Feeding/Eating, Elimination, and Sleep-Wake Disorders

Question 1

Changes from DSM IV to DSM 5 for Feeding and Eating Disorders.
This is a new chapter in the DSM 5 and includes ———– and ————- disorder.

Answer 1

This is a new chapter in the DSM 5 and includes PICA and RUMINATION disorder.

Question 2

Changes from DSM IV to DSM 5 for Feeding and Eating Disorders.
Feeding and eating disorder of infancy/early childhood has been renamed ———–, ——————- disorder.

Answer 2

Feeding and eating disorder of infancy/early childhood has been renamed AVOIDANT/RESTRICTIVE FOOD INTAKE disorder.

Question 3

DSM-5 introduced three changes to the criteria defining anorexia nervosa

Answer 3

The weight loss criterion was revised, fear of weight gain does not need to be verbalized if behaviors interfering with weight gain can be observed, and amenorrhea was no longer required

Question 4

Changes from DSM IV to DSM 5 for Bulimia

Answer 4

The minimum average frequency of binge eating required for diagnosis has been changed from at least twice weekly for 6 months to at least once weekly over the last 3 months,

Question 5

Changes from DSM IV to DSM 5
————– is a new diagnosis involving recurrent episodes of binge eating once weekly for at least 3 months.

Question 6

Changes from DSM IV to DSM 5 for Sleep-Wake Disorders.
Primary Insomnia has been renamed ———— Disorder, as there is now no differentiation between primary and secondary insomnia.

Answer 6

Primary Insomnia has been renamed INSOMNIA Disorder, as there is now no differentiation between primary and secondary insomnia.

Question 7

Q: What are the changes in Narcolepsy disorder from DSM-IV to DSM-5?

Answer 7

A: DSM-5 introduced significant changes to the classification of Narcolepsy:
Narcolepsy with cataplexy is now classified as Narcolepsy type 1, characterized by low levels of hypocretin-1 (orexin A).
Narcolepsy without cataplexy is now classified as Narcolepsy type 2, with normal hypocretin levels.
DSM-5 emphasizes the importance of hypocretin deficiency in the diagnosis of Narcolepsy type 1.

Question 8

Q: How does DSM-5 distinguish Narcolepsy from other forms of Hypersomnolence?

Answer 8

A: DSM-5 distinguishes Narcolepsy by its specific symptoms, including cataplexy, hypnagogic hallucinations, and sleep paralysis, which are not typical of other forms of Hypersomnolence. Other forms of Hypersomnolence, such as Idiopathic Hypersomnia and Hypersomnolence Disorder, lack these specific features and are characterized primarily by excessive daytime sleepiness without the distinctive symptoms seen in Narcolepsy.

Question 9

Q: What changes were made to breathing-related sleep disorders in DSM-5?

Answer 9

A: DSM-5 combined several disorders under the category of “Sleep-Related Breathing Disorders,” which include Obstructive Sleep Apnea Hypopnea, Central Sleep Apnea, Sleep-Related Hypoventilation, and Sleep-Related Hypoxemia Disorder. This category emphasizes the common feature of disrupted breathing during sleep and distinguishes between obstructive and central mechanisms affecting respiratory functions during sleep.

Question 10

What are the changes in Circadian Rhythm Sleep Disorders from DSM-IV to DSM-5

Answer 10

Changes: DSM-5 removed the “jet lag type” and focused more on chronic circadian rhythm sleep disorders with significant daily impact.

Emphasis: DSM-5 clarifies criteria and expands classification to include disorders like delayed sleep-wake phase disorder, advanced sleep-wake phase disorder, irregular sleep-wake rhythm disorder, and non-24-hour sleep-wake disorder.

Purpose: These changes aim to better reflect clinical understanding and improve treatment approaches in sleep medicine.

Question 11

Question: What are the disorders in Sleep-Wake Disorders from DSM-IV to DSM-5?

Answer 11

Answer:
Restless Legs Syndrome (RLS) is now classified as a distinct disorder characterized by an urge to move legs with uncomfortable sensations.
Rapid Eye Movement (REM) Sleep Behavior Disorder (RBD) is recognized as acting out dreams due to loss of muscle atonia during REM sleep.

Question 12

Question: How does the DSM-5 describe Feeding and Eating Disorders?

Answer 12

Answer: The DSM-5 defines these disorders as involving “a persistent disturbance of eating or eating-related behavior that results in altered consumption or absorption of food and significantly impairs physical health or psychosocial functioning” .

Question 13

Question: What is Pica according to the DSM-5?

Answer 13

Answer: Pica involves persistent eating of non-nutritive, nonfood substances (e.g., paper, paint, coffee grounds) for at least one month, which is inappropriate for the individual’s developmental level and not culturally or socially acceptable. It can lead to medical complications such as intestinal obstruction and lead poisoning.

Question 14

Question: What defines Anorexia Nervosa according to the DSM-5?

Answer 14

Answer: Anorexia Nervosa involves restrictive eating leading to significantly low body weight, intense fear of weight gain, disturbance in body weight or shape perception, and may involve binge-eating or purging behaviors.

Question 15

Question: What are the specifiers used for Anorexia Nervosa?

Answer 15

Answer: Anorexia Nervosa specifiers include type (restricting or binge-eating/purging), course (full remission, partial remission, or active), and severity based on current BMI.

Question 16

Question: What are common medical complications associated with Anorexia Nervosa?

Answer 16

Answer: Medical complications of Anorexia Nervosa result from malnutrition and extreme weight loss, affecting nearly all major organ systems and potentially leading to death if untreated.

Question 17

Question: What are the treatment goals for Anorexia Nervosa?

Answer 17

Answer: Treatment goals for Anorexia Nervosa include restoring healthy weight, addressing physical complications, improving motivation for treatment, providing nutrition education, and addressing psychological contributors to the disorder.

Question 18

Question: What are two evidence-based treatments for Anorexia Nervosa?

Answer 18

Answer: Enhanced cognitive-behavior therapy for eating disorders (CBT-E) and family-based treatment (FBT) are effective interventions for Anorexia Nervosa, focusing on core maintaining mechanisms and family involvement, respectively.

Question 19

Question: What characterizes Bulimia Nervosa according to the DSM-5?

Answer 19

Answer: Bulimia Nervosa involves recurrent episodes of binge eating with a sense of lack of control, inappropriate compensatory behaviors (e.g., vomiting, excessive exercise), and self-evaluation excessively influenced by body shape and weight. Binge eating and compensatory behaviors must occur at least once a week for three months.

Question 20

Question: What are the specifiers used for Bulimia Nervosa?

Answer 20

Answer: Specifiers for Bulimia Nervosa include course (partial or full remission) and severity, which is based on the average number of episodes of inappropriate compensatory behavior per week.

Question 21

Question: What are common medical complications of Bulimia Nervosa?

Answer 21

Answer: Medical complications from Bulimia Nervosa often result from compensatory behaviors like purging and can include dental erosion, caries, gastroesophageal reflux, dehydration, electrolyte imbalances, heart arrhythmias, and potentially death.

Question 22

Question: What are the primary treatments for Bulimia Nervosa?

Answer 22

Answer: The primary treatments for Bulimia Nervosa include nutritional rehabilitation combined with cognitive behavior therapy (CBT) or interpersonal therapy (IPT). SSRIs and tricyclic antidepressants may be used to alleviate comorbid depression and reduce binge eating and purging.

Question 23

Question: What is the enhanced version of cognitive behavior therapy (CBT-E) for Bulimia Nervosa?

Answer 23

Answer: CBT-E is a transdiagnostic intervention that addresses the core psychopathology of eating disorders. It consists of four stages: engaging the patient, creating a formulation, self-monitoring, and education; reviewing progress; addressing overvaluation of shape and weight, perfectionism, low self-esteem, and interpersonal problems; and identifying ways to maintain progress and prevent relapse.

Question 24

Question: How does telepsychology compare to face-to-face interventions for Bulimia Nervosa?

Answer 24

Answer: Studies generally find telepsychology and face-to-face CBT produce positive results, with similar client acceptability and retention. However, face-to-face CBT may slightly better reduce binge eating, purging, and eating-disordered cognitions.

Question 25

Question: How does motivation impact treatment outcomes for Bulimia Nervosa?

Answer 25

Answer: Individuals with Bulimia Nervosa are often more distressed by their symptoms and more motivated to change than those with Anorexia. Higher levels of autonomous (intrinsic) motivation predict greater symptom reduction and lower dropout rates from treatment.

Question 26

Question: What are the diagnostic criteria for Binge-Eating Disorder (BED) according to the DSM-5?

Answer 26

Answer: The diagnosis of BED requires recurrent episodes of binge eating that involve eating a larger amount of food than most people would eat in a similar period and circumstances, with a sense of lack of control over eating during episodes. The person must also have at least three of five characteristic symptoms and episodes must occur, on average, at least once a week for three months.

Question 27

Question: What are the characteristic symptoms of Binge-Eating Disorder?

Answer 27

Answer: The characteristic symptoms of BED include eating more rapidly than usual; eating until uncomfortably full; eating large amounts when not feeling hungry; eating alone due to embarrassment; and feeling disgusted, depressed, or very guilty about one’s binge eating.

Question 28

Question: How is the severity of Binge-Eating Disorder determined?

Answer 28

Answer: The severity of BED is determined by the number of binge-eating episodes per week: mild (1-3 episodes), moderate (4-7 episodes), severe (8-13 episodes), and extreme (14 or more episodes).

Question 29

Question: How does Binge-Eating Disorder differ from Bulimia Nervosa?

Answer 29

Answer: Unlike Bulimia Nervosa, individuals with BED do not engage in recurrent inappropriate compensatory behaviors (e.g., vomiting, excessive exercise). Dieting often follows the onset of BED, whereas dysfunctional dieting often precedes Bulimia Nervosa.

Question 30

Question: What is the gender prevalence of Binge-Eating Disorder?

Answer 30

Answer: BED is two to three times more common in women than in men.

Question 31

Question: What are common treatments for Binge-Eating Disorder?

Answer 31

Answer: Cognitive-behavior therapy-enhanced (CBT-E) and interpersonal therapy (IPT) are evidence-based treatments for BED. Medications such as SSRIs, the anti-seizure medication topiramate, and the CNS stimulant lisdexamfetamine have been evaluated, but medication alone is generally less effective than CBT. Combining CBT with medication is no more effective than CBT alone.

Question 32

Question: What is the recommended focus when treating individuals with BED who are overweight or obese?

Answer 32

Answer: Experts generally recommend focusing on reducing binge-eating episodes before or concurrently with weight loss.

Question 33

Question: What is the diagnostic criteria for Enuresis?

Answer 33

Answer: Enuresis involves repeated voiding of urine into the bed or clothing, either occurring two or more times a week for at least three consecutive months or causing significant distress or impaired functioning. Urination is usually involuntary, not due to substance use or a medical condition, and the person must be at least five years old or the equivalent developmental level.

Question 34

Question: What specifiers are used to identify subtypes of Enuresis?

Answer 34

Answer: Specifiers for Enuresis include nocturnal only (bedwetting during sleep), diurnal only (urination during waking hours), and nocturnal and diurnal (urination during both sleep and waking hours).

Question 35

Question: What are common treatments for nocturnal Enuresis?

Answer 35

Answer: The most common treatment for nocturnal Enuresis is the moisture alarm (also known as the bell-and-pad), which rings when a child begins to urinate while sleeping. The antidiuretic hormone desmopressin is also used to reduce or stop bedwetting, though it has a high risk for relapse when discontinued.

Question 36

Question: How does the DSM-5 describe Sleep-Wake Disorders?

Answer 36

Answer: The DSM-5 describes Sleep-Wake Disorders as involving “dissatisfaction regarding the quality, timing, and amount of sleep … [with] resulting daytime distress and impairment”.

Question 37

Question: What are the primary symptoms of Insomnia Disorder according to the DSM-5?

Answer 37

Answer: Insomnia Disorder is characterized by dissatisfaction with sleep quality or quantity, associated with one or more of the following symptoms: difficulty initiating sleep, difficulty maintaining sleep, and early-morning awakening with an inability to return to sleep.

Question 38

Question: What criteria must be met for an Insomnia Disorder diagnosis?

Answer 38

Answer: The sleep disturbance must occur at least three nights a week, be present for at least three months, occur despite sufficient opportunities for sleep, and cause significant distress or impaired functioning.

Question 39

Question: What are the three types of insomnia?

Answer 39

Answer: The three types of insomnia are sleep-onset (initial) insomnia, which involves difficulty initially falling asleep; sleep maintenance (middle) insomnia, which involves frequent or extended awakenings during the night; and late insomnia, which involves awakening early in the morning with an inability to return to sleep.

Question 40

Question: Which type of insomnia is the most common?

Answer 40

Answer: Sleep maintenance insomnia is the most common single type, but the combination of all three types is most common overall.

Question 41

Question: What is the nonpharmacological treatment-of-choice for Insomnia Disorder?

Answer 41

Answer: The nonpharmacological treatment-of-choice is a multi-component cognitive-behavioral intervention that includes stimulus control or sleep restriction, sleep-hygiene education, relaxation training, and/or cognitive therapy.

Question 42

Question: What is stimulus control therapy for Insomnia Disorder?

Answer 42

Answer: Stimulus control therapy involves strengthening the bedroom and bed as cues for sleep by going to bed only when tired and sleeping only in the bedroom.

Question 43

Question: What is sleep restriction therapy for Insomnia Disorder?

Answer 43

Answer: Sleep restriction therapy involves restricting the time allotted for sleep each night so that the time spent in bed matches sleep requirements.

Question 44

Question: What characterizes Narcolepsy according to the DSM-5?

Answer 44

Answer: Narcolepsy involves attacks of an irrepressible need to sleep that cause sleep or daytime naps at least three times a week for three months or more.

Question 45

Question: What are the diagnostic criteria for Narcolepsy?

Answer 45

Answer: The diagnosis requires episodes of cataplexy (loss of muscle tone), hypocretin deficiency, or a rapid eye movement latency of 15 minutes or less as determined by nocturnal sleep polysomnography.

Question 46

Question: What additional symptoms are commonly associated with Narcolepsy?

Answer 46

Answer: Many people with narcolepsy experience hypnagogic or hypnopompic hallucinations (vivid hallucinations just before falling asleep or just after awakening, respectively) and/or sleep paralysis when falling asleep or awakening.

Question 47

Question: What triggers cataplexy in people with Narcolepsy?

Answer 47

Answer: Cataplexy is often triggered by strong emotions, so people with this disorder may attempt to control their emotions to prevent sleep episodes.

Question 48

Question: What behavioral strategies are recommended for the treatment of Narcolepsy?

Answer 48

Answer: Behavioral strategies include establishing good sleep habits, taking daytime naps, and staying active.

Question 49

Question: What medications are used to improve alertness in people with Narcolepsy?

Answer 49

Answer: Medications for alertness include modafinil and its newer form armodafinil, which increase dopamine levels, and amphetamines and other psychostimulants (e.g., methylphenidate), which increase dopamine levels and, to a lesser degree, serotonin and norepinephrine levels.

Question 50

Question: What is the primary medication for cataplexy in Narcolepsy patients?

Answer 50

Answer: The primary medications for cataplexy are antidepressants such as venlafaxine, fluoxetine, and clomipramine.

Question 51

Question: What is sodium oxybate and how is it used in the treatment of Narcolepsy?

Answer 51

Answer: Sodium oxybate is a derivative of a natural chemical in the brain and is taken at bedtime to improve deep sleep at night and reduce cataplexy and daytime sleepiness.

Question 52

Question: What are the types of Non-Rapid Eye Movement Sleep Arousal Disorders?

Answer 52

Answer: The types include sleepwalking and sleep terrors, which involve recurrent episodes of incomplete awakening from sleep, usually during Stage 3 or 4 sleep in the first third of a major sleep period.

Question 53

Question: What characterizes sleepwalking?

Answer 53

Answer: Sleepwalking involves getting out of bed during sleep and walking about, which may include sleep-related eating or sexual behavior. The person has little or no memory of the episode on awakening.

Question 54

Question: What characterizes sleep terrors?

Answer 54

Answer: Sleep terrors involve an abrupt arousal from sleep, usually starting with a panicky scream and accompanied by intense fear and autonomic arousal (e.g., tachycardia, rapid breathing). The person is unresponsive to attempts to awaken or comfort him/her during an episode and has little or no memory of the episode upon awakening.

Question 55

Question: What age group is most affected by sleepwalking and sleep terrors?

Answer 55

Answer: Sleepwalking and sleep terrors occur most often in childhood and decrease in frequency with increasing age.

Question 56

Question: What is Nightmare Disorder?

Answer 56

Answer: Nightmare Disorder involves repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity.

Question 57

Question: When do nightmares usually occur in Nightmare Disorder?

Answer 57

Answer: Nightmares usually occur during rapid eye movement (REM) sleep in the second half of a major sleep period.

Answer 58

Question: How does a person typically react upon awakening from a nightmare?

Answer: When awakened during a nightmare, the person is usually oriented and alert but may continue to experience a dysphoric mood.