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3a psychiatry > Liaison psych > Flashcards

Liaison psych Flashcards

1
Q

What are eating disorders

A

psychiatric conditions involving an unhealthy and distorted obsession with body image and food

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2
Q

Give 5 features of anorexia nervosa

A
  • bodyweight <15% expected or BMI <17.5
  • bradycardia
  • hypotension
  • enlarged salivary glands
  • lanugo hair
  • amenorrhoea
  • poor insight
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3
Q

Give 4 examples of compensatory behaviour to prevent weight gain in people with eating disorders

A
  • self-induced vomiting
  • laxatives/ diuretic/ diet pill misuse
  • excessive exercise
  • fasting
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4
Q

Give 4 physiological abnormalities that may be seen in patients with anorexia

A
  • hypokalaemia
  • low FSH, LH, oestrogens and testosterone
  • low T3
  • hypercholesterolaemia
  • hypoglycaemia
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5
Q

What type of anaemia is more common in people with anorexia

A

normocytic normochromic anaemia

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6
Q

Based on the DSM 5 criteria, what is needed for a diagnosis of anorexia nervosa

A
  1. Restriction of energy intake relative to requirements leading to a significantly low body weight
  2. Intense fear of gaining weight or becoming fat, even though underweight
  3. Disturbed body image, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
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7
Q

How is anorexia nervosa managed in adults

A

One of:
1. Maudsley Anorexia Nervosa Treatment for Adults
2. Individual ED focused CBT
3. specialist supportive clinical management
* consider potassium supplements

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8
Q

How is anorexia nervosa managed in children

A
  • first line: anorexia focused family therapy
  • 2nd: CBT
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9
Q

Give 3 complications of anorexia

A
  • osteopenia/ osteoporosis
  • female infertility
  • refeeding syndrome
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10
Q

When is inpatient care recommended for anorexia

A

for patients with a body weight <75% expected
and/or significant:
* bradycardia/ hypotension/ hypothermia
* electrolyte disturbance, hypoglycaemia
* psychiatric instability including suicidality.

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11
Q

What is refeeding syndrome

A

a metabolic disturbance which occurs as a result of reinstitution of nutrition in people who are starved or severely malnourished

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12
Q

State 2 factors that put a patient at higher risk of refeeding syndrome

A

The lower the BMI and the longer the period of malnutrition, the higher the risk

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13
Q

What are the metabolic consequences of refeeding syndrome

A
  • hypophosphataemia
  • hypokalaemia
  • hypomagnesaemia
  • abnormal fluid balance
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14
Q

Explain the pathophysiology of refeeding syndrome

A
  • 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
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15
Q

What are the clinical consequences of refeeding syndrome

A
  • Peripheral oedema
  • cardiac dysfunction: impair myocardial contractility -> HF
  • Respiratory Failure
  • Rhabdomyolysis
  • Neurological: confusion, seizures, coma
  • haemolytic anaemia
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16
Q

How is refeeding syndrome managed

A
  • referral to emergency care w continuous cardiac monitoring if severe
  • slowly reintroduce food
  • monitoring electrolytes
  • electrolyte supplementation
17
Q

What is bulimia nervosa

A

involves compulsive uncontrollable binge eating, followed by compensatory behaviour to prevent weight gain

18
Q

Give 5 features of bulimia

A
  • 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.
19
Q

Give 3 signs that may occur due to repeated vomiting in bulimia nervosa

A
  • dental erosion
  • swollen salivary (parotid) glands
  • mouth ulcers
  • Russell’s sign - Calluses on the knuckles or back of hand
20
Q

How is bulimia managed

A
  • 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
21
Q

Give 4 complications of bulimia

A
  • metabolic alkalosis
  • MW tear
  • dehydration
  • arrhythmias
22
Q

What is binge eating disorder

A
  • episodes where the person excessively overeats, often as an expression of underlying psychological distress
  • patients are likely to be overweight.
23
Q

What is illness anxiety disorder (hypochondriasis)

A
  • 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
24
Q

What is somatisation disorder

A
  • 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
25
Q

Describe dissociative disorder

A
  • ‘separating off’ certain memories from normal consciousness
  • psychiatric symptoms e.g. Amnesia, fugue, stupor
26
Q

What is factitious disorder? Give an example

A
  • the intentional production of physical or psychological symptoms
  • diabetic taking too much insulin to cause hypos
27
Q

What is malingering? Give an example

A
  • 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
28
Q

Features of conversion disorder (Functional neurological disorder)

A
  • loss of motor or sensory function
  • patient doesn’t consciously feign the symptoms

3a psychiatry (10 decks)

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