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

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

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7
Q

Anorexia nervosa

Biological factors

A
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8
Q

Anorexia nervosa

Psychological factors

A
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9
Q

Anorexia nervosa

Social factors

A
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10
Q

Anorexia nervosa

History taking questions

A
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11
Q

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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, Self-help, online support, day hospital support

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

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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

*

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
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
40
Q

Narcolepsy

Clinical features

A
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
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
47
Q

Nightmare disorder

S/S
Mx

A
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
51
Q

Circadian sleep-wake rhythm disorders

Investigations

A
52
Q

Circadian sleep-wake cycle disorder

Types
Management

A
53
Q

Sexual dysfunctions and orgasm disorders

Classification

A
54
Q

Paraphilic disorders
Gender dysphoria

Classification

A
55
Q

*

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