Food, sex Flashcards
What are s/s of Anorexia Nervosa? What are the subtypes?
Restriction of energy intake relative to requirements
< 18.5 BMI
significantly low body weight
fear of gaining weight
Disturbance in the way ones see themself
Lack of awarness
Subtypes:
Restricting type
Binge-eating / purging type
Mild- extreme – based on BMI
What is common age, location, race for Anorexia?
0.4% in young females (less is known about men)
adolescence or young adulthood (rarely before puberty)
high income countries
lower amongst African Americans, Latinos and Asians
Why is Anorexia Nervosa life threatening medical condition?
compromise major organ systems, brain etc.
co-morbidity with mood symptoms, separate from the anorexia or secondary to the undernourished state
Body Dysmorphic Disorders (one-many points of focus on body, but way ABN to them, nose)
Obsessive Compulsive Disorders
MDD
GAD
Suicide
What is the ideal team approach for Anorexia Nervosa?
doctors, mental health professionals and dietitians.
Hospitalization
severe psychiatric problems
severe malnutrition
No FDA medications- antidepressants, psychiatric medication
Family-based therapy-EVB for teenagers
Cognitive Behavioral therapy (for adults)- goal is to normalize eating patterns, weight gain.
2nd goal-change distorted thoughts that maintain restrictive eating.
What are differences with Bulimia Nervosaand Anorexia?
Recurrent episodes of binge eating AND purging
Recurrent compensatory to prevent weight gain (MC vomiting, laxatives, diuretics, exercise)
AN vs BN- LOW BW
1/wk for 3 months
1-1.5% (less known about prevalence in men)• adolescence or young adulthood• Caucasians normal or overweight co-morbidity behavioral health
Rare life threatening- esophageal / gastric rupture, cardiac arrhythmias,
What is the ideal treatment for Bulimia Nervosa?
OUTpatient team-primary care provider, a mental health professional and a dietitian
Psychotherapy: Cognitive Behavioral Therapy, Interpersonal Therapy, Family Based Therapy
Antidepressants w/ psychotherapy
may require treatment in a hospital
Poss. recover- symptoms don’t go away entirely
What are the other ED and describe?
Binge Eating Disorder – lack “purging” behaviors
Pica – Persistent eating of non food substances
Rumination Disorder – Repeated regurgitation
Avoidant / Restrictive Food Intake Disorder – Lack of interest in eating. No desire to loose weight
What is the difference btwn Hypnogogic, Hyponompic?
What is the difference btwn Sleep and REM ?
Hypnogogic- going to sleep, state btwn wake and sleep, as transitioning
Hypnopompic- opposite, sleep and wakefullness
Sleep Latency- how long to take to rest
REM Latency- asleep to 1st REM sleep, sleep study
Five stages of sleep
Normal-Stages 1-4(Non-REM), dreaming is REM (maybe people watching dream. Paralysis.
Waking when body feels Paralysis
What will patient complain about with Insomnia? What is s/s of MDD?
Difficulty w/ sleep: initiation, maintain, early morning wakes (MDD), non restorative sleep
Truth-NO idea why we sleep, 1/3. There is a death relationship w/ death. REM needed
DX-3 nights/wk/for 3 months
daytime impairments-fatigue, sleepiness, impaired cognitive
1/3 of adults w/ 6-10% meeting criteria for Insomnia
Inc. older adults- Need 4-8h, changes as we age. Baby - Age
Misprecerption of sleep status- We all some issues.
What are the ideal treatments for Insomnia?
Change thoughts- Self-fulfilling prophecy
comorbid behavioral or medical disorders
Most insomnia is “secondary insomnia”
80% - MDD experience insomnia
Next 3 night take pill if you need or not. 3 nights in the drawer. Relaxations strategies Sleep Hygiene – Stimulus Control Cognitive Behavioral Therapy Benzodiazipines Non-benzodiazipines Alternative Treatments
Pt has recurrent episodes of an irrepressible need to sleep, or napping, at least 3/wk for past 3 months? What Dx and other criteria?
At least one:
Cataplexy (with or without) – episodes of sudden bilateral loss of muscle tone with maintained consciousness
Hypocretin deficiency (CSF) – loss of hypocretin (orexin) producing cells in the hypothalamus
REM Sleep Latency -less than or equal to 15 minutes (normal = 50-150 minutes)
0.2-0.4% of the population
all ethnic groups in many cultures
Is there a cure for Narcolepsy?
NO
Drugs to stimulate CNS to stay awake
DOC- Modafinil, amodafinil
SSRI, SNRI - supress REM sleep.
Tricyc- treat cataplexy
WHat is very effective fro cataplexy?
Sodium oxybate (Xyrem). Gamma-hydroxybutyrate (GHB) improve nighttime sleep and daytime sleepiness.
Xyrem-ADRs ,nausea, bed-wetting and worsening of sleepwalking. AVOID other sleeping medications, narcotic pain relievers or alcohol can lead to difficulty breathing, coma and death.
What is self reported excessive sleepiness despite sleep period of at least 7 hours vs Narcolepsy?
Hypersomnolense Disorder Normal sleep duration Normal REM Persistent daytime sleepiness vs. sleep attacks Lack of cataplexy
What is an urge to move the legs in response to uncomfortable or unpleasant sensations?
Creeping, crawling, tingling, burning or itching
Restless Legs Syndrome
Worse at rest, evening or night (compared to day)
delay sleep onset (latency) and awakens Pt
Relief obtained by moving the legs
2-7.2 %
Women
inc. w/ age
Lower in Asian
Medications that increase dopamine in the brain. ropinirole (Requip),
rotigotine (Neupro) and pramipexole (Mirapex)
Drugs affecting calcium channels.
Gabapentin (Neurontin) pregabalin (Lyrica),
Opioids
Muscle relaxants and sleep medications.
Benzodiazepines help, sleep but NOT leg sensations
