Last bits: Flashcards
What are the characteristics of anorexia nervosa?
- Distorted body image
- Overvalued idea (fear of fatness)
- BMI <17.5
- Disturbed endocrine function (amenorrhoea)
Who does anorexia typically affect?
12-20y/o women
What is the treatment for anorexia nervosa?
- Education
- CBT
- +/- hospitalisation (beware of refeeding syndrome)
What is refeeding syndrome?
Starting to eat again after a long period of starvation appears to precipitate cardiac failure (usually occurs within 4 days of refeeding). This is due to intracellular low phosphate during starvation but normal blood phosphate (due to catabolism of fat and protein). When refeeding starts insulin is produced which then causes phosphate to go into cells thus causing hypophasphataemia = cardiac failure.
What are the characteristics of bulimia?
- Binging and purging
- Weight low/normal/high
- Morbid dread of fatness
- Self-set low weight threshold
Who does bulimia usually present in?
15-35 y/o women
What is the treatment for bulimia?
- Education - dietician
- CBT
- SSRIs
What would you seen in someone acute alcohol withdrawal and delerium tremens?
8-12 hours: - Tremor - Agitation - N&V - Sweating - Palpitations 36 hours: - Seizures (GCT) 48-72hours (delirium): - Coarse tremor - Confusion - Agitation - Delusions - Auditory and visual hallucinations - Fever - Tachycardia - HTN
What is the management of acute alcohol withdrawal?
1) ABCDE
2) Treat hypoglycaemia
3) Reducing regime of chlordiazopoxide (5-7 days)
4) Carbamazapine or phenytoin (if seizures)
5) Thiamine (Pabrinex)
What does giving thiamine prevent in alcohol withdrawal?
Wernickes encephalopathy and ultimately Korsakoffs syndrome
What is the triad of possible compllications in you don’t give thiamine in alcohol withdrawal?
Wernickes Encephalopathy triad: - Opthalmoplegia - Ataxia - Confusion (+/- nystagmus)
What are two symptoms which may suggest Korsakoffs Syndrome is developing?
- Amnesia
- Confabulation
What is the recommended intake of alcohol per week for men and women?
14 for both
What medications can be used to prevent long term drinking in someone?
Disulfiram - produces an acute sensitivity of ethanol due to inhibition of ADH
Acamprosate - thought to stabilise chemical signalling in the brain that would otherwise be disrupted by alcohol withdrawal
Naltrexone - treats withdrawal symptoms
What questionaries can be used to assess someones drinking habits?
- CAGE
- AUDIT
What symptoms infer alcohol dependence?
(CANT SSTOP) C - Compulsion to drink A - Aware of harms but persists N - Neglecting other activities T - Tolerance of alcohol
S -Stopping=Withdrawal S - Stereotyped pattern T - Time preoccupied by alcohol O - Out of control use P - Persistent desire to cut down
What are personality disorders?
Groups of disorders characterised by rigid, maladaptive traits that cause great distress or an inability to get along with others.
What is the classification of personality disorders?
Cluster A (MAD):
- Paranoid
- Schizoid
- Schizotypal
Cluster B (BAD):
- Antisocial
- *Borderline (unstable moods and relationships)
- Histrionic (attention seeking)
- Narcissistic (self-importance)
Cluster C (SAD):
- Avoidant
- Dependent
- OCD
What is the treatment for personality disorders?
- DBT (Dialectal behavioural therapy)
- Education
What is the management in Delerium tremens?
BZDs +/- haloperidol
What is the triad of Derlerium Tremens?
1) Delirium
2) Visual Hallucinations
3) Tremor
What is Wernickes encephalopathy caused by?
Thiamine deficiency (vitamin B1) due to poor intake/reduced absorption
List 3 physical features of anorexia nervosa:
- Cachexia (weakness/wasting of body)
- Malnutrition
- anaemia
Give 3 physical signs of bulimia nervosa:
- Seizures
- Salivary gland swelling
- Dental carries
- Arrhythmias
What is insomnia?
Condition whereby there is insufficient quality or quantity of sleep (transient or chronic)
What is the management of insomnia?
1) Sleep hygiene education
2) Hypnotics (rarely - only short periods and intermittently)
3) Melatonin
What is psychosexual dysfunction?
Unable to participate in a sexual relationship as they would wish to.
What is the management for psychosexual dysfunction?
- Sex therapy
- Marital therapy/individual therapy
What is transexualism?
A desire to live and be accepted as a member of the opposite sex (transsexual identity has to persist for at least 2 years)
What IQ suggests a learning difficulty?
<70
What can cause the production of learning difficulties?
Any trauma or issues surrounding pregnancy/birth
What is fragile X syndrome?
Common inherited cause of LD - X-linked dominant transmission. Heterozygote female carriers may show no clinical features.
What are 3 features of fragile X syndrome?
- Elongated face
- Large everted ears
- Mitral valve prolapse
What is management of those with learning difficulties?
- MDT
- Special education
- Behavioural approaches
- CBT
What triad of symptoms are typically seen on someone with autism?
- Abnormal reciprocal social interaction
- Communication and language impaired
- Restricted, stereotyped and repetitive repertoire of interests and activities
What management can be used in those with autism?
- Structure, routine and predictability
- Aids to improve communication
- Education
- Behavioural interventions
- Family interventions
- MDT advice
- Meds: AP and/or AD if indicated
What is the difference between Aspergers and autism?
Same symptoms but often normal language and IQ. Associated with depression/BAD.
What is a tic? and what are they usually seen in?
An involuntary recurrent non-rhythmic motor movement (motor tic) or vocal (seen in Tourettes)
What is the treatment for ADHD?
(ADHD=hyperkinetic disorder)
- Support and advice
- Behavioural management/therapy
- Stimulant medication (methylphenidate/ dexamfetamine)
