Behavioural disorders (F5) Flashcards
Eating disorders
Classification
Anorexia nervosa
Epidemiology
Co-morbidities
Anorexia nervosa
Clinical features
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Anorexia nervosa
Main physical features
S/S
Ix
Cx
Symptoms:
Cold intolerance
Amenorrhoea, Loss of libido
Poor sleep
Constipation
Dizziness
Signs:
Emaciation
Dry skin
Lanugo hair
Salivary gland swelling
Cold peripheries, hypotension, bradycardia, arrhythmia
Peripheral edema
Proximal muscle weakness
Ix:
Low FSH/LH/ Estradiol
Low thyroid hormones
High Cortisol, GH
Low glucose
Cx:
Pancytopenia: anemia, leucopenia, thrombocytopenia
Long QT, arrhythmia
Delayed gastric emptying and gut motility
Hypercholesterolemia
HypoK, HypoPO4, Dehydration
Anorexia nervosa
Course and prognosis
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Anorexia nervosa
DSM-5 classification
RIPDUL
Restrict energy intake, significantly low body weight
Intense fear of gaining weight or becoming fat
Persistent behaviour to stop weight gain
Disturbed experience of body weight
Undue influence of weight or shape on self-evaluation
Lack of recognition of seriousness of low body weight
Restricting = dieting, fasting, excessive exercise
Binge-eating/ purging
Anorexia nervosa
Biological factors
Anorexia nervosa
Psychological factors
Anorexia nervosa
Social factors
Anorexia nervosa
History taking questions
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Anorexia nervosa
D/dx
Bulimia
Avoidant/ restrictive food intake disorder
Atypical eating disorder (neither AN or BN)
OCD (about food)
Social phobia (about eating in public)
Body dysmorphic disorder (defect in body not weight)
Genuine medical diseases
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Anorexia nervosa
Management
Admit if BMI <14 or complicated
Nutritional rehab: Supervised meal, stop exercise, nutritionist
Psychotherapy, Psychoeducation: MAUDSLEY Family therapy, MANTRA therapy, Self-help, online support, day hospital support
Medication: Olanzapine (Anti-histamine S/E) +/- Chlorpromazine, Antidepressant
Nutritional rehabilitation for anorexia nervosa
Anorexia nervosa
Refeeding syndrome S/S, Pathogenesis
Mx
Due to high insulin surge»_space; cell reuptake»_space; HypoMg, PO4, K
Anorexia nervosa
General Psychotherapy
Anorexia nervosa
Family therapy
Anorexia nervosa
Social support
Anorexia nervosa
Medical therapy
Bulimia nervosa
Epidemiology
S/S
Binging + Purging/ Fasting/ Excessive exercise
+ Physical cx of vomiting and stimulant laxative
+ Associated depression
Bulimia nervosa
Clinical course
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Bulimia nervosa
DSM-5 criteria
BICBUN
Binge- Innapropriate compensation- Both 1/w 3 months - Undue influence - Not AN
Binging: large amount of food, lack of control over eating
Inappropriate compensation to prevent weight gain: vomiting, laxatives, diuretics, fasting, excessive exercise
Both Binging and behaviour at least once a week for 3 months
Unduly influence/ self-evaluation based on body weight or shape
Not during AN
Bulimia nervosa
Causes
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Bulimia nervosa
Management
CBT- E specific for BN
Psychosocial intervention: Cognitive analytic therapy, MI, family therapy
Drugs: SSRI (esp. fluoxetine)
Sleep disorders
Define sleep
Regulation of sleep-wakefulnessS
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Sleep cycles and EEG patterns
Sleep cycles
1 = 5% = Theta waves
2 = 45% = Sleep spindles/ K complex
3&4 = 25% = Delta waves
REM sleep = 25% = low amp, high frequency, Saw tooth waves
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REM vs NREM sleep