Behavioural disorders (F5) Flashcards

1
Q

Eating disorders

Classification

A
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2
Q

Anorexia nervosa

Epidemiology
Co-morbidities

A
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3
Q

Anorexia nervosa

Clinical features

A
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4
Q

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Anorexia nervosa

Main physical features
S/S
Ix
Cx

A

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

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5
Q

Anorexia nervosa

Course and prognosis

A
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6
Q

*

Anorexia nervosa

DSM-5 classification

A

Rest In Peace Dull Underweight Lady
RIPDUL

Restrict energy intake causing 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

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7
Q

Anorexia nervosa

Biological factors

A

MZ 55%
Familial illness - 12X risk FDR

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8
Q

Anorexia nervosa

Psychological factors

A
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9
Q

Anorexia nervosa

Social factors

A

Precipitating
- Puberty, life event, comorbid illness, weight loss

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10
Q

Anorexia nervosa

History taking questions

A

Eating pattern: Restriction, Binging, Purging, Exercise
Attitude: Weight, Body image, Disorder, Formulation (3Ps)
Risk: Medical, Suicide, BMI (<13.5 for admission)

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11
Q

*

Anorexia nervosa

D/dx

A

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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12
Q

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Anorexia nervosa

Management

A

Admit if BMI <14 or complicated

Nutritional rehab: Supervised meal, stop exercise, nutritionist
Psychotherapy, Psychoeducation: MAUDSLEY Family therapy, MANTRA therapy, CBT-E
Support: Self-help, online support, day hospital support

Lifestyle: Regular weighing, food diary

Medication: Olanzapine (Anti-histamine S/E) +/- Chlorpromazine, Antidepressant

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13
Q

Nutritional rehabilitation for anorexia nervosa

A
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14
Q

Anorexia nervosa

Refeeding syndrome S/S, Pathogenesis
Mx

A

Due to high insulin surge&raquo_space; cell reuptake&raquo_space; HypoMg, PO4, K

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15
Q

Anorexia nervosa

General Psychotherapy

A
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16
Q

Anorexia nervosa

Family therapy

A
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17
Q

Anorexia nervosa

Social support

A
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18
Q

Anorexia nervosa

Medical therapy

A
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19
Q

Bulimia nervosa

Epidemiology
S/S

A

Binging + Purging/ Fasting/ Excessive exercise
+ Physical cx of vomiting and stimulant laxative
+ Associated depression

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20
Q

Bulimia nervosa

Clinical course

A
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21
Q

*

Bulimia nervosa

DSM-5 criteria

A

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

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22
Q

Bulimia nervosa

Causes

A
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23
Q

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Bulimia nervosa

Management

A

CBT- E specific for BN
Psychosocial intervention: Cognitive analytic therapy, MI, family therapy
Drugs: SSRI (esp. fluoxetine)

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24
Q

Sleep disorders

Define sleep
Regulation of sleep-wakefulnessS

A
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25
Q

*

Sleep cycles and EEG patterns

A

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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26
Q

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REM vs NREM sleep

A
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27
Q

Sleep disorder

DSM-5 classification

A
28
Q

*

Sleep disorder

Investigations

A

Sleep diary
Actigraphy
Polysomnography
Multiple Sleep Latency Test (Nap test during day) for narcolepsy - MSLT
Maintenance of wakefulness test (staying awake) - MWT

29
Q

*

Insomnia

Definition (important)
Classification

A

Acute = lasting less than 3 months with identifiable stressor
Chronic = At least 30 minute delay in falling asleep/ awake/ early wakening; occur at least 3 times per week for at least 3 months

30
Q

Etiology of primary insomnia

A
31
Q

*

Insomnia

Clinical feature

A
32
Q

*

Insomnia

DSM-5 criteria

A

Dissatisfaction with quality or quanitity with difficulty in:
Initiating, Maintaining, Early morning wakening
At least 3 nights/ week, at least 3 months
Despite adequate opportunities for sleeping
Not due to another sleep-wake disorder
Not due to substance, any co-existing mental or medical disorder

33
Q

*

Insomnia

D/dx

A

Normal: Short sleepers, Inadequate opportunities for sleep
Situational insomnia: life event
Circadian rhythm sleep-wake disorder
Restless leg syndrome
OSA
Narcolepsy +/- cataplexy: Sleep paralysis, sleep hallucinations, excessive daytime sleepiness
Parasomnia: Intermittent waking, difficulty resuming sleep

34
Q

*

Insomnia

Investigations

A
35
Q

*

Insomnia

Management

A

CBT-I
Drugs: Z-drugs, Ramelteon, Low dose Doxepin (TCA)
Others: melatonin, promethazine
Alternatives: Mindfulness practice, hypnosis, TCM

36
Q

Daytime sleepiness

Definition
Causes

A
37
Q

*

Daytime sleepiness

Assessment

A
38
Q

Idiopathic hypersomnia

S/S
Dx
Mx

A
39
Q

Narcolepsy

Definition
Etiologies

A

Sleep invades wakefulness: Hypnagogic hallucination, Cataplexy, Sleep paralysis
Wakefulness invades sleep: Fragmented sleep
Orexin deficiency
HLA- DQB1- 0602
Posterior hypothalamic/ Midbrain lesion

40
Q

Narcolepsy

Clinical features

A

4 core:
- Daytime sleepiness
- Hypnagogic hallucination
- Cataplexy
- Sleep Paralysis

41
Q

Narcolepsy

Diagnosis

A
42
Q

*

Narcolepsy

Cause
S/S
Ix
Management

A

Sleep wake control disorder: sleep into waking hours, wakefulness into sleep
Cause: OREXIN deficiency, HLA-DQB1-0602, posterior hypothalamic or midbrain lesions
S/S: Daytime sleepiness, Cataplexy (type 1) with transient muscle weakness under 2 minutes, Hypnagogic hallucinations (vivid frightening experiences), Sleep paralysis (between REM and wakefulness), Fragmented sleep
Ix:
Polysomnography: early REM entry, spontaneous waking, light NREM sleep
MSLT: At least one immediate sleep onset REM sleep out of 4 naps
Low CSF Orexin-A
Mx: Sleep hygiene + MODAFINIL + SSRI/SNRI + SODIUM OXYBATE

43
Q

*

Compare REM and NREM Parasomnia

A

Early sleep = NREM and later sleep = REM

NREM - Sleep walking, Sleep/Night Terror, Sleep related eating disorders
- First half of night
- Seconds to minutes
- Begin in early childhood, resolve by teenage
- Open eyes
- No recall

REM – Nightmare disorder, Sleep paralysis, REM-Sleep behaviour disorder
- Latter half of night
- Lasting seconds
- Older male
- Closed eyes
- Reasonable dream recall

44
Q

Somnambulism

S/S
Mx

A
45
Q

Sleep-related eating disorder, confusional arousal, night terrors

Define

A
46
Q

Sleep paralysis

S/S
Mx

A

Sleep paralysis = REM disorder

47
Q

Nightmare disorder

S/S
Mx

A

Nightmare disorder = REM disorder

48
Q

REM sleep behavior disorder

S/S
Mx

A
49
Q

Breathing related sleep disorders

S/S
Mxs

A
50
Q

Restless leg syndrome and periodic limb movement disorder

Definition
S/S
Mx

A

Periodic limb movement of sleep (PLMS) = at least 5 limb movements lasting 0.5s-10s with 5s-90s interval: characteristic limb movements, quite common in elderly

PLM disorder (PLMD) = Sleep disturbance ONLY due to PLM

Restless leg syndrome = Unpleasant Urge to move legs during inactivity/ at evening

Mx:
* Avoid caffeine
* Gabapentin, Pregabalin, Levodopa, Pramipexole, Opioid, Clonazepam

51
Q

Circadian sleep-wake rhythm disorders

Investigations

A
52
Q

Circadian sleep-wake cycle disorder

Types
Management

A
  1. Delayed = Night Owl = Melatonin + early bedtime
  2. Advanced = Too sleepy at night = Bright light therapy
  3. Non-24h = Blind people with day-night reversal = Timed Melatonin
  4. Irregular = Demented people with short sleeps/ wakefulness = Melatonin + Structured daytime activity
  5. Jet lag = Timed light exposure + Melatonin
  6. Shift work = Sleep hygiene, hypnotics, melatonin, CBT-I + Caffeine, Scheduled naps
53
Q

Sexual dysfunctions and orgasm disorders

Classification

A
54
Q

Paraphilic disorders
Gender dysphoria

Classification

A
55
Q

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Sexual dysfunction

Common dysfunctions in M/F

A
56
Q

*

Sexual response cycle

4 phases

A
57
Q

*

Causes of sexual dysfunction

A
58
Q

Phase 1 (desire) sexual dysfunctions

A
59
Q

Phase 2 (Excitement) Sexual dysfunctions

A
60
Q

Phase 3 (orgasm) sexual dysfunctions

A
61
Q

Pain-related sexual dysfunctions

A
62
Q

*

Sexual dysfunctions

Investigations
Management

A

Sexual dysfunction clinic: Advice, reassurance, Relationship counselling, Sex therapy
Organic cause: Urology clinic, screen for vascular/ neurological/ hormonal/ genital problems

63
Q

*

Paraphilia

Classification
Definition

A
64
Q

Paraphilia

Etiologies

A
65
Q

*

Paraphilia

Management

A
66
Q

Gender dysphoria

Definition
Causes

A
67
Q

Gender dysphoria

Management

A