Impulse Control, Eating, Sleep, Sexual disorders Flashcards
What is impulse control disorders?
disorder characterized by an inability to resist reactions towards internal/external stimuli without considering the consequences (ie harm to self or others)
What are the 4 core qualities of impulse control disorders?
1) repetitive or compulsive engagement in behavior despite adverse consequences
2) little control over the behavior
3) anxiety/craving experienced PRIOR to the behavior
4) relief or satisfaction DURING or AFTER completion of the behavior
What is intermittent explosive disorder (based on DSM)?
recurrent outbursts of aggression that result in assault against people or property; response is out of proportion to the inciting event/stressor
Intermittent explosive disorder is more common in…
men, late teens
Treatment of Intermittent explosive disorder?
PALS: propranolol anticonvulsants Lithium SSRIs
What is kleptomania (based on DSM)?
uncontrollable urges to steal objects that are NOT needed for personal use/monetary reasons; objects are normally given or thrown away, returned, or hoarded
pleasure or relief is experienced while stealing
who tends to be kleptomanics?
women, esp during times of stress
kleptomania is highly comorbid with:
mood disorders
eating disorders
OCD
kleptomania prognosis
chronic
1/4 of these types of patients are also comorbid with kleptomania
bulimia nervosa
kleptomania treatment
insight-oriented psychotherapy
systematic desensitization/aversive conditioning
SSRIs
what is pathological gambling (based on DSM)
at least 5 symptoms of gambling
- preoccupation with it
- lying to hide it
- committing legal acts to finance it
- jeopardizing relationships or job because of it
- relying on others to financially support it
- need to gamble with increasing $$ to achieve pleasure
- done to escape problems or relieve dysphoria
- returning to gambling to reclaim losses
- unsuccessful with cutting down
- restlessness or irritability when attempting to cut down
pathological gambling is highly comorbid with
mood d/o
anxiety d/o
OCD
(possible ADHD)
treatment of pathological gambling?
gambler’s anonymous
What is trichotillomania?
what triggers the behavior?
recurrent, repetitive, intentional pulling out of one’s hair causing visible hair loss;
tension is experienced before the hair pulling, with immediate relief or pleasure afterwards
trigger: the texture of the hair
who does trichotillomania usually happen in?
women
trichotillomania is comorbid with…
OCD/OCPD
mood disorders
borderline personality disorder
trichotillomania treatment
SSRI
antipsychotics
lithium
N-acetylcysteine
What is pyromania (based on DSM)?
- at least 1 episode of deliberate/impulsive fire setting with pleasure, gratification, or relief from tension/arousal experienced when setting the fire
- patient has a fascination with, interest in, curiosity about, or attraction to fire
who usually has pyromania?
males, late adolescents
treatment for pyromania?
behavior therapy
supervision
SSRIs
What type of cardiovascular changes may a patient with anorexia nervosa present with? 7
bradycardia orthostatic hypotension arrhythmias QTc prolongation ST-T wave changes cardiomyopathy mitral valve prolapse
What type of lab changes may a patient with anorexia nervosa present with? 5
anemia (normocytic, normochromic) leukopenia increased LFTs elevated BUN decreased albumin
What type of neurological changes may a patient with anorexia nervosa present with? 5
enlarged ventricles decreased G/W matter cognitive impairment peripheral neuropathy seizures
What type of endocrine changes may a patient with anorexia nervosa present with? 6
hypoglycemia hypothyroidism increased GH increased cortisol amenorrhea due to decreased LH/FSH and estrogen, testosterone
What type of physical changes may a patient with anorexia nervosa present with? 5
parotid enlargement (with increase amylase levels)
languo hair/alopecia
muscle wasting
cold-intolerance
bone fractures (due to osteopenia/osteoporosis)
What type of electrolyte changes may a patient with anorexia nervosa present with? 3
hypochloremic hypokalemic alkalosis (if vomiting)
hyponatremia
hypokalemia
2 types of anorexia nervosa?
restrictive type
binge-eating/purging type
DSM V for anorexia nervosa?
BMI < 17.5 kg/m2 or < 85% of ideal body weight)
intense fear of gaining weight
distorted body image
(note DSM IV has amenorrhea)
How do you differentiate btwn anorexia nervosa and MDD as the cause of significant weight lost in a patient?
anorexia nervosa - patients have GOOD appetite but will starve themselves due to distorted body image; PREOCCUPIED with food but do not eat it themselves
MDD - patients have POOR appetite, which causes the weight-loss; NO INTEREST in food
What is the refeeding syndrome?
Edema and decreased levels of PO4, Mg, and Ca that occurs when a severely malnourished patient is refed too quickly
“Must Carefully Pour Everything”
prognosis of patients with anorexia nervosa?
poor: chronic/relapsing illness
mortality is cumulative (starvation, suicide, or cardiac failure)
rates of suicide in patients with anorexia nervosa
57x greater than normal
Treatment for patients with anorexia nervosa 3
1) food…
2) low-dose atypical antipsychotics - treat excessive preoccupation with weight/food
3) benzodiazepines - administered prior to meals to reduce pre-prandial anxiety
Why have SSRIs not been shown to work in patients with anorexia nervosa?
because anorexia nervosa is believed to be due to an inadequate dietary intake of tryptophan, which is the precursor of serotonin
What is bulimia nervosa
binge eating combined with behaviors intended to counteract weight gain
- vomiting
- laxatives
- enemas
- diuretics
- excessive exercise
two types of bulimia nervosa?
purging type - vomiting, laxatives, enemas, diuretics
non-purging type - excessive exercising, fasting
What is bulimia nervosa as defined by DSM
≥ 2x/week for 3 months of recurrent episodes of binge eating + recurrent attempts to compensate for over-eating/prevent weight gain
What type of physical changes may a patient with bulimia nervosa present with? 6
parotid gland enlargement dental erosions/caries callouses/abrasions on dorsum of hand petechiae peripheral adema esophagitis
What type of electrolyte changes may a patient with bulimia nervosa present with? 1
hypochloremic hypokalemic alkalosis
metabolic acidosis (laxative abuse)
increased HCO3, Na, BUN, amylase
decreased Mg/K
What type of hormonal changes may a patient with bulimia nervosa present with? 2
∆ TH, cortisol homeostasis
bulimia nervosa is highly comorbid with…
mood disorders anxiety disorders impulse control disorders substance abuse childhood abuse increased cluster B, C personality disorders
What is IPECAC?
used to cause vomiting
What does anorexia and bulimia nervosa have in common?
at risk of developing CARDIAC ARRHYTHMIAS due to electrolyte disturbances (ie hypokalemia)
prognosis of bulimia nervosa?
chronic relapsing illness, but better prognosis than anorexia nervosa
only SSRI that is FDA-approved for bulimia nervosa
fluoxetine
best treatment for bulimia nervosa?
SSRI (fluoxetine) + group therapy
why do you want to avoid buproprion in bulimics?
lowers seizure threshold!!
What is binge-eating disorder?
patients who binge eat and suffer emotional distress over it but do NOT try to control their weight (via purging or restricting calories) and are NOT fixated on their body shape/weight
Making the binge-eating disorder diagnosis according to DSM
recurrent binge-eating episodes in a 2-hour period
binge-eating occurs at least 2 days/week for 6 months
not associated with compensatory behaviors (vomiting, laxatives, etc)
Treatment for binge-eating disorder?
individual psychotherapy
behavioral therapy
strict diet
exercise program
What can you use to promote weight loss in patients with binge-eating disorder?
1) stimulants (phentermine, amphetamine) to suppress appetite
2) orlistat - inhibits pancreatic lipase, thus decreasing the amount of fat absorbed from the GI tract
3) sibutramine - inhibits reuptake of NE, serotonin, and dopamine
Awakening from what part of the sleep cycle is associated with vivid dream recall?
REM
∆ btwn dyssomnias and parasomnias? Examples of each?
dyssomnias - disorders that make it difficult to fall or remain asleep (insomnia) or excess daytime sleepiness (hypersomnia) that result in insufficient, excessive, or altered timing of sleep
- 1˚ insomnia
- OSA
- narcolepsy
- idiopathic hypersomnia
- kleine-levin syndrome
- circadian rhythm sleep disorder
parasomnias - unusual behaviors or experiences that occur during sleep and is often associated with sleep disruption
- sleep walking
- sleep terror
- nightmare disorder
- REM sleep behavior disorder
What are dyssomnias? 6
disorders that make it difficult to fall or remain asleep (insomnia) or excess daytime sleepiness (hypersomnia) that result in insufficient, excessive, or altered timing of sleep
- 1˚ insomnia
- OSA
- narcolepsy
- idiopathic hypersomnia
- kleine-levin syndrome
- circadian rhythm sleep disorder
What are parasomnias? 4
unusual behaviors or experiences that occur during sleep and is often associated with sleep disruption
- sleep walking
- sleep terror
- nightmare disorder
- REM sleep behavior disorder
What type of sleep disorder is 1˚insomnia
dyssomnia
How is 1˚ insomnia diagnosed (based on DSM)?
difficulty of initiating or maintaining sleep, or non-restorative sleep, for at least 1 month
(note: patients are so preoccupied with getting enough sleep and the fact that they are not doing so further increases their frustration and inability to sleep)