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Reasoning in mental health 5 > Class 1 > Flashcards

Class 1 Flashcards

1
Q

ARFID criteria

A

Avoidance or restriction of food intake characterized by eating a quantity or variety of foods insufficient to respond to energy or nutritional needs leading to one or more of the following:
–Loss of weight (or inability to gain expected weight);
–Significant nutritional deficits;
–Dependence upon nutritional supplements
–Marked interference with psychosocial functioning.

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2
Q

ARFID m=W?

A

a little more common than anorexia in males

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3
Q

Sub-types ARFID

A

Fear of negative consequences (orthorexia)
Loss of interest
Sensory Sensitivity

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4
Q

RESTRICTER comorbid

A

anx, dep (50%), compulsivity, preference for order. Overregulation.

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5
Q

BINGER/PURGER comorbid

A

substance abuse (50%), impulsivity, parasuicidality, lability, anxiety, dep. Dysregulation

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6
Q

Perinatal Factors

A

•Sex hormone exposure in utero: brain makes serotonin out of tryptophan which it gets only
with eating so if you diet you lose serotonin. even 2-3 weeks women are more sensitive to that due to estrogen. ring finger longer than index = more estrogen = more at risk of ED
•Obstetric complications
•Combined obstetric complications and childhood stress
•Season of birth: developing a more serotonergic environment
•In utero exposure to viral infection

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7
Q

Risk factors Development

A
  • No necessity of adversity
  • Inconsistent association with anxious or unstable attachments
  • Association with childhood trauma and adult victimization experiences (in binge-purge variants)
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8
Q

Risk factors Family

A
  • No ED-prone family
  • No special meal-related problems
  • No excessive parental body-image concerns
  • No pre-requisite family dysfunction
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9
Q

Are there genetic factors involved?

A

50% explained by genetic factors alone

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10
Q

The genetic architecture of AN implicates

A

psychiatric disorders, metabolic factors and anthropometric traits

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11
Q

Is there a link between AN and immune function?

A

Significant relationships between previous celiac, Crohn’s, ulcerative colitis, psoriasis, type-1 diabetes and later EDs.
Significant relationships between previous AN, BN, AED or OED and Any Autoimmune disease.

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12
Q

Transactional model

A

Genes (•Brain function and psychiatric disorders, Metabolism, set point, Immune function) X Environments (Perinatal, Developmental, Current)
genetic factors need to be turned on by the enviro

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13
Q

DNA Methylation

A

if methyl binds to promoter = no gene expression.

Nutrients contribute to methylation. If you don’t eat = mess your methylation and the way your DNA produces proteins

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14
Q

The ED Trajectory

A

genetic susceptibility + obstetric/ perinatal insults + developmental stress + life stress + dieting

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15
Q

Hospitalise or not?

A
  • Hospitalization not associated with favorable outcome

* no difference really between short or long hospit on long term outcome

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16
Q

Main Practice Principles

A
  • Not coercive
  • Ensure safety
  • Encourage re-evaluation of beliefs and values
  • Encourage experimentation with behaviors that put mistaken beliefs to the test: Did you pat the dog today?
  • Go for personal engagement (« Is this really in your best interest? »)
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17
Q

Risk Evaluation: The Big 7

A 
Precipitous or extreme weight loss
Hypokalemia- Hyponatremia –Hypoglycemia
Pulse (< 50 bpm); EKG; Orthostatic hypotension (BP decreases by ≥20 (≥10 if adolescent) /Pulse increases by ≥20)
Elevated liver enzymes
Hypothermia ( ≤ 35.0°)
Weakness; Fainting
Total fasting; Refusing to drink
18
Q

Examens de Laboratoire for all pts

A 
•Formule sanguine complète avec différentiel
•Biochimie
–Électrolytes
–Fonctions rénales
•Fonctions thyroïdiennes
•ECG
19
Q

Examens de Laboratoire

Dénutrition marquée ou patient très symptomatique

A 
•Biochimie
–Calcium, magnésium, phosphores
–Fonctions hépatiques
–Amylase
–B12, folate
•Ostéodensitométrie (Aménorrhée > 6 mois)
20
Q

Evidence-supported ED treatments- Adolescent AN or BN

A
  • FBT

- CBT

21
Q

Evidence-supported ED treatments-Adult BN or BED

A
  • CBT
  • IPT
  • DBT
22
Q

Evidence-supported ED treatments-Adult AN

A
  • CBT
  • IPT
  • Specialist Supportive Clinical Management
23
Q

x% can be helped short term but y% need something more

A

50%

24
Q

Can we predict who will have a good prognosis?

A

No

25
Q

Stepped Care

A
  • Admission
  • Day Hospital
  • Day Program
  • Intensive Outpatient (individual, group, family/couple, meds)
  • Psychoeducation (and other low-intensity interventions)
  • Self Help, Web-based, Community Support
26
Q

CBT, Guiding Principles:

A

1An ED is a Phobia
Is it a weight problem …or a fear-of gaining-weight problem ?
2An ED is an OCD
Is this a sensible weight-control strategy…or a compulsion?
3. Dietary Restraint Promotes Compulsive or Binge-like Eating

27
Q

Restraint has 2 components:

A

1) Physiological: hold your breath but eventually you lose control
2) Psychological

28
Q

BASIC CONCEPT-psychoeducation

A

Rapid weight gain/loss is not real weight gain/loss

29
Q

TOOLS

A

food diary

30
Q

FBT

A
  • Agnostic view – no causal assumptions
  • Rivals more-intensive treatments
  • Externalize the illness: you are someone who developed an ED
  • Therapist is an expert, but not authoritarian
  • Provides carers with skills to support the person with the ED
  • Family Meals
  • Emphasize to the family that this is a crisis
31
Q

FBT Phases

A

Assist relatives in supporting, guiding, setting limits during mealtime situations
Gradually transfer control of eating to the affected family member
Work concomitant issues and problems

32
Q

DBT

A

Mindfulness
Emotion Regulation
Distress Tolerance
Interpersonal Effectiveness

33
Q

DBT to treat dysregulation in

A
  • Emotional
  • Behavioural
  • Interpersonal
  • Cognitive
  • Self
34
Q

Self-Determination Theory (SDT), Key concepts:

A

–Autonomous motivation

–Controlled motivation

35
Q

Trans-Theoretical Model of Change, Key concepts:

A

–Preparedness for Change

–Stages of Change

36
Q

Points in Common: Trans-Theoretical Model of Change and Self-Determination Theory (SDT)

A

Non-coerciveness; Aim for intrinsic motivation

37
Q

Therapist Stance

A

Acknowledge the individual’s frame of reference; curb “pathologizing” assumptions
Validate patients’ experience
Avoid pressuring
Inform realistic choices, educate
Encourage experimentation
Respect choices; weigh “pros” and “cons”
Evaluate goals, find shared goals
•Help people become engaged in a way they can personally endorse
•Be collaborative (on the same side)
•Be persuasive, not argumentative or coercive
•Mobilize ambivalence
•Make it safe to stay connected
•Communicate beliefs that foster self acceptance

38
Q

The more therapists supported patient autonomy….

A
  • The more patients’ motivation for change increased

* The better were outcomes on measures of eating symptoms

39
Q

Challenges

A

Arbitrariness (poor rationale)
Unduly Coercive (too controlling)
Unexpected
Inconsistent

40
Q

Do anorexics recover?

A

Evidence of incremental response

–…after 30 years: 64%

Reasoning in mental health 5 (11 decks)

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