MNT for Psychiatric Disorders Flashcards
The brain is made up of about ___% fat
80
The fatty acid composition of neuronal cell membranes reflects ___ ___
Dietary intake
Essential fatty acids are involved in the synthesis of _____
Neurotransmitters
Effect of nutrients on mental health:
-Support the normal development of the brain and central nervous system
-Maintain structure and function of neurons
-Serve as precursors and cofactors for neurotransmitter production
-Provide an energy source for the brain
-Support mood and sense of well-being
What amino acids are needed for neurotransmitter production?
-Phenylalanine
-Tyrosine
-Tryptophan
-Glutamine
What vitamins are needed for neurotransmitter production?
-B1
-B2
-B3
-B6
-B12
-Folate
What minerals are needed for neurotransmitter production?
-Zinc
-Copper
-Iron
-Iodine
-Selenium
-Magnesium
___ ___ are also needed for neurotransmitter production
Fatty acids
The gut contains about ____ million neurons
100
What are three major neurotransmitters in the enteric nervous system?
-Acetylcholine
-Serotonin
-Norepinephrine
Neural activity in the gut is triggered by receptors responding to what three types of stimuli?
-Mechanical
-Osmotic
-Chemical
Bidirectional information continually passes between the ___ and ___
Gut, CNS
Gut bacteria and byproducts influence brain ____ and ____
Function and behavior
Rapid and abrupt increases in blood glucose can trigger rapid and excessive release of ____, followed by a rapid drop in blood glucose
Insulin
The body compensates for this rapid drop in blood glucose by raising levels of ____ and ____, which can trigger emotional changes and erratic behavior
Epinephrine and cortisol
Reducing ____ carbohydrate and sugar intake can decrease these blood glucose fluctuations considerably
Refined
What are two examples of of Omega-3 Fatty Acids?
-Eicosapentaenoic acid (EPA)
-Docosahexaenoic acid (DHA)
Omega 3 fatty acids are the preferred fatty acids in the ___ and ___ ____
Brain and nervous system
EPA and DHA (omega-3s) may have benefits in the management of…
-Anxiety
-Depression
-Post-partum depression
-Bipolar disorder
-Schizophrenia
Higher intake of fish (high in omega-3) is associated with decreased risk of ____, especially for women
Depression
____ is an essential coenzyme for neurotransmitters (like serotonin) that are potential targets for antidepressant therapies
Thiamin
Vitamin B12 deficiency may be involved in the pathogenesis of…
Depression
Bipolar
Panic disorders
Psychosis
Phobias
Folate deficiency is associated with…
Depression
Schizophrenia
Vitamin D deficiency is associated with…
Major and minor depression in older adults
Iron deficiency is associated with ____
Depression
Magnesium deficiency can cause ____
Anxiety
Selenium deficiency is linked to ____
Depression
____ may reduce depressive symptoms
Zinc
Amino acids are precursors for what three neurotransmitters?
-Serotonin
-Dopamine
-Norepinephrine
____ and ____ are targeted by depression medication
Serotonin and dopamine
Amino acids are precursors for the antioxidant ____
Glutathione
Research suggests that ____ found in plant-based foods are important for normal brain function and mental health
Phytochemicals
____ have antioxidant activity and protect and preserve brain cell structure and metabolism
Flavonoids
What foods contain flavonoids?
-Berries
-Onions
-Kale
-Red cabbage
-Grapes and red wine
-Tea
-Curcumin
-Dark chocolate
-Citrus fruit
What are specific nutrition factors to consider for someone with a psychiatric disorder?
-Increase or decrease in appetite
-Increase or decrease in activity level and therefore calorie requirements
-Use of medications that cause dry mouth, thirst, constipation, and weight change
-Decrease in ability to concentrate, understand, and follow directions
-Altered nutritional needs due to use of alcohol or tobacco
-Possible decrease in ability for self-care such as adequate income, shopping, or meal preparation
-History of comorbid conditions that may have resulted in suboptimal nutritional intake
-Use of nutrition supplements
_____ disorders are the most common type of mental illness in the United States
Anxiety
Common to anxiety disorders are ____ and poorly controlled emotional, somatic, and neurological symptoms triggered by a specific situation
Heightened
The underlying etiology of anxiety is not well understood, but may be related to…
-Genetics
-The stress of an adverse childhood experience can constitute a significant etiologic factor for anxiety that may impact the individual into and throughout adulthood
What are 3 classes of medication that may be used for medical management of anxiety?
-Benzodiazepines
-Selective serotonin reuptake inhibitors (SSRI)
-Serotonin and norepinephrine reuptake inhibitors (SNRI)
What are two examples of Benzodiazepines?
-Alprazolam
-Clonazepam
What are food-drug interactions with Benzodiazepines?
-Avoid concurrent ingestion of alcohol
-Limit/avoid caffeine
What are two examples of selective serotonin reuptake inhibitors (SSRIs)?
-Sertraline
-Fluoxetine
What are food-drug interactions with selective serotonin reuptake inhibitors (SSRIs)?
-May increase appetite and weight
-May cause dry mouth
-Avoid St. John’s Wort
-Avoid alcohol
What is one example of a serotonin and norepinephrine reuptake inhibitor (SNRI)?
Duloxetine
What are food-drug interactions with serotonin and norepinephrine reuptake inhibitors (SNRIs)?
-Avoid St. John’s Wort
-Avoid alcohol
MNT for management of anxiety:
-Eat regularly schedules meals with protein and low glycemic carbohydrates to promote stable blood glucose
-Eliminating caffeine for 3-4 weeks to see if anxiety decreases
-Consider MVI with minerals if dietary intake does not meet the DRI for folate, B12, zinc, magnesium, and vitamin D
-Include dietary sources of omega-3 fatty acids
-Encourage physical activity
Major depressive disorder (MDD) affects ___% of Americans
6.7
What gender is more commonly affected by major depressive disorder?
Women
No definitive ___ of major depressive disorder has been identified
Cause
About ____ of people do not respond adequately to treatment for depression
1/3
What are contributing factors to the development of major depressive disorder?
-Genetics
-Nutrition
-Environmental stressors
-Hormonal disruption (especially in the hypothalamic-pituitary-adrenal axis)
-Alterations in neurotransmitter biology and function (monoamine deficiency theory)
The ___ ____ theory states that deficiency of serotonin, dopamine, and norepinephrine, or altered receptor function, is the main pathophysiologic factor of depression
Monoamine deficiency
What 3 classes of drugs are used for medical management of depression?
-SSRIs
-SNRI
-Norepinephrine-dopamine reuptake inhibitors
What SSRIs are used for treating depression?
-Fluoxetine
-Paroxetine
-Sertaline
What SNRIs are used for treating depression?
-Duloxetine
-Venlafaxine
What is one example of a norepinephrine-dopamine reuptake inhibitor?
-Bupropion
Food-drug interactions with norepinephrine-dopamine reuptake inhibitors:
-May cause increased or decrease appetite and weight
-May cause dry mouth
-May cause taste change
-May cause stomatitis
-N/V
-Take with food to decrease GI irritation
-Limit/avoid alcohol
-Avoid St. John’s Wort
MNT for depression:
-Mediterranean dietary pattern may protect against the development of depressive symptoms later in life and decrease risk of Major Depressive Disorder
-Encourage regular meals and snacks that help maintain blood glucose levels
-Ensure adequate folate, vitamin B12, vitamin D, and omega-3 fatty acid intake (treat deficiencies of B12 or folate)
-Social eating if possible
-Recommend exercise
-Curcumin may be beneficial due to anti-inflammatory effects
-Zinc deficiency may play a role in depression, so treat deficiencies
-Monitor for weight changes
-Assess for food-drug interactions
-Caution must be used if treating depression with St. John’s Wort
Zinc may reduce depressive symptoms by…
-Decreasing dopamine reuptake
-Increasing conversion of thyroid hormone T4 to T3
-Promoting excitatory neurotransmitter function
Why should we use caution if someone is using St. John’s Wort to treat depression?
-Food-drug interactions
-Increases risk of triggering “serotonin syndrome” if patient is taking a SSRI or SNRI
____ ____ causes episodes of an elevated or agitated mood known as mania alternating with episodes of depression
Bipolar disorder
The average age of onset of bipolar disorder is ___ years old
25
There is a genetic component to the development of bipolar disorder, but other factors that trigger the illness include…
-Hormones
-Neurotransmitter abnormalities
-Stress
Medical management of bipolar disease is done with ____
Lithium
Food drug interactions with Lithium:
-A stable, moderate amount of sodium is needed to stabilize lithium levels
-Drink 2-3 liters of fluid/day
-Limit caffeine
-Monitor for weight gain
-Can cause N/V/D
____ is a severe mental disorder that presents as psychosis, often with paranoia and delusions
Schizophrenia
Diagnosis of Schizophrenia requires at least one of the following three symptoms:
-Delusions
-Hallucinations
-Disorganized speech
Symptoms typically appear in ____ during their late teens to early 20s, and in ____ during their 20s to early 30s
Males; females
The ____ of Schizophrenia is poorly understood, but could be a heterogenous disorder generated by a combination of biochemical, genetic, structural, nutritional, and environmental factors, including infections and toxins
Pathophysiology
Medical management of Schizophrenia is a combination of…
-Dopamine-blocking antipsychotic medications
-Antidepressants
-Tranquilizers
What are two examples of dopamine-blocking antipsychotic medications?
-Haloperidol
-Risperidone
Side effects of antipsychotics:
-Dry mouth
-Constipation
-Increased appetite
-Weight gain
Schizophrenia is associated with altered ____
Metabolism
Schizophrenia ____ energy needs
Reduces
Schizophrenia ____ visceral fat
Increases
We should monitor weight in people with Schizophrenia; a weight gain of ___% should trigger assessment for metabolic syndrome
7
We should refer those with schizophrenia to ___ ___ ___ programs as needed
Behavioral weight management
MNT for schizophrenia:
-Recommend regular meal pattern and trial of a low-glycemic, dairy free, Mediterranean diet
-Recommend sources of EPA and DHA (omega 3)
-Rx screening for celiac disease
-Assess for vitamin D and folate deficiency (associated with worse symptoms)
-Assess for food-drug interactions
-Avoid alcohol
We should caution against including ____ in the diet for someone with schizophrenia and it can cause increased blood levels of certain antipsychotic medications
Grapefruit
Addiction involves numerous _____
Neurotransmitters
The production of ____ produces a sense of pleasure
Dopamine
Production of dopamine is triggered by use of…
-Heroin
-Amphetamines
-Marijuana
-Alcohol
-Nicotine
-Cocaine
___ and ____ are also involved in addiction
Serotonin and glutamate
Effects of addiction on nutrition status:
-Poor appetite
-Craving for sugar and sweets
-Constipation
-Lack of motivation to prepare meals
-Malnutrition
Malnutrition in someone with addiction may be due to…
-Insufficient food or nutrient intake
-Alterations in absorption, digestion, metabolism, or excretion of nutrients
____ million people age 12 and up have alcohol use disorder (5.3% of this age group)
14.5
What screening tool is used to identify people at risk for alcohol use disorders?
AUDIT
MNT for alcohol use disorder:
-Assess dietary intake, GI function, risk of malnutrition, and for potential micronutrient deficiencies
-Prescribe biochemical assessment of thiamin, folic acid, magnesium, and selenium
-Rx multivitamin with minerals for 6 months
-Provide nutrition education
In addition to a multivitamin with minerals, what additional supplementation should be given to those with alcohol use disorder?
-Thiamin: 50-100 mg
-Folic acid: 1 mg daily
We should recommend a nutritionally adequate diet with ___-___% of kcal from high quality protein for those with alcohol use disorder
25-30
For those with alcohol use disorder, we should prescribe an omega-3 fatty acid supplement of ___-___ mg/day
800-1000
