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Psychiatry > Neurotic disorders > Flashcards

Neurotic disorders Flashcards

1
Q

What are the features of anorexia nervosa? (4)

A

Markedly low weight: BMI< 17.5
Weight loss self induced by: restriction, exercise, vomiting
Cognitive distortions: “too fat”, fear of fatness
Endocrine disturbance: Amennorrhoea, Loss of libido

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2
Q

Define OCD. (2)

A

Obsessive compulsive disorder is an anxiety disorder in which the patient suffers from time-consuming obsessions and compulsions that interfere with everyday life.

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3
Q

Name 2 other psychiatric disorders that are associated with OCD. (2)

A

Anankastic personality disorder
Depression
Tourettes syndrome

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4
Q

Describe 3 features of the compulsions and obsessions experienced in OCD. (3)

A 
Acknowledged as originating in the mind
persistent, repetitive and intrusive
patient tries to resist them
Not intrinsically pleasurable
Cause distress and interfere with functioning
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5
Q

Define compulsions. (2)

A

Stereotyped acts, recognised as excessive, unreasonable or exaggerated. If patient tries to resist there is a sense of mounting tension that is immediately relieved by performing compulsion.

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6
Q

What is the management of OCD? (2)

A

CBT

Clomipramine or SSRIs

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7
Q

Define obsession. (2)

A

Persistent thoughts, images, doubts or impulses. Common content include contamination, bodily fears, aggression, orderliness/symmetry.

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8
Q

What supplementary questions should be asked in a psychiatric history relating to eating disorders? (4)

A 
Weight
 - current weight
 - how often do you weigh yourself
 - what has your weight been like in the past (high and low)
Eating
 - What do you eat on a normal day
 - Are you dieting at the moment?
 - Do you ever binge eat?
 - Do you think about food a lot?
 - Do you try any other methods of losing weight?
 - Do you ever make yourself sick?
 - Do you take laxative/diuretics?
Body image
 - How do you see yourself?
 - Do you feel fat?
 - What would your ideal weight be?
 - Are you dissatisfied with particular parts of your body?
Physical problems associated with weight loss
 - Are your periods regular?
 - Are you interested in sex?
 - Do you feel tired and weak?
 - Do you suffer from dizziness?
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9
Q

What are the diagnostic criteria for anorexia nervosa? (4)

A 
Low body weight: 
 ->15% below expected / BMI < 17.5
 -Weight loss self induced
 -Avoidance of eating
 -Vomiting
 -Purging
 -Excessive exercise
 -Use of appetite suppressants, diuretics, laxatives
Body image distortion
 -Over-valued idea of fatness, fear of being fat
Endocrine disorders
 -Amenorrhoea
 -Reduced libido
 -Raised GH levels, raised cortisol, altered TFTs, abnormal insulin secretion
 -Delayed or arrested puberty.
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10
Q

Name 3 predisposing/precipitating factors for anorexia nervosa. (3)

A

Bio
Genetics (65% concordance in MZ twins)

Psycho
Family: over-protectiveness, lack of conflict resolution, weak generational boundaries
Individual: disturbed body image due to dietary problems in early life, parents’ preoccupation with food, lack of sense of identity, low self-esteem

Social
Pressure from peers
Occupation: ballet dancers or models
Higher socio-economic groups
Western caucasians
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11
Q

Name 6 physical consequences of anorexia. (6)

A

Oral: dental caries
CV: hypotension, prolonged QT, arrhythmias, cardiomyopathy
GI: prolonged GI transit, constipation
Endo: hypokalaemia, hyponatraemia, hypoglycaemia, hypothermia, altered thyroid function, hypercortisolaemia, amenorrhoea, arrested growth, delayed puberty, osteoporosis
Renal: Calculi
Repro: infertility
Derm: dry skin, brittle hair, lanugo (fine body hair)
Neuro: peripheral neuropathy, loss of brain volume, ventricular enlargement, cerebral atrophy
Haem: anaemia, leucopenia, thrombocytopenia

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12
Q

Name 4 investigations you would perform in a girl diagnosed with anorexia. (4)

A

ECG
BMI
FBC – anaemia, leucopenia, thrombocytopenia
ESR – normal or reduced (if elevated look for organic cause)
U&Es – high U&Cr if dehydrated, hyponatraemia from excessive water intake or SIADH, metabolic alkalosis from vomiting, metabolic acidosis from laxative abuse.
Glucose – low (prolonged starvation, low glycogen stores)
LFTs – minimal elevation
TFTs – low T3, T4, sick euthyroid syndrome
Cholesterol – may be dramatically elevated (starvation)
Endocrine – hypercortisolaemia, high GH levels, low LHRH/LH/FSH/oestrogens/progesterone

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13
Q

Name 3 differentials for anorexia. (3)

A 
Organic
 -Brain tumour
 -GI disorder: Crohns, malabsorption syndrome
 -Loss of appetite eg side effects of SSRIs
(Psychotic- none)
Mood disorder
 -Depression
Neurotic disorder
 -OCD
(Personality disorder- none)
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14
Q

What is the management for anorexia? (3)

A

Pharmacological:
Fluoxetine
Feeding

Psychological:
Family therapy
Individual therapy eg CBT

Education
Nutritional education can challenge over valued ideas

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15
Q

What are the criteria for hospitalisation in anorexics? (3)

A 
Extremely rapid or excessive weight loss
Severe electrolyte imbalance
Serious physiological complications
Cardiac complications
Marked change in mental status
Psychosis or risk of suicide
Failure of outpatient treatment
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16
Q

What is the main risk of re-feeding and how can it be avoided? (3)

A

Risk of cardiac decompensation

  • Myocardium cannot withstand stress of increased metabolic demand
  • Symptoms: excessive bloating, oedema and CCF

Minimise risk:

  • Measure U&Es and correct imbalance before feeding
  • Recheck every 3 days for first 7 days and then weekly
  • Increase caloric intake slowly by 200-300kcal every 3-5 days until sustained weight gain of 1-2lb/week
  • Monitor regularly for tachycardia or oedema.
17
Q

What is the prognosis for anorexia? (2)

A 
Untreated – 10-15% mortality
Treated – rule of thirds
 1/3 full recovery
 1/3 partial recovery
 1/3 chronic problems
18
Q

Name 3 poor prognostic features for anorexia. (3)

A 
Late age of onset
Bulimic features
Poor parental relationships
Males
Excessive weight loss
Anxiety when eating with others
19
Q

What is bulimia nervosa? (2)

A

Characterised by recurrent episodes of binge eating, with compensatory behaviours and overvalued ideas about “ideal” body shape and weight.

Often may have history of anorexia nervosa or obesity and body weight may be normal.

20
Q

What are the diagnostic criteria for bulimia nervosa? (3)

A

Persistent preoccupation with eating
Irresistible craving for food
“Binges” – episodes of overeating
Attempts to counter the fattening effects of food
Self-induced vomiting, purgatives, starvation, use of drugs
Morbid dread of fatness with imposed low weight threshold.

21
Q

What are the differentials for bulimia? (3)

A 
Organic: 
 -Upper GI disorder
 -Brain tumour
 -Drug related increased appetite
Psychotic - none
Mood
 -Depressive disorder
Neurotic
 -OCD
Personality disorder
22
Q

What is the management for bulimia? (3)

A

Pharmacological
SSRIs – Fluoxetine

Psychological
CBT best evidence
Guided self help
Interpersonal psychotherapy

23
Q

What are the SCOFF questions? (5)

A

Screening tool for eating disorders in primary care
2 yes answers indicates need for detailed history

Do you make yourself Sick when you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone in a 3 month period?
Do you believe yourself to be too Fat when others say you are too thin?
Would you say that Food dominates your life?

24
Q

Name 3 complications of anorexia. (3)

A 
Osteoporosis
cardiac arrhythmias
Renal failure
Pancreatitis
Hepatitis
Seizures
Peripheral neuropathies
Suicide
25
Q

Name 3 psychiatric differentials for an anxious patient. (3)

A 
Generalised anxiety disorder
Panic disorder
Phobias
OCD
PTSD
Acute stress reaction
Depression
Substance misuse (especially withdrawal)
Personality disorder
Dementia
26
Q

Name 3 medical differentials for an anxious patient. (3)

A

Hypoglycaemia
Hyperthyroidism
Phaeochromocytoma
Delirium

27
Q

What is agoraphobia? (2)

A

Anxiety associated with places or situations from which escape may be difficult eg crowds, public places, travelling alone, being away from home.
Often associated with avoidance.

28
Q

Name 4 anxiety symptoms. (4)

A 
Palpitations
Sweating
Shaking
Dry mouth
Difficulty breathing
Chest pain
Nausea
Dizziness
Hot flushes
Fear of losing control
Fear of dying
29
Q

What is social phobia? (2)

A

Persistent fear of social situations that may lead to scrutiny, criticism or embarrassment.

30
Q

How is social phobia managed? (2)

A

Graded exposure and desensitisation
CBT
SSRIs

31
Q

Define generalised anxiety disorder? (2)

A

Persistent and generalised anxiety, not restricted to or predominanting in any particular circumstances.

Symptoms should be present most days for at least several weeks at a time.

32
Q

What symptoms are associated with generalised anxiety disorder? (3)

A

Symptoms should be present on most days for several weeks at a time.
Symptoms should involve elements of;
-apprehension
-motor tension (restless, fidgeting, tension headaches)
-autonomic over-activity

33
Q

How can generalised anxiety disorder be treated? (2)

A

Anxiety management: psychoeducation, distraction techniques, breathing/relaxation techniques
Benzodiazepines short term
SSRI or venlafaxine can be useful.

34
Q

Describe a specific phobia. (3)

A

Persistent fear of a specific object or situation that is out of proportion to the threat. The fear is recognised as excessive but cannot be reasoned away.

35
Q

What is the management of a specific phobia? (2)

A 
Systematic desensitisation (relaxation therapy with graded exposure)
Use of benzodiazepines is sometimes helpful in short term to help patient engage with desensitisation.

Psychiatry (8 decks)

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