Behavioural disorders Flashcards
What are the causes of eating disorders?
genetics
personality - anxious, obsessive/compulsive, depressive, low self esteem, perfectionist
biological- altered brain serotonin function to dysregulate appetite, mood and control of impulse
childhood environment - sexual/ physical/ emotional abuse, overprotective environment, troubled relationships
culture- media, image aware work (ballet, model), previous bullying
What are the criteria of DSM5 for anorexia nervosa?
- restriction of energy intake relative to requirements leading to significantly low weight (in context to age, sex, physical health)
- intense fear of fatness/ gaining weight, even though underweight
- disturbance in way body weight / shape experienced, undue influence of body weight/ step/ self evaluation or denial of seriousness of current low body weight
What are the associated signs of a patient with anorexia nervosa?
fatigue cognition reduced dizziness constipation fullness after eating self conscious about eating in public depressive or obsessive/ compulsive symptoms low self worth
List some of the red flags in a patient with anorexia nervosa?
BMI <13
weight loss >1kg/week
observations - temp <34.5, BP <80/50, pulse <40
muscles - unable to get up without using arms
ECG - long QT, flat T wave
What are the complications associated with anorexia nervosa?
oral - dental carries
CV - hypotension, cardiomyopathy, bradycardia, ECG changes (prolonged QT, flat T wave)
GI- prolonged GI transit (delayed gastric emptying), constipation
Endocrine - amenorrhoea, delay in puberty, osteoporosis
Reproductive - infertility, low birth weight of infant
Dermatological - dry scaly skin, brittle hair, hair los
Haematological - anaemia, leucopaenia, thrombocytopenia
What are some of signs of repeated vomiting?
hypokalaemia metabolic alkalosis pitted teeth parotid swelling scarring of dorsum of hand "Russels sign" oesophageal tears
Describe the SCOFF questionnaire?
used in prevention and screening of anorexia
- do you ever make yourself SICK because you feel too full?
- do you ever worry you’ve lost CONTROL over eating
- have you recently lost more than ONE stone in 3 months?
- do you believe you are FAT when others say you are thin?
- does FOOD dominate your life?
Which blood tests would you carry out to diagnose anorexia and what would you expect to see?
FBC : anaemia, leukopenia, thrombocytopenia
UandEs: raised urea and creatinine, hyponatraemia, hypokalaemia, metabolic alkalosis / acidosis (if laxative abuse)
Glucose: hypoglycaemia
cholesterol: elevated
endocrine: reduced LH, FSH oestrogen, progesterone, raised cortisol and GH
TFT: low T3/T4
How should anorexia nervosa be managed?
Psychological:
1st line for adolescents: family interventions and therapy
1st line for adults: CBT anorexia nervosa focussed
+ motivational counselling, interpersonal psychotherapy, Maudsley anorexia nervosa treatment
Pharmacological:
fluoxetine
When should a patient with anorexia nervosa by hospitalised?
severe or rapid weight loss
suicide risk
physical complications due to starving
what is the DSM5 criteria for bulimia nervosa?
- recurrent episodes of binge eating
- sense of lack of control when eating in episode
- recurrent inappropriate compensatory behaviour in order to prevent weight gain e.g. laxatives, self induced vomiting, excessive exercise
- lasts for >3 months
- self evaluation is unduly influenced by body shape and weight
What are the complications of bulimia nervosa?
amennorhoea hypokalaemia signs of excessive vomiting GI problems - bloating, constipation, abdominal pain heart problems - cardiomyopathy, oedema fatigue and lethargy
How is bulimia managed?
1st line = bulimia nervosa focussed guided self help
if ineffective = bulimia nervosa focussed CBT
Define insomnia
persistent problems (>3 days/ week for 1 month) falling asleep, maintaining sleep or poor quality of sleep
What are the types of insomnia?
primary = no identifiable underlying cause secondary = when it is symptom of, or associated with other conditions
What are the causes of primary insomnia causes/types?
psychophysiological insomnia - tension anxiety and concern of sleep
paradoxal insomnia - patient complains of little/ no sleep but no evidence of disturbance
adjustment sleep disorder - related to stress, conflict or environmental change
inadequate sleep hygiene- disruption of sleep wake cycle due to lifestyle e.g. coffee, late nights
idiopathic insomnia- life long inability to sleep
behavioural insomnia of childhood
what are the causes of secondary insomnia?
stress
psychiatry comorbity e.g. depression, bipolar, GAD
medication e.g. alcohol, caffeine, chronic benzo use, corticosteroids, NSAIDs, anti depressants
medical comorbidity e.g. parkinsons, pain, incontinence, heart failure, COPD
What are the clinical features of insomnia?
> 3 days/ week for 1 month …
problems with falling asleep, maintaining sleep and poor quality
patient preoccupied and excessively concerned with sleep problems
social/ occupational functioning affected
How is insomnia assessed?
sleep history - daily routine, description of sleep, daytime activities
history
third party history - breathing problems, motor activity, frequency of occurrence, mood changes
methods of further assessment - sleep diary, video recording, actigraphy
How is insomnia managed?
sleep hygiene advice
CBT ** - 1st line in chronic patients
medication: benzodiazepines and Z drugs (no more than 2-4 weeks), melatonin
What is included in sleep hygiene advice?
limit caffeine intake avoid naps in the day regular daily exercise wind down/ quiet activities before bed avoid lie ins
Define “psychosexual dysfunction”
inability to become sexually aroused or achieve sexual satisfaction in the appropriate situations because of mental or emotional reasons
What are the clinical features of psychosexual dysfunction?
symptoms for men: erectile failure ejaculation failure not able to become aroused when stimulated not able to achieve orgasm inhibited sexual desire
symptoms for women:
vaginismus
dyspareunia
How is psychosexual dysfunction managed?
Medication:
oral phosphodiesterase inhibitors (viagra)
low dose anti depressant
Psychological treatment:
CBT - facilitate communication
education
sex/ couple therapy
