behavioral psychological Flashcards
Over-consumption of palatable food may affect brain’s reward system by 3
Stimulates opioid release
Decreases biologic stress response
Simulates addiction like changes in the brain
BED criteria for diagnosis Recurrent episodes of BE marked by:2 Associated with 3 or more:5 Associated feeling of \_\_\_\_ Frequency Absence of
- LACK of control
- Eating LARGE amounts in discrete period
- Eating more RAPIDLY than normal
- Eating until uncomfortably FULL
- Eating large amounts WHEN NOT HUNGRY
- HIDING eating behavior because of embarassment
- FEELING disgusted,depressed,guilty after episode
Associated marked distress
Minimum 1/week x 3 mos
No purging
Severity of BED
Mild 1-3
Moderate 4-7
Severe 8-13
Extreme >14
Meds for BED - 5
Lisdexamfetamine
topiramate, zonisamide
anti-depressants
phentermine
Loss of Control ED kids <12 Similar to BED Recurrent episodes marked by :2 Associated with >3 : 5 Frequency Absence of
- Sense of LACK of control
- Food SEEKING in absence of hunger or after satiation WHEN FULL
- Eating IN RESPONSE TO NEGATIVE affect
- NEGATIVE AFFECT FOLLOWING eating (shame/guilt)
- Feeling of NUMBNESS while eating
- Eating MORE (or perception of) than others
- SECRECY about episode
episodes occur on average 2x/month for 3 months
No compensatory behaviors
Bulimia medical complications 4
Metabolic alkalosis ( from volume contraction)/OR metabolic acidosis from loss of bowel fluid/ other lyte imbalances
Arrythmia
Gastric and esophageal ruptures
Melanosis coli from laxative dependance
Best meds for bulemia 2
fluoxetine
sertraline
Anorexia diagnostic criteria 3
- Restriction of energy intake leading to BMI<18.5
- Intense fear of gaining weight
- Distorted body image
Anorexia severity specifiers
Mild/moderate/severe/extreme
BMI >17/16/15/<15
Anorexia sequelae 9
Anemia Low K, Mg Bradycardia,hypotension Amenorrhea Osteoporosis Increased ventricle:brain ratio Abnormal LFT Impaired renal function Death
Obesity hypoventilation syndrome criteria 3
Obesity BMI>30,
Daytime hypercapnia CO2>45
Sleep disordered breathing
Sleep deprivation associated with changes in 4 hormones
Decreased leptin
Increased ghrelin, Orexin, Neuropeptide Y
Sleep-related Eating Disorder - 3 associations
80% have other sleep related conditions
Precipitated by stress in 16% of cases
Associated with sedative/anti-psychotics
Sleep-related Eating Disorder Diagnostic criteria - 1 core ( obvious) and other possible
Recurrent episodes of INVOLUNTARY eating/drinking during sleep period
Presence of 1 or more:
Adverse health consequences
Insomnia due to sleep disruption from eating
Morning anorexia
Eating odd foods/non-foods
Sleep-related injury/Dangerous behaviors while obtaining food
Sleep related Eating disorder treatments 6(4 drugs)
-Remove offending drug (Zolpidem, anti-psychotics,TCA)
-CPAP in OSA,treat other associated disorders ie RLS
Topiramate
SSRI
pramipexole
Trazodone
Borderline personality disorder - diagnosis requires impulsivity in 2/5 areas including
Spending Sex Substance abuse Reckless driving Binge eating
Outcome of weight loss surgery in patients with eating disorders
BED-improves LOC-ED/grazing - poor weight loss Night Eating Syndrome - no effect Food addiction - may remit Grazing - this worsens
What are the 3 methods of communication used in motivational interviewing?
Collaborative
Goal oriented
Language of change
4 RULEs of MI
RESIST the righting reflex : patient needs to fix the problem, not you.
UNDERSTAND the patient’s motivation: patient should give you arguments for change
LISTEN to your patient - listen reflectively, summarize
EMPOWER your patient : patient makes own decisions about life
Key processes in MI
EFEP
Engagement- be curious, patient-centred, non-judgemental
Focusing - focus on a single topic, small changes support success to build motivation for other challenges
Evoking - evoke change talk!
Planning - explore barriers to change, facilitate change, assess confidence
MI skills OARS*NB
OPEN QUESTIONS What have you tried in the past?
AFFIRMATIONS So, low carb diets have worked in the past?
REFLECTIONS You have tried to lose weight many times
SUMMARIES Indicate you’re about to summarize, then offer series of reflections, note ambivalence. Let’s try low carb and schedule your weight loss appt
Principles of MI
EMPATHY
DEVELOP DISCREPANCY
ROLL WITH RESISTANCE
SUPPORT SELF-EFFICACY
What is the importance ruler/Readiness scale? How is this question helpful?
How ready are you on a scale of 1/10 to make a change? Why not a higher number? Why not a lower number?
This question elicits change and avoids sustain talk
Definition: Cognitive therapy
The identification and modification of dysfunctional thoughts to improve affect.
