Eating, Sleeping and Sex disorders

Question 1

BMI below 17. 5. Has not regularly engaged in binge-eating or purging behavior; often with obessive-compulsive personality traits. Dx?

Answer 1

Anorexia Nerosa Restrictive Type.

Question 2

BMI below 17. 5. Eat in binges followed by self induced vomiting, using laxatives, excessively exercising, and/or using diuretics. Dx?

Answer 2

Anorexia Nervosa Binge-Eating/Purging Type.

Question 3

BMI

Answer 3

Anorexia Nervosa. Treat as outpatient unless need to be hospitlized for severe symptoms that requires refeeding.

Question 4

BMI > 17.5. Involves vomiting, laxatives, enemas or diuretics. Dx? Rx?

Answer 4

Bulima Nervosa - Purging Type. SSRI

Question 5

BMI > 17.5. Involves excessive exercise or fasting. Dx? Rx?

Answer 5

Bulima Nervosa - Nonpurging Type. SSRI

Question 6

Recurrent episodes of binge eating, severe distress over binge eating, occurs at least 2 days a week for 6 months and is not associated with compensatory behaviors. ( Eat rapidly, eats until uncomfortably full, eat large amounts when not hungry, eat alone due to embarrassment, feeling disgusted and depressed after.)

Answer 6

Binge Eating Disorder. Individual therapy, behavioral therapy with a strict diet and exercise program. Pharmcothrapy to promote weightloss - Stimulants, Orlistat (Xenical), Sibutramine (Meridia)

Question 7

Difficulty initiating sleep (sleep-onset insomnia,) Frequent nocturnal awakenings ( middle-of-the night or sleep maintenance insomnia,) Early morning awakenings (late night or sleep-offset insomnia,) Waking up feeling fatigued and unrefreshed (nonrestorative sleep) Dx? 1. Occurs between 1 and 4 weeks)? 2. Last for > 1 month to years?

Rx?

Answer 7

Primary Insomina. 1. Acute Insomnia. 2. Chronic Insomnia. Rx: Sleep Hygiene measures. CBT (First line for Chronic Insomnia), Benzos and NonBenzos (Zolpidem (Ambien), Eszopiclone (lunesta), Zaleplon (Sonata.)

Question 8

Irresistible attacks of refreshing sleep that occur daily for at least 3 months. Hallucinations and/or sleep paralysis at the beginning or end of sleep episodes. Dx? Rx?

Answer 8

Narcolepsy. Sleep Hygiene Measures, Scheduled daytime naps, Modafinil.

Question 9

Hypersomina, Hyperphagia, Hypersexual and aggression. Dx?

Answer 9

Kleine- Levin Syndrome

Question 10

Chronic or recurrent delay in sleep onset and awakening times with preserved quality and duration of sleep. Dx?

Answer 10

Delayed Sleep Phase Disorder

Question 11

Normal duration and quality of sleep with sleep onset and awakening times earlier than desired. Dx?

Answer 11

Advanced Sleep Phase Disorder

Question 12

Sleep deprivation and misalignment of the circadian rhythm secondary to nontraditional work hours. Dx?

Answer 12

Shift work disorder.

Question 13

Sleep disturbances (insomnia, hypersomnia) associated with travel across multiple time zones.

Answer 13

Jet lag disorder.

Question 14

Sudden arousal with screaming from slow-wave sleep in what appears to be a state of complete terror. Sympatheic hyperactivation, including tachycardia, tachypnea, diaphoresis and increase muscle tone. After episode, pts usually return to sleep without awakening. Usually amnesic about episode. Confused and disoriented upon forced awakening. Dx? Rx?

Answer 14

Sleep Terrors. Rx:Reassurance that is condition is benign and self limited. Low dose, short acting benzos. Sleep hygiene and psychotherapy.

Question 15

Recurrent frightening dreams that ten to terminate in awakening with vivid recall. No confusion or disorientation upon awakening. Can cause distress and anxiety. Dx? Rx?

Answer 15

Nightmare Disorders. Rx: Imagery rehearsal therapy (mental imagery to modify the outcome of a recurrent nightmare)

Question 16

Characterized by muscle atonia during REM Sleep and complex motor activity associated with dream mentation. Dream-enacting behaviors. Dx?

Answer 16

REM Sleep Behavior Disorder.