Management Flashcards
Highest incidence of anorexia?
15-19
What mental disorder has the highest mortality rate?
Anorexia
Risk assessment for anorexia?
MARSIPAN
Anorexia in adults tend to look at their ______ for health
BMI
What is Waterloo scale?
Pressure ulcer prevention for bed ridden patients
Refeeding syndrome in anorexia
Potentially fatal metabolic response to too rapid re-feeding after a period of starvation
7-14 days after
When does referring syndrome happen?
Body switches from carbohydrates to fats and protein as its energy source
What happens cellularly to cause reseeding syndrome?
Intracellular minerals become depleted but serum levels may remain normal - referring stimulates insulin production which causes potassium/magnesium and phosphate to be taken into the cells whilst serum levels fall - rapid change in BMR contributes as well
Supplement to avoid refeeding
Multivitamine - forceval
Thiamine
CBT
Cognitive behavioural therapy
Bulimia treat
CBT
Fluoxetine
ICD definition of adult personality disorders
Individuals characteristic and enduring patterns of inner experience and behaviour deviate markedly as a whole from the culturally expected and accepted range
Personality disorders need to be ________
Pervasive - present across time, maladaptive or dysfunctional
Anankastic definition
Arising from compulsion especially in an obsessive or compulsive neurosis
Traits vs an actual disorder
It is only a disorder if it is:
Pervasive
Causes distress
Causes impairment of functioning in most areas
How do you diagnose a personality disorder?
Clinical
Rating scale for borderline personality disorder
ZANBPD
What % of personality disorders have genetic heritability?
60%
Anxious personality genetic
69%
What proportion of people in general population have a personality ‘disorder’?
10.6%
1/_ psychiatric outpatients have a personality disorder
3
Cluster A personality disorders AKA
Odd and eccentric
What makes up cluster A personality disorders
Paranoid, Schizoid
Paranoid PD features
Excessive sensitivity to setbacks
Tendency to bear grudges
Suspiciousness and tendency to misconstrue the neutral/friendly actions of others as hostile
Suspiciousness regarding sexual infidelity of partner
Persistent self-referential attitude, excessive self-important
Schizoid disorder features
Few activities provide pleasure
Emotional coldness, detachment, or flattened affectivity
Limited capacity to express warm feelings for others
Solitary activities
Fantasy
No close friends
Insesntivity to social normas/conventions
Schizoid PD has overlap with
Autism
Schizotypal PD
Delusions Odd beliefs or magical thinking Unusual perceptual experiences Odd thinking and speech Suspiciousness or paranoid Odd behaviour Lack of close friends Social anxiety
Example of someone with Schizotypal PD
Willy Wonka
Cluster B PD
Dramatic and emotional
Types of cluster B
Dissocial
Anti-social
Narcissism
Dissocial PD needs
Callous unconcern for feelings of others Irresponsible and disregard for social norms/rules/obligations No guilt No relationships Low tolerance for frustration
Dissocial person example
Grinch
2 factors of psychopathy
Interpersonal/affective
Social deviation
2 parts of interpersonal psychopathy
- interpersonal (superficial charm, pathological lying, manipulative)
- affective (lack of remorse or guilt, lack of empathy, failure to accept responsibility)
2 parts of social deviance of psychopathy
- lifestyle (need for stimulation, prone to boredom, parasitic lifestyle, lack of realistic long term goals, irresponsible/impulsive)
- antisocial (poor behavioural controls, juvenile delinquency, criminal versatility)
Emotionally unstable PD - impulsive features
Tendency to act unexpectedly, without consideration of consequences
Liability to outbursts of anger or violence
Unstable mood
Difficulty in maintaining any course of action that offers no immediate reward
Borderline PD features
2+ of: Disturbances in and uncertainty about self-image aims and internal preferences (including sexual) Intense and unstable relationships Emotional crises Efforts to avoid abandonment Threats or acts of self-harm Emptiness
Borderline personality disorder are like people with third degree burns over 90% of their bodies. What does this mean?
Lack emotional skin, they feel agony at the slightest touch or movement
Histrionic PD features
Excessive attention-seeking behaviours
Shallow
Continually seeks excitement and activities in which the subject is the centre of attention
Inappropriately seductive
Overly concerned with physical attractiveness
Example of someone with histrionic PD
Regina George
Nacissistic personality disorder personality traits
Fixation with fantasies of infinite success, control, brilliance, beauty, or idyllic love Desire for unwarranted admiration Sense of entitlement No form of empathy Resentment of others Egotistical
Example of someone with narcissistic PD
Walter white
Cluster C personality disorders
Anxious and avoidant
Anankastic PD features
OCD like
Perfectionism
Excessive doubt and caution
Preoccupation with details, rules, lists, order, organization or schedule
Stubbornnes
Unreasonable insistence that others submit to exactly his or her way of doing things
Anankastic PD person example
Monica Gellar
Anxious PD features
Persistent pervasive feelings of tension/apprehension
Belief that oneself is socially inept/inferior to others
Unwillingness to get involved with people unless certain of being liked
Restrictions in lifestyle because of need of security
Dependent PD
Encouraging or allowing others to make most of one’s important life decisions
Unwillingness to make even reasonable demands on the people one depends on
2 cluster A, B, and C PDs
A: schizoid, paranoid
B: histrionic, dissocia
C: anankastic, avoidant
Do you treat a PD pharmacologically?
NO - will not cure and could be harmful
Use of antipsychotic drugs in PD?
Can reduce suspiciousness of the three cluster A
Examples of antipsychotic drugs
Olanzapine, haloperidol
Antidepressants in PD?
Cluster B - mood and emotional difficulties
Cluster C - anxiety disorders
Examples of mood stabilizers
Lamotrigine
Treat difficulties with impulse control
SSRI
Affective dysregulation treat
SSRI
Cognitive perceptual symptoms
Low dose antipsychotic
What is SSRI?
Serotonin reuptake inhibitor
Antidepressant
Goal of dialectical behavioural therapy ?
Learning to accept and regulate emotions
What is STEPPS?
Systems training for emotional predictability of problem solving
CBT based skills training programme focussed on stabilization
