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Management of neuropsychiatric disorders > Nutrition Psychiatry > Flashcards

Nutrition Psychiatry Flashcards

1
Q

What is malnutrition?

A

A state of nutrition in which deficiency or excess of energy or nutrients causes measurable adverse effects on tissue/body form and function, and clinical outcome

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2
Q

What are the two routes to malnutrition?

A

Insufficient or inappropriate food intake

Appropriate food intake but failures in digestion or metabolism

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3
Q

What are the two major categories of malnutrition?

A

Marasmus - calorie deficiency
Kwashiorkor - protein deficiency

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4
Q

What are the WHO criteria for malnutrition?

A

Number of SDs between observed and expected values for weight and height
-2 moderate malnutrition
-3 severe malnutrition

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5
Q

How does acute starvation affect the CNS?

A

CNS is among the last systems to be affected by
Delirium, encephalopathy, and coma might be seen.

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6
Q

How might chronic malnutrition affect the CNS?

A

Not fatal but might cause long term problems , including neuropsychiatric

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7
Q

What is the complication in understanding nutrition related psychiatry?

A

Disentangling of psychiatric problems from underlying condition and malnutrition (eg not eating due to mania)
Or situation and the malnutrition (eg concentration camps)

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8
Q

How does pyloric stenosis affect psychiatry?

A

Childhood pyloric stenosis associated with short term memory and attentional deficits

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9
Q

What did the Barbados nutrition study show?

A

Over 40 years
Period of protein-energy malnutrition in the first year of life showed:
Attentional deficits
Hyperactivity
Lower IQ
Increased prevalence of learning disability
Subtle motor deficits

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10
Q

Why does alcohol cause thiamine deficiency?

A

Affects both absorption and metabolism

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11
Q

What percentage of alcoholics are thiamine deficient?

A

30%

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12
Q

What other conditions might cause thiamine deficiency?

A

Associated with protracted vomiting
Anorexia/bulimia
Hyperemesis gravidarum

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13
Q

How does beriberi affect the nervous system?

A

Dry beriberi - peripheral nerve damage, muscle wasting, sensory and motor deficits

(Wet beriberi is dominated my cardiac failure and oedema)

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14
Q

How does Wernicke’s encephalopathy present?

A

Classic triad:

Confusion
Cerebellar ataxia
Ophthalmoplegia

But more variable than this: look for any acute change in mental status

Fatal if untreated

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15
Q

How is WE treated?

A

High dose parenteral thiamine.

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16
Q

What is the prognosis for WE?

A

85% of survivors of alcoholic WE progress to Korsakoff syndrome.

Outcomes are better in non-alcoholic WE

17
Q

What is the rehabilitative outlook for Korsakoff’s syndrome?

A

No evidence for rehabilitation

18
Q

What areas of the brain does WE affect?

A

Mammillary body atrophy to point of absence (still normal in 20%)

Thalamus
Superior colliculi
Cerebellar vermis
Pons, medulla, brainstorm
Walls of third ventricle

19
Q

How does Korsakoff syndrome present?

A

Chronic amnesia
Confabulation

Not treatable and requires long term care

20
Q

What are the postulated syndromes of cerebral folate deficiency

A

Autistic
Schizophrenic
Spastic ataxic
Epileptic

21
Q

In what groups might you see scurvy?

A

Severe self neglect (dementia)
Refugee populations

22
Q

What neuropsychiatric disorders is vitamin d deficiency associated with?

A

Depression
Schizophrenia
Parkinsonism
Dementia

(Reverse causality?)

23
Q

How does calcium deficiency affect the nervous system?

A

Neuromuscular hyperexcitability triad:
Spasm
Tetany
Hyperreflexia

Depression and acute confusion states

24
Q

What other deficit matches calcium deficiency in presentation?

A

Magnesium

25
Q

What neuropsychiatric disorders is iron deficiency associated with?

A

Autism
ADHD
Depression
Mood disorders

26
Q

What nutrients might be used as treatments for neuropsychiatric disorders?

A

B vitamins might reduce symptoms in schizophrenia

27
Q

What are the 4Ds associated with niacin deficiency?m (pellagra)?

A

Dermatitis
Diarrhoea
Dementia (psychiatric symptoms generally)
Death

28
Q

What is the function of B12 in the nervous system

A

Myelin production

29
Q

How might B12 present neurologically?

A

Early sign: loss of vibration sense

Later stage: Subacute combined degeneration of the spinal cord

Management of neuropsychiatric disorders (22 decks)

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