Food, sex Flashcards
(27 cards)
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
What are other Sleep-Wake Disorders?
Breathing Related Sleep Disorders
Circadian Rhythm Sleep-Wake Disorders
Parasomnias
Non-Rapid eye Movement Sleep Arousal Disorders
Nightmare Disorder
Rapid Eye Movement Sleep Behavior Disorders
Pt c/o difficulty in obtaining an erection during sexual activity maintaining an erection until the completion of sexual activity. What is DX?
Erectile Disorder Marked: decrease in erectile rigidity Must be on almost all occasions Min. 6 month duration Separate from “secondary to” conditions (e.g. medication or medical condition)
impact self-esteem, self-confidence and sense of masculinity
TX: Psychological Counseling exercise Phosphodiesterase type 5 (PDE5) inhibitors Nitric Oxide enhancing agents Sildenafil (Viagra) Tadalafil (Cialis) Vardenafil (Levitra) Alprostadil Pumps and implants
Describe Delayed Ejaculation and
Premature Ejaculation
DE:
Marked delay, infrequency or absence of ejaculation
-individual does not desire delay
PE-Pattern of ejaculation before one minute and before the individual wishes it.
Pt c/o the following: What is Dx and criteria? Absent/reduced: sexual interest or arousal fantasies sexual excitement or pleasure during Reduced initiation reduced sensations
Female Sexual Interest / Arousal Disorder
Min. duration of 6 months
significant distress for the individual
TX-Psychological Counseling Estrogen therapy Androgen (testosterone) therapy Flibanserin (Addyi) Asexual Identity?
Pt c/o in all sexual encounters
delay of orgasm, reduced intensity of orgasmic sensations for past 6 months and is distress to her. What is DX and TX?
Female Orgasmic Disorder
10 – 42 % based on age, culture, severity of symptoms
Treatment is mostly psychotherapy
Bupropion? Nitric oxide enhancing agents?
Pt has a sexual arousal from observing an unsuspecting person who is naked, disrobing, engaged in sexual activities as manifested in fantasies urges or behaviors
Paraphilic Disorders
Voyeuristic Disorder
Is behavior necessary for a diagnosis?
Acted on with a non-consenting person
Cause clinically significant distress or impairment in social, occupational or other important areas of functioning
Pt c/o sexual arousal from the act of being humiliated, beaten, bound, suffer
Sexual Masochism Disorder –
Pt c/o sexual urges with prepubescent children
acted on these urges, or they cause marked distress or interpersonal difficulty
Pedophilic Disorder - The individual is at least 16years and at least 5 years older than the child Is the law in alignment with the DSM5? Hebephilia Ephebophilia
What differentiates Transvestic Disorder from or transgender or other manifestations of gender identity?
Is this a part of the gender identity spectrum?
How does this differentiate from drag personas?
Fetishistic Disorder – arousal from either the use of non-living objects or a highly specific focus on non-genital body parts. Feet fetish
Transvestic Disorder - arousal from cross dressing
