Conditions Flashcards
Psychosis
an individual is experiencing a reality different to everyone else
Schizophrenia
Schizophrenia - disorder characterised by psychotic episodes and negative symptoms
- paranoid (most common) - dominated by positive symptoms (hallucinations & delusions)
- hebephrenic - thought disorganisation predominates
- catatonic - rare form characterised by one or more catatonic symptoms
- simple - rare form where negative symptoms develop without psychotic symptoms
Hallucinations
1) hallucinations
- perception of an object in the absence of an external stimulus
- 5 modalities - visual, auditory, gustatory, olfactory & tactile
- auditory is the most common in psychosis (2nd and 3rd: 3rd most likely for schizophrenia)
- check for organic pathology, eg. olfactory - frontal lobe pathology, visual - delirium
Delusions
2) delusions
- fixed, firmly held belief that is (usually) false, that cannot be reasoned away, that is held despite evidence to the contrary and is out of keeping with a person’s sociocultural norms
- different content - persecutory, grandiose, reference, erotomanic, hypochondriacal
Formal thought disorder
3) formal thought disorder
- a problem of speech which means that each sentence does not follow on from the next
Fragmentation of boundaries of the self
4) fragmentation of the boundaries of the self
- individual can no longer distinguish himself and the world
- thought broadcast - feelings are thoughts are heard out loud by others
- passivity phenomena - actions, feelings or emotions being controlled by an external force
- thought insertion - feelings that thoughts are being inserted
Negative symptoms
- avolition (decreased motivation) - reduced ability (or inability) to initiate and persist in goal-directed behaviour
- asocial behaviour - loss of drive for any social engagements
- anhedonia - lack of pleasure in activities that were previously enjoyable to the patient
- alogia (poverty of speech) - a quantitative and qualitative decrease in speech
- affected blunted - diminished/absent capacity to express feelings
- attention (cognitive deficits) - may experience problems with attention, language, memory and executive function
Schizophrenia investigations
Blood tests - FBC, TFTs, glucose/HbA1c, serum calcium, U&Es, LFTs, cholesterol, vitamin B12 & folate
Urine drug test
ECG
CT scan - rule out space-occupying lesions
EEG - rule out temporal lobe epilepsy
ICD-10 criteria for schizophrenia
ICD-10 criteria for schizophrenia:
- group A
- thought echo/insertion/withdrawal/broadcast
- delusions of control, influence or passivity phenomenon
- running commentary auditory hallucinations
- bizzare persistent delusions
- group B
- hallucinations in other modalities that are persistent
- thought disorganisation
- catatonic symptoms
- negative symptoms
- One clear symptoms from group A or two or more from group B for at least 1 month or more (DON’T DIAGNOSE in presence of organic brain disease)
Psychosis general management
First presentation of psychosis - early intervention in psychosis team: provide interventions targeted at reducing the duration of untreated psychosis
Psychosis biological management
- antipsychotics: typical and atypical
- atypical are first line
- depot formulations should be considered if patient prefers/problem with non-compliance
- clozapine is used for treatment-resistant schizophrenia (failure to respond to two other antipsychotics)
- adjuvants
- benzodiazepines can provide short-term relief of behavioural disturbance
- antidepressants and lithium can be used to augment antipsychotics
- ECT
- pts who are resistant to pharmacological agents
- effective for catatonic schizophrenia
Psychosis psychological treatment
- CBT - strongly recommended & reduces residual symptoms
- family intervention
- art therapy - alleviation of negative symptoms
- social skills training - behavioural approach to help patients improve interpersonal, self-care and coping skills needed in everyday life
Psychosis social management
- support groups
- peer groups - delivered by a peer support worker who has recovered from psychosis/schizophrenia & remains stable
- supported employment programmes
Depression
An affective mood disorder characterised by a persistent low mood, loss of pleasure and/or lack of energy accompanied by emotional, cognitive and biological symptoms
Depression core symptoms
- anhedonia - lack of interest in things
- low mood - present for at least 2 weeks
- anergia - lack of energy
Depression cognitive symptoms
- lack of concentration
- negative thoughts
- excessive guilt
- suicidal ideation
Depression biological symptoms
- diurnal variation in mood
- early morning wakening
- loss of libido
- psychomotor retardation - slow speech & slow movement
- weight loss & loss of appetite
Depression psychotic symptoms
- hallucinations - 2nd person auditory hallucinations
- delusions - hypochondriacal, guilt, nihilistic or persecutory in nature
Depression ix
- diagnostic questionnaires
- blood tests - FBC, TFTs, U&Es, LFTs, calcium levels, glucose
- imaging - MRI/CT scan
Depression staging
- mild depression = 2 core symptoms + 2 other symptoms
- moderate depression = 2 core symptoms + 3-4 other symptoms
- severe depression = 3 core symptoms + >3 other symptoms
- severe depression with psychosis = 3 core symptoms + >3 other symptoms + psychosis
Depression biological management
Antidepressants (not recommended as first-line for mild depression)
Adjuvants
ECT
Depression psychological management
Psychotherapies - CBT, IPT, behavioural activation, counselling, psychodynamic therapy
Self-help programmes - works through a self-help manual
Physical activity
Depression social management
Social support groups
Bipolar
Chronic episodic mood disorder, characterised by at least one episode of mania and a further episode of mania or depression
Bipolar aetiology
- genetics - strong FHx
- neurochemical - increased dopamine, increased serotonin
- endocrine - increased cortisol, increased aldosterone, increased thyroid
- adverse life events
- post-partum period
- loss of a loved one
Bipolar symptoms
- symptoms of mania or depression
- mania symptoms
- irritability
- disinhibited
- impaired insight
- grandiose delusions
- flight of ideas
- sleep decreased
- pressured speech
- elevated mood
Bipolar ix
- blood tests - FBC, TFTs, U&Es, LFTs, glucose, calcium
- urine drug test - illicit drugs
- CT head
Bipolar diagnosis
- requires at least two episodes in which a person’s mood and activity levels are significantly disturbed
- one of which must be mania/hypomania
Bipolar mx
Biological - mood stabilisers, benzodiazepines, antipsychotics, ECT (severe uncontrolled mania)
Psychological - psychoeducation, CBT
Social - social support groups, self-help groups, encourage calming activities
Patients who present with an acute episode should be followed-up once a week initially & then 2-4 weekly for the first few months
GAD
A syndrome of ongoing, uncontrollable, widespread worry about many events or thoughts that the patient recognises as excessive and inappropriate
- must be present on most days for 6 months
GAD aetiology
- biological
- genetics - concordance rate greater for monozygotic twins than dizygotic twins, 5-fold in GAD in first degree relative of patients of GAD
- neurophysiology - dysfunction of ANS, exaggerated responses in the amygdala and hippocampus
- environmental
- stressful life events, history of child abuse, problems with relationships, personal illness, employment/finances
- substance dependence/exposure to organic solvents
GAD risk factors
- predisposing
- genetics
- childhood upbringing
- personality type & demands for high achievement
- being divorced
- living alone/as a single parents
- precipitating
- stressful life events
- domestic violence
- unemployment
- relationship problems
- personal illness eg. chronic medical issues
- stressful life events
- maintaining
- continuing stressful events
- marital status
- living alone
GAD symptoms
- worry
- autonomic hyperactivity
- tension in muscles/tremor
- concentration difficulty/chronic aches
- headache/hyperventilation
- energy loss
- restlessness
- startled easily/sleep disturbance
GAD diagnosis
- period of at least 6 months with prominent tension, worry and feelings of apprehension about everyday events and problems
- at least four of the anxiety symptoms with at least one symptoms of autonomic arousal
- palpitations
- sweating
- shaking/tremor
- dry mouth
GAD mx
- biological
- first-line drug treatment of choice is an SSRI which has anxiolytic
- sertraline
- if this does not help, SNRI can be given
- if both of those cannot help → pregabalin
- medication should be continued for at least a year
- benzodiazepines should not be offered except as short-term measures
- first-line drug treatment of choice is an SSRI which has anxiolytic
- psychological
- psychoeducation groups
- CBT
- applied relaxation
- social
- self-help methods
- support groups
- exercise
Panic disorder
Characterised by recurrent, episodic, severe panic attacks which are unpredictable & not restricted to any particular situation or circumstance
Panic disorder aetiology
- biological
- one of the most heritable anxiety disorders
- post synaptic hypersensitivity to serotonin and adrenaline
- fear or worry stimulates the SNS → increased cardiac output which can lead to further anxiety
- cognitive
- misinterpretation of somatic symptoms
- environmental
- life stressors
Panic disorder risk factors
- family history
- major life events
- age (20-30)
- recent trauma
- females
- other mental disorders
- white ethnicity
- asthma
- cigarette smoking
- medication
Panic disorder symptoms
- palpitations
- abdominal distress
- numbness
- nausea
- intense fear of death
- choking feeling
- sweating
- shortness of breath
Panic disorder diagnosis
- recurrent panic attacks that are not consistently associated with a specific situation or object & often occur spontaneously → not associated with marked exertion/with exposure to dangerous or life-threatening situations
- all of the following:
- discrete episode of intense fear or discomfort
- starts abruptly
- reaches a crescendo within a few minutes and lasts at least some minutes
- at least one symptom of autonomic arousal
- other symptoms of anxiety
Panic disorder mx
- SSRIs are first line, TCA can be given if not suitable
- CBT
- Self-help methods: support groups and encouraging exercise
- Stepped care approach
Phobias
- phobia: an intense, irrational fear of an object, situation, place or person that is recognised as excessive or unreasonable
- agoraphobia: fear of public spaces or fear of entering a public space from which immediate escape would be difficult in the event of a panic attack
- social phobia: fear of social situations which may lead to humiliation, criticism or embarrassment
- specific phobia: a fear restricted to a specific object/situation
Phobias aetiology
- agoraphobia: maintained by avoidance which prevents deconditioning and sets up a vicious cycle of anxiety
- social phobia: uncertain aetiology
- specific phobia: conditioning event in early life, possibly a role for learned behaviour
Phobias risk factors
- aversive experiences
- stress and negative life events
- other anxiety disorders
- mood disorders
- substance misuse disorders
- family history
Phobias symptoms
- biological - tachycardia is the usual autonomic response, syncope from a vasovagal response
- psychological - unpleasant anticipatory anxiety, inability to relax, urge to avoid the feared situation & fear of dying
Agoraphobia
Marked & consistently manifest fear in, or avoidance of, at least two of the following:
1) crowds
2) public spaces
3) travelling alone
4) travelling away from home
Symptoms of anxiety in the feared situation with at least two symptoms present together (& at least one symptoms of autonomic arousal)
Significant emotion distress due to the avoidance/anxiety symptoms
Recognised as excessive or unreasonable
Symptoms restricted to feared situation
Social phobia
Marked fear of being the focus of attention, or fear of acting in a way that will be embarrassing or humiliating
At least two symptoms of anxiety in the feared situation & one of the following:
1) blushing
2) fear of vomiting
3) urgency/fear of micturition/defecation
Significant emotion distress due to the avoidance/anxiety symptoms
Recognised as excessive or unreasonable
Symptoms restricted to feared situation
Specific phobia
Marked fear of a specific object or situation that is not agoraphobia or social phobia
Symptoms of anxiety in the feared situation
Significant emotion distress due to the avoidance/anxiety symptoms
Recognised as excessive or unreasonable
Symptoms restricted to feared situation
Agoraphobia mx
CBT - behavioural component includes graduated exposure and desensitisation
Graduated exposure - walking increased distances from home day by day can be used
SSRIs
Social phobia mx
CBT - specifically designed for social phobia
Graduated exposure to feared situations is included both within treatment sessions and as homework
SSRIs, SNRIs
If no response, a MAOI can be used
Psychodynamic psychotherapy for those who decline CBT or medication
Specific phobia mx
Exposure either using self-help methods or more formally through CBT
Benzodiazepines may be used as anxiolytics for short term eg. patients needs an urgent CT scan & they are claustrophobic
OCD
- obsessive-compulsive disorder: characterised by recurrent obsessional thoughts/compulsive acts
- obsessions: unwanted intrusive thoughts, images or urges that repeatedly enter the individual’s mind
- distressing for the individual who attempts to resist
- compulsions: repetitive, stereotyped behaviours/mental acts that a person feels driven into performing
OCD aetiology
- biological
- decreased serotonin and abnormalities of the frontal cortex and basal ganglia
- genetic contribution
- childhood group A beta-haemolytic streptococcal infection (PANDAS)
- psychoanalysis
- filling the mind with obsessional thoughts → prevent undesirable ideas from entering consciousness
- behavioural
- compulsive behaviour is learned and maintained by operant conditioning
OCD risk factors
- early adulthood
- relatives with OCD
- developmental factors - neglect, abuse, bullying and social isolation may have a role
OCD symptoms
- failure to resist obsession/compulsion
- originate from patient’s mind
- repetitive and distressing
- carrying out the obsessive thought is not in itself pleasurable
OCD diagnosis
- obsessions or compulsion present on most days for a period of at least 2 weeks
- obsessions or compulsions share a number of features of which all must be present
- failure to resist
- originate from own mind
- repetitive and distressing
- carrying out the obsessive thought is not in itself pleasurable
- obsessions or compulsions cause distress or interfere with the subject’s social or individual functioning, usually by wasting time
OCD mx
- CBT
- ERP (exposure and response prevention) - patients are repeatedly exposed to the situation which causes them anxiety → after initial anxiety on exposure, the levels of anxiety gradually decrease
- pharmacological therapy
- SSRIs - fluoxetine, fluvoxamine, paroxetine, sertraline or citalopram
- clomipramine is an alternative drug therapy
- general
- psychoeducation techniques
- distracting techniques
- self-help books
- risk should be identified and managed
PTSD
- Post-traumatic stress disorder - an intense, prolonged, delayed reaction following exposure to an exceptionally traumatic event
- Abnormal bereavement - delayed onset, is more intense and prolonged (> 6 months)
- Acute stress reaction - abnormal reaction to sudden stressful events
- Adjustment disorder - significant distress (greater than expected), accompanied by an impairment in social functioning
PTSD aetiology
- Exceptionally stressful event in which the individual was involved directly or as a witness
- Pre-existing vulnerability
- Cognitive theories → failure to process emotionally charged events causes memories to persist in an unprocessed form which can intrude into conscious awareness
PTSD risk factors
- exposure to a major traumatic event
- professions at risk - armed forces, police, fire services, journalists, doctors
- groups at risk - refugees, asylum seekers
- pre-trauma
- previous trauma
- history of mental illness
- females
- low socio-economic background
- childhood abuse
- peri-trauma
- severity of trauma
- perceived threat to life
- adverse emotional reaction during/immediately after event
- post-trauma
- concurrent life stressors
- absence of social support
PTSD symptoms
- reliving the situation - flashbacks, vivid memories, nightmares, distress when exposed to similar circumstances as the stressor
- avoidance - avoiding reminders of the trauma
- hyperarousal - irritability or outbursts, difficulty with concentration, difficulty with sleep
- emotional numbing - negative thoughts about oneself, difficulty experiencing emotions
PTSD diagnosis
- exposure to stressful event or situation of extremely threatening or catastrophic nature
- persistent remembering of the stressful situation
- actual or preferred avoidance of similar situations resembling or associated with the stressor
- either:
- inability to recall some important aspects of the period of exposure to the stressor
- persistent symptoms of increased psychological sensitivity and arousal
- above should all occur within 6 months of the stressful event/end of stressful period
PTSD where sx < 3 months mx
Watchful waiting may be used for mild symptoms < 4 weeks
Trauma-focused CBT should be given at least once a week for 8-12 sessions
Short-term drug treatment may be considered in the acute phase for management of sleep disturbance
Risk assessment to assess risk of neglect/suicide
PTSD sx > 3 months mx
CBT & eye movement desensitisation and reprocessing (EMDR)
EMDR - reduce distress in the shortest period of time
Drug treatment (little benefit from therapy, patient preference, co-morbid depression/severe hyperarousal)
Paroxetine, mirtazapine, amitriptyline & phenelzine
PD
- deeply ingrained and enduring pattern of inner experience and behaviour that deviates markedly from expectations in the individual’s culture, is pervasive and inflexible
- has an onset in adolescence/early adulthood, is stable over time & leads to distress/impairment
PD aetiology
- genetic
- adverse social circumstances
- difficult childhood experiences
PD risk factors
- society: both low socioeconomic status & social reinforcement of abnormal behaviour
- genetics: positive family of PD
- dysfunctional family
- abuse during childhood
PD types
- cluster A (odd)
- paranoid
- schizoid
- cluster B (dramatic/emotional)
- emotionally unstable
- dissocial
- histrionic
- cluster C
- dependent
- avoidant
- anankastic (obsessional)
Cluster A PD symptoms
Paranoid - suspicious of others, unforgiving, perceives attack, envious, self-reference, trust in others reduced
Schizoid - detached affect, indifferent to praise/criticism, sexual drive reduced, absence of close friends, no emotion
Cluster B PD symptoms
EUPD - abandonment feared, mood instability, suicidal behaviour, intense relationships, impulsivity, emptiness (chronic)
Dissocial - callous, others blamed, remorseless, underhanded, temper, tendency to violence
Histrionic - provocative behaviour, real concern for physical attractiveness, attention seeking, egocentric
Cluster C PD symptoms
Dependent - reassurance required, expressing disagreement is difficult, abandonment feared, exaggerated fears
Anxious - inadequacy felt, certainty of being liked needed before becoming involved with people, embarrassment potential prevents involvement in new activities, social inhibition
Anankastic - loses point of activity, ability to complete tasks compromised, workaholic, fussy, rigidity, stubborn, inflexible
PD mx
- treatment of co-morbid conditions
- risk assessment is crucial, especially in EUPD
- psychosocial interventions
- pharmacological management may be used to control symptoms
- written crisis plan
Substance misuse disorder types
Acute intoxication - acute, usually transient, effect of the substance
Harmful use - recurrent misuse associated with physical, psychological and social consequences, but without dependence
Dependence syndrome - prolonged, compulsive substance use leading to addiction, tolerance and the potential for withdrawal syndromes
Withdrawal state - physical and/or psychological effects from complete cessation of a substance after prolonged, repeated or high level of use
Psychotic disorder - onset of psychotic symptoms within 2 weeks of substance use; must be more than 48 hours
Amnesic syndrome - memory impairment in recent memory & ability to recall past experiences, also defect in recall, clouding of consciousness and global intellectual decline
Residual disorder - specific features (flashbacks, personality disorder, affective disorder, dementia, persisting cognitive impairment) subsequent to substance misuse
Complications of substance misuse
Physical - death, infection, endocarditis, superficial thrombosis, DVT, PE
Psychological - craving, anxiety, cognitive disturbance, drug-induced psychosis
Social - crime, imprisonment, homelessness, prostitution, relationship problems
Substance misuse ix
Bloods - HIV screen, hep B, hep C & TB, U&Es, LFTs and clotting & drug levels
Urinalysis - drug metabolites can be detected in urine
ECG for arrhythmias
ECHO if suspected endocarditis
Substance misuse mx
Keyworker with a therapeutic alliance
Hep B immunisation for those at risk
Motivational interviewing to help with controlling substance misuse & CBT may be offered
Contingency management - changing specific behaviours by offering incentives for positive behaviours eg. abstinence
Supportive help - housing, finance, employment; co-existing alcohol misuse & smoking cessation
Self-help groups
Opioid dependence mx
Methadone or buprenorphine for detox & maintenance
Naltrexone - formerly opioid dependent but have now stopped & motivated to continue abstinence
IV naloxone - antidote to opioid overdose
Oppositional disorder sx
Uncooperative, unwilling to comply with requests, frequent temper tantrums
Wilful, defiant, may also be aggressive aggression
Unless managed, tends to escalate
Conduct disorder types
Socialised and unsocialised types
- socialised - usually viewed as less serious and tends to be phasic in nature; able to still have good peer relationships
- unsocialised - more serious, and potentially leads to criminality and a later diagnosis of antisocial personality disorder
- lying, stealing, truanting, violence to people & animals
Conduct disorder RFs
Lack of clear boundaries, inconsistent parenting
Rejection
Family conflict, especially witnessing violence and aggression
Child abuse
Child temperament
Comorbid learning or development difficulties
Conduct disorder mx
Consistent care and parenting
Behavioural therapy
School-based interventions
Community interventions
Anorexia nervosa
Anorexia nervosa is an eating disorder characterised by deliberate weight loss, an intense fear of fatness, distorted body image and endocrine disturbance
Anorexia nervosa aetiology (biological)
Genetics, family history, female, early menarche
Adolescence and puberty
Starvation leads to neuroendocrine changes that perpetuate anorexia
Anorexia nervosa aetiology (psychological)
Sexual abuse, preoccupation with slimness, dieting behaviours in adolescence, low self-esteem, premorbid anxiety/depressive disorder, perfectionism, obsessional/anankastic personality
Criticism regarding eating, body shape or weight
Perfectionism, obsessional/anankastic personality
Anorexia nervosa aetiology (social)
Pressure to diet in a society that emphasises that being thin is beauty, bullying around weight, stressful life events
Occupational or recreational pressure to be slim
Occupation, western society
Anorexia sx
- fear of weight gain
- emaciated
- deliberate weight loss
- distorted body image
- physical - fatigue, hypothermia, bradycardia, arrhythmias, peripheral oedema, headaches, lanugo hair
Anorexia ix
- FBC, U&Es, TFTs, LFTs, lipids, cortisol, sex hormones, glucose, amylase
- VBG
- DEXA scan
- ECG
- questionnaires
Anorexia diagnosis
- adults: BMI < 18.5 OR rapid weight loss (more than 20% total body weight within 6 months)
- persistent pattern of restrictive eating/other behaviours aimed at establishing or maintaining abnormally low body weight
- fasting
- choosing low calorie food
- excessively slow eating of small amounts of food
- hiding food
- chewing and spitting
- excessive preoccupation with body, weight and shape
Anorexia mx
- treatment of medical complications
- SSRIs for co-morbid depression/OCD
- psycho-education about nutrition
- CBT, MANTRA, SSCM, family therapy
- self-help groups
Anorexia complications
- metabolic - hypokalaemia, hypercholesterolaemia, hypoglycaemia, impaired glucose tolerance, deranged LFTs
- endocrine - increased cortisol, increased GH, decreased LH, FSH, oestrogens & progestogens
- gastrointestinal - enlarged salivary glands, pancreatitis, constipation, peptic ulcers
- cardiovascular - cardiac failure, ECG abnormalities, arrhythmias
- renal - renal failure, renal stones
- neurological - seizures, peripheral neuropathy
- haematological - iron deficiency anaemia, thrombocytopenia, leucopenia
- msk - proximal myopathy, osteoporosis
ASD
Pervasive developmental disorder characterised by a triad of impairment in social interaction, impairment in communication and restricted, stereotyped interests and behaviours
ASD aetiology
- prenatal
- genetics - chromosome 7, fragile X syndrome, tuberous sclerosis
- parental age - a study found that women who are 40 years old have a 50% greater chance of having a child with autism as compared with women aged 20-29 years
- drugs - exposed to certain medications in the womb have a greater risk of developing autism (include sodium valproate in particular)
- infection - viral infections increase the risk of autism
- antenatal
- hypoxia during childbirth
- decreased gestational age at birth
- very low birthweight
- postnatal
- toxins - lead and mercury may increase the risk of autism
- pesticide exposure may affect those genetically predisposed to autism
ASD risk factors
- males are 4x more likely
- genetics
- family history
- advancing parental age
- parental psychiatric disorders
- prematurity
- maternal medication use
ASD sx
- asocial
- few social gestures
- lack of eye contact, social smile, response to name, interest in others, emotional expression, sustained relationships
- behaviour restricted
- restricted, repetitive and stereotyped behaviour
- upset at any change in daily routine
- obsessively pursued interests
- communication impaired
- distorted and delayed speech
- echolalia (repetition of words)
ASD diagnosis
- presence of abnormal or impaired development before the age of three
- qualitative abnormalities in social interaction
- qualitative abnormalities in communication
- restrictive, repetitive and stereotyped patterns of behaviour, interests and activities
- the clinical picture is not attributable to other varieties of pervasive developmental disorder
ASD mx
- general points
- local autism teams
- CBT
- ensure all physical health, mental health and behavioural issues
- families and carers should also be offered personal, social and emotional support
- interventions
- social-communication intervention
- treat co-existing physical disorders, mental health and behavioural problems
- modification of environmental factors which initiate or maintain challenging behaviour
- antipsychotics
ADHD
Characterised by an early onset, persistent pattern of inattention, hyperactivity and impulsivity that are more frequent and severe than in individuals at a comparable stage of development
- present in more than one situation
ADHD aetiology
- genetic predisposition - DRD4 and DRD5 thought to be implicated
- neurochemical - abnormality in dopaminergic pathways
- neurodevelopmental - abnormality of pre-frontal cortex
- social - social deprivation, family conflict, parental cannabis & alcohol exposure
ADHD RFs
- males
- family history
- social deprivation
- family conflict
- parental cannabis
- alcohol exposure
ADHD symptoms
- inattention
- hyperactivity
- impulsivity
ADHD diagnosis
Demonstrate abnormality of attention, activity and impulsivity at home for the age & developmental level of the child
Onset < 7 years
Duration > 6 months
IQ > 50
ADHD treatment
Support groups
Parent training & education programmes
Psychoeducation & CBT
Severe → offer methylphenidate (CNS stimulant)
- atomoxetine is alternative
- SE: headache, insomnia, loss of appetite and weight loss
Bulimia
Characterised by recurrent binge-eating episodes with a loss of control, followed by inappropriate compensatory behaviours to prevent gain
Compensatory behaviours - self-induced vomiting, laxative or diuretic misuse, fasting or excessive exercise
Behaviours/episodes occur once a week/more for one month
Bulimia symptoms
Psychological symptoms
- binge eating: loss of control, consuming large amounts of high-caloric food urgently
- purging: induced vomiting, laxative or diuretic misuse & excessive exercise
- body image distortion: distorted perception despite maintaining normal/slightly above average weight
Physical symptoms
- dental erosion
- parotid gland swelling
- Russell’s sign
- amenorrhea
- excessive vomiting complications - Boerhaave syndrome or Mallory-Weiss tear
Bulimia mx
Bulimia nervosa focused guided self-help/focused family therapy for children
Specialist referral - essential for ongoing management
High-dose fluoxetine considered in some cases
Binge-eating disorder
Recurrent episodes of binge eating in the absence of compensatory behaviours
Episodes are marked by feelings of lack of control
Binge eating disorder symptoms
Recurrent episodes of binge eating (once per week for 3 months) in the absence of compensatory behaviours
Body weight may be maintained at normal, overweight or obese
Binge eating mx
Psychological interventions
- group/individual CBT-ED
- evidence-based self-help programmes with brief supportive sessions
