
Eating Disorder
Excessive diet and exercise that leads to low body weight
-BMI of less than 18.5 kg/m^2
Anorexia Nervosa
Have an intense fear of gaining weight and increased mortality from malnutrition
Anorexia Nervosa
What are the endocrine effects of Anorexia Nervosa?
Decreased GnRH and decreased LH/FSH, and amenorrhea
The type of amenorrhea seen with anorexia Nervosa is
Functional hypothalamic amenorrhea
Anorexic patients have a inability to concentrate urine and have characteristic free water loss and accompanying
Hyponatremia
What is a major physiological sign of anorexia Nervosa?
Decreased creatinine and this decreased muscle mass
Anorexic patients have decreased bone density due to
Low estrogen and high cortisol
We often see bone marrow suppression, anemia, leukopenia, and thrombocytopenia with
Anorexia Nervosa
On physical exam, why will we see in a patient with anorexia Nervosa?
Bradycardia, hypotension, lanugo hair growth
The hallmark of re-feeding syndrome is
Hypophosphatemia
Most fatalities from re-feeding syndrome are
Cardiac
Have poor contractility and low stroke volume due to cardiac and respiratory failure from loss of ATP
Re-feeding syndrome
Binge eating followed by vomiting or the use of laxatives to compensate and avoid weight gain
Bulimia Nervosa
Occurs at least once a week for three months
Bulimia Nervosa
Contrasts with anorexia Nervosa in that these patients have normal weight
Bulimia Nervosa
What are three complications that wee see as a result of purging from bulimia Nervosa?
Contraction alkalosis, loss of K+, and low urinary chloride
A useful test to perform when we have a metabolic acidosis with an unknown cause
Urinary chloride
Urinary chloride is low (Less than 10-20) in
Vomiting
-Due to loss of Cl- in gastric secretions
A young woman with an unexplained metabolic alkalosis and low urinary chloride is likely to have
Bulimia Nervosa
Two other purging complications in bulimia Nervosa are
PArotid swelling and erosion of dental enamel
Scars on knuckles from induced-vomiting
Russel’s Sign
Compulsive overeating of excessively large amounts of food
Binge eating
Occurs at least once a week for three months
Binge eating disorder
Binge eating disorder often occurs with other disorders such as anxiety and depression. The first line of treatment is
Psychotherapy (CBT)
An ADHD stimulant used to treat Binge eating disorder
Lisdexamfetamine
A seizure medication used to treat binge eating disorder
Topiramate
Clinical trials of lisdexamfetamine and topiramate show increased abstinence from binge episodes. This leads to
Reduced weight
In anorexia Nervosa, we give inpatient treatment to individuals below
75-80% of ideal body weight
