Mental Health Flashcards
Whenever reviewing someone who has presented with weight loss, what is it important to do?
Carry out a full history.
Weight loss could in be caused by many different things and so it is important to take a full history
What conditions can cause rapid weight loss other than Anorexia Nervosa?
Coeliac disease
Type 1 diabetes mellitus
Hyperthyroidism
Malignancy
Inflammatory bowel disease
Oesphageal problems eg achalasia
Severe depression/OCD/autism
Juvenile arthritis
Addisons
What is lanugo hair?
This is hair that develops when the body experiences rapid weight loss. It is a way of keeping the body warm following the rapid loss of fat insultation.
What is the short term management for a patient with Anorexia Nervosa?
Measure weight for height ratio (bit different to BMI)
- if this is less than 75%, start Thiamine, Vitamin B complex and Multivitamins
Diet plans (to help gain weight), monitor bloods, repeat ECGS
Only discharge when stable
Who is part of the MDT for children with Anorexia Nervosa and what does each do?
Psychiatrist - to help diagnose the underlying mental illness
Prescribe medications to treat underlying mental illness or comorbidities
Paediatrician - Also to monitor health, using different scans and tests
Dietician - help with weight gain journey
Therapists - to help with thought processes
What are the two most common eating disorders in adolescents?
Anorexia Nervosa and Bulimia
What is the Weight-for-Height Ratio?
A method of calculating whether a childs weight is appropriate for their height. This is used instead of BMI in younger people.
What are the clinical features of Anorexia Nervosa?
Wearing oversized clothing OR wearing fitted clothing to exaggerate appearances
Lanugo hair
Rough or scaly skin
Bradycardia and hypothermia
Decreased BMI - underweight
Acrocyanosis of the hands and the teeth
What are the risk factors of Anorexia Nervosa?
Familial
Personality traits
Previously overweight
Affective disorders
Psychiatric disease
What can help with the diagnosis of Anorexia Nervosa?
The patient could demonstrate any of the below diagnostic criteria:
- Intense fear of gaining weight despite being incredibly underweight.
- Denial of the seriousness of the low body weight—a disturbance in the way in which one’s body weight or shape is experienced
- Amenorrhoea in postmenarche females
- Refusal to maintain body weight at or above a minimally normal weight for age and height - this means they want to be thinner or smaller than the smallest expected amount for the height and weight of their age.
What is Thiamine used for?
B1 deficiency in children with Anorexia Nervosa
(Unrelated!! but also those with Wernicke’s Encephalopathy in Alcohol Withdrawal)
What questions should you consider in a child who is presenting with Behavioural Issues?
Ask about members of the family and if the px gets on with the others?
What is giving the impression that the px has behavioural problems?
TED and SOCRATES - e.g. onset of the problems, describe the problems, what makes it worse or better, when is it seen most, how much is it affecting every everyone?
Stresses around the start of the problems or current stresses?
ICE - from guardians and px themselves
Development and Progression
What is the clinical diagnosis of Autism Spectrum Disorder?
It is impaired social interaction and communication, seen with stereotyped behaviours, interests and activities.
How many times more likely are males to get Autism in comparison to females?
4 times more likely
Which 4 mental conditions all come under the general umbrella of Autism Spectrum Disorder?
Autism
Aspergers Syndrome
Childhood Disintegrative Disorder
Pervasive Developmental Disorder
At what age is Autism Spectrum Disorder expected to be seen in children?
<5 years old
What is the main aetiological factor of Autism Spectrum Disorder (ASD)?
Genetics
What are the clinical features of Autism Spectrum Disorder?
Markedly impaired social interaction and social communication
Delays in responding to social cues like smiling and speaking
Continuous repetitive behaviours, interests and activities
Meltdowns
ADHD - in some cases
Some have learnign disabilities; others are genuises
How is Autism Spectrum Disorder investigated?
ASD screening programmes
- CARS, CAST and MChAT
How is Autism Spectrum Disorder treated/managed?
Improving their ability to function independently
Using pharmacology to treat the mental conditions that surface as a result of the disease
Non-pharmacological treatment - education and early behavioural interventions
What is Attention Deficit Hyperactivity Disorder (ADHD)?
Chronic neurobehavioral disorder characterised by inattention, hyperactivity, impulsivity, or a combination of these symptoms.
At what age is ADHD usually identified?
Between 3 - 7 years old
Which three clinical features are characteristic of ADHD?
Inattention
Hyperactivity
Impulsiveness
How is ADHD diagnosed?
It is usually diagnosed based on clinical history taking and reports from the childs parents, guardians and teachers.
What is the Connor’s Rating Scale?
A questionnaire assessing academic, behavioural & social issues in young people (6-18 years old
What are some differentials for inattention and hyperactivity?
Hyperthyroidism
Sleep disorders
Seizure disorder
Substances Use
Genetic Disorders - Digeorge syndrome and Neurofibromatosis
How long is the “wait and watch” phase after a positive diagnosis of ADHD in a child?
10 weeks
Are medications used to treat children with ADHD?
It is not advised to use medication in children unless it is the last resort and the child is older than 5 years old
What are the pharamcological treatments of ADHD?
(when meds are actually used)
Methylphenidate and Amphetamines
Methylphenidate is also known as Ritalin
What is the MAIN side effect to look out for in medications for ADHD?
Cardiotoxicity - make sure to get an ECG before starting the medications. Refer the px to Cardiology if there is a past medical hx or family hx of heart disease
What are the important things to look out for in a Mental State Exam?
Appearance - clothing, weight, scars, objects
Behaviour - engagement and rapport, eye contact, facial expressions
Speech - rate, quanity, tone etc
Mood and Affect
Thoughts
Perceptions and Cognitions
Insight and Judgement
How do you assess suicidal thoughts in a person?
Ask directly about suicidal thoughts
have they attempted?
If they have, what prevented them from going through with it
If they haven’t, whats stopping them from wanting to?
How often do they have suicidal thoughts?
What is Conduct Disorder?
A repetitive and persistent pattern of dissocial, aggressive or defiant behaviour.
What is Somatisation?
The manifestation of psychological distress by the presentation of physical symptoms.
