Liaison psych Flashcards
What are eating disorders
psychiatric conditions involving an unhealthy and distorted obsession with body image and food
Give 5 features of anorexia nervosa
- bodyweight <15% expected or BMI <17.5
- bradycardia
- hypotension
- enlarged salivary glands
- lanugo hair
- amenorrhoea
- poor insight
Give 4 examples of compensatory behaviour to prevent weight gain in people with eating disorders
- self-induced vomiting
- laxatives/ diuretic/ diet pill misuse
- excessive exercise
- fasting
Give 4 physiological abnormalities that may be seen in patients with anorexia
- hypokalaemia
- low FSH, LH, oestrogens and testosterone
- low T3
- high cholesterol and cortisol
- high glucose and growth formone
What type of anaemia is more common in people with anorexia
normocytic normochromic anaemia
Based on the DSM 5 criteria, what is needed for a diagnosis of anorexia nervosa
- Restriction of energy intake relative to requirements leading to a significantly low body weight
- Intense fear of gaining weight or becoming fat, even though underweight
- Disturbed body image, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
How is anorexia nervosa managed in adults
One of:
1. Maudsley Anorexia Nervosa Treatment for Adults
2. Individual ED focused CBT
3. specialist supportive clinical management
* consider potassium supplements
How is anorexia nervosa managed in children
- first line: anorexia focused family therapy
- 2nd: CBT
Give 3 complications of anorexia
- osteopenia/ osteoporosis
- female infertility
- refeeding syndrome
When is inpatient care recommended for anorexia
for patients with a body weight <75% expected
and/or significant:
* bradycardia/ hypotension/ hypothermia
* electrolyte disturbance, hypoglycaemia
* psychiatric instability including suicidality.
What is refeeding syndrome
a metabolic disturbance which occurs as a result of reinstitution of nutrition in people who are starved or severely malnourished
State 2 factors that put a patient at higher risk of refeeding syndrome
The lower the BMI and the longer the period of malnutrition, the higher the risk
What are the metabolic consequences of refeeding syndrome
- hypophosphataemia
- hypokalaemia
- hypomagnesaemia
- abnormal fluid balance
Explain the pathophysiology of refeeding syndrome
- reintroduction of carbohydrates leads to a shift from fat to carbohydrate metabolism
- This switch activates insulin secretion, which in turn increases cellular uptake of glucose
- the body rapidly shifts electrolytes from the blood into cells to metabolise food
- This can lead to dangerously low levels of electrolytes
What are the clinical consequences of refeeding syndrome
- Peripheral oedema
- cardiac dysfunction: impair myocardial contractility -> HF
- Respiratory Failure
- Rhabdomyolysis
- Neurological: confusion, seizures, coma
- haemolytic anaemia
How is refeeding syndrome managed
- referral to emergency care w continuous cardiac monitoring if severe
- slowly reintroduce food
- monitoring electrolytes
- electrolyte supplementation
What is bulimia nervosa
involves compulsive uncontrollable binge eating, followed by compensatory behaviour to prevent weight gain
Give 5 features of bulimia
- recurrent episodes of binge eating
- a sense of lack of control over eating during the episode
- recurrent inappropriate compensatory behaviour in order to prevent weight gain
- self-evaluation is unduly influenced by body shape and weight.
- the binge eating and compensatory behaviours both occur, on average, at least once a week for three months.
Give 3 signs that may occur due to repeated vomiting in bulimia nervosa
- dental erosion
- swollen salivary (parotid) glands
- mouth ulcers
- Russell’s sign - Calluses on the knuckles or back of hand
How is bulimia managed
- bulimia-nervosa-focused guided self-help
- if above ineffective or CI then individual ED-focused CBT
- children: bulimia-nervosa-focused family therapy
- fluoxetine - decrease binging/ purging
Give 4 complications of bulimia
- metabolic alkalosis
- MW tear
- dehydration
- arrhythmias
What is binge eating disorder
- episodes where the person excessively overeats, often as an expression of underlying psychological distress
- patients are likely to be overweight.
What is illness anxiety disorder (hypochondriasis)
- excessive worry about having or acquiring a serious illness, often with minimal or no physical symptoms
- patient refuses to accept reassurance or negative test results
What is somatisation disorder
- significant distress or impairment due to symptoms that are not fully explained by a medical condition
- multiple physical symptoms present for at least 2 years
- patient refuses to accept reassurance or negative test results
Describe dissociative disorder
- ‘separating off’ certain memories from normal consciousness
- psychiatric symptoms e.g. Amnesia, fugue, stupor
What is factitious disorder? Give an example
- the intentional production of physical or psychological symptoms
- diabetic taking too much insulin to cause hypos
What is malingering? Give an example
- fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
- faking whiplash after a road traffic accident for an insurance payment
Features of conversion disorder (Functional neurological disorder)
- loss of motor or sensory function
- patient doesn’t consciously feign the symptoms
