Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3a psychiatry > Behavioural disorders > Flashcards

Behavioural disorders Flashcards

1
Q

What are the causes of eating disorders?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the criteria of DSM5 for anorexia nervosa?

A
  1. restriction of energy intake relative to requirements leading to significantly low weight (in context to age, sex, physical health)
  2. intense fear of fatness/ gaining weight, even though underweight
  3. disturbance in way body weight / shape experienced, undue influence of body weight/ step/ self evaluation or denial of seriousness of current low body weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the associated signs of a patient with anorexia nervosa?

A 
fatigue
cognition reduced
dizziness
constipation
fullness after eating 
self conscious about eating in public
depressive or obsessive/ compulsive symptoms 
low self worth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List some of the red flags in a patient with anorexia nervosa?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the complications associated with anorexia nervosa?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some of signs of repeated vomiting?

A 
hypokalaemia
metabolic alkalosis
pitted teeth
parotid swelling
scarring of dorsum of hand "Russels sign"
oesophageal tears
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the SCOFF questionnaire?

A

used in prevention and screening of anorexia

  1. do you ever make yourself SICK because you feel too full?
  2. do you ever worry you’ve lost CONTROL over eating
  3. have you recently lost more than ONE stone in 3 months?
  4. do you believe you are FAT when others say you are thin?
  5. does FOOD dominate your life?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which blood tests would you carry out to diagnose anorexia and what would you expect to see?

A

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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How should anorexia nervosa be managed?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When should a patient with anorexia nervosa by hospitalised?

A

severe or rapid weight loss
suicide risk
physical complications due to starving

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the DSM5 criteria for bulimia nervosa?

A
  1. recurrent episodes of binge eating
  2. sense of lack of control when eating in episode
  3. recurrent inappropriate compensatory behaviour in order to prevent weight gain e.g. laxatives, self induced vomiting, excessive exercise
  4. lasts for >3 months
  5. self evaluation is unduly influenced by body shape and weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the complications of bulimia nervosa?

A 
amennorhoea 
hypokalaemia 
signs of excessive vomiting
GI problems - bloating, constipation, abdominal pain
heart problems - cardiomyopathy, oedema
fatigue and lethargy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is bulimia managed?

A

1st line = bulimia nervosa focussed guided self help

if ineffective = bulimia nervosa focussed CBT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define insomnia

A

persistent problems (>3 days/ week for 1 month) falling asleep, maintaining sleep or poor quality of sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the types of insomnia?

A 
primary = no identifiable underlying cause
secondary = when it is symptom of, or associated with other conditions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the causes of primary insomnia causes/types?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the causes of secondary insomnia?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the clinical features of insomnia?

A

> 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

19
Q

How is insomnia assessed?

A

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

20
Q

How is insomnia managed?

A

sleep hygiene advice

CBT ** - 1st line in chronic patients

medication: benzodiazepines and Z drugs (no more than 2-4 weeks), melatonin

21
Q

What is included in sleep hygiene advice?

A 
limit caffeine intake 
avoid naps in the day 
regular daily exercise 
wind down/ quiet activities before bed 
avoid lie ins
22
Q

Define “psychosexual dysfunction”

A

inability to become sexually aroused or achieve sexual satisfaction in the appropriate situations because of mental or emotional reasons

23
Q

What are the clinical features of psychosexual dysfunction?

A 
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

24
Q

How is psychosexual dysfunction managed?

A

Medication:
oral phosphodiesterase inhibitors (viagra)
low dose anti depressant

Psychological treatment:
CBT - facilitate communication
education
sex/ couple therapy

25
Q

Define “gender dysphoria”

A

feeling strongly that they are not the gender they physically appear to be and desire to be accepted as a member of the opposite sex

26
Q

What does “dialectical behavioural therapy” involve?

A

focuses on emotional regulation, interpersonal skills, problem solving, approach to self harm, mindfulness training

27
Q

List organic causes of weight loss

A 
diabetes mellitus
addison
malignancy 
crohns 
malabsorption
hyperthyroidism
28
Q

What are the immediate risks for someone presenting with anorexia?

A 
seizures
dehydration
collapse
ECG changes 
heart failure 
death
29
Q

What are the signs of severe starvation?

A

irritability
loss of muscle mass and fat
fatigue
dehydration

30
Q

What is the process of refeeding?

A

a process of reintroducing food after malnourishment or starvation

31
Q

How is refeeding carried out?

A

increase daily caloric intake slowly by 200/300 kcal daily every 3-5 days
aim to gain 1-2 lb a week
recheck UandE every 3 days

32
Q

what is refeeding syndrome?

A

serious and potentially fatal condition that can occur during refeeding caused by sudden shifts in electrolytes that help your body metabolise food

33
Q

How can someone with refeeding syndrome present?

A 
CV- cardiac failure, peripheral and pulmonary oedema
fatigue, weakness
confusion
hypertension 
seizures
coma
death 
rhabdomyolysis
34
Q

What is the electrolyte disturbance seen in refeeding syndrome?

A

hypophosphateaemia
hypokalaemia
hypomagnesia

35
Q

What are the differentials for medically unexplained symptoms?

A 
Munchausens "factitious disorder"
somatoform pain disorder
somatisation disorder
hypochondriacal disorder 
conversion disorder
malingering
36
Q

describe the features munchausens disorder?

A

intentionally fabricate/ falsify physical and mental health signs in order to gain medical attention and treatment

37
Q

Describe the features of somatoform pain disorder?

A

complaints of persistent severe and distressing pain which is not explained by organic pathology

depression is often associated

38
Q

How is somatoform pain disorder managed?

A
  1. treat comorbid depression
  2. CBT
  3. pain clinic
39
Q

describe somatisation disorder?

A

repeated presentation for >2 years of medically unexplained symptoms affecting multiple organs and vague
refuse to accept -ve tests and reassurance

40
Q

Describe hypochondriacal disorder?

A

persistent belief that normally bodily functions/minor symptoms are serious illness e.g. cancer
fearful and preoccupied

41
Q

Describe conversion/ dissociative disorder?

A

physical (usually neurological e.g. weakness, sensory loss) symptoms occur in absence of pathology and clear relationship with psychological stressor (stressful event , emotional conflict)

42
Q

Describe malingering

A

fraudulent symptoms or stimulations with the intention of gain e.g. financial

43
Q

How are medically unexplained symptoms managed?

A

CBT

3a psychiatry (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions