Nutrition Psychiatry Flashcards
What is malnutrition?
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
What are the two routes to malnutrition?
Insufficient or inappropriate food intake
Appropriate food intake but failures in digestion or metabolism
What are the two major categories of malnutrition?
Marasmus - calorie deficiency
Kwashiorkor - protein deficiency
What are the WHO criteria for malnutrition?
Number of SDs between observed and expected values for weight and height
-2 moderate malnutrition
-3 severe malnutrition
How does acute starvation affect the CNS?
CNS is among the last systems to be affected by
Delirium, encephalopathy, and coma might be seen.
How might chronic malnutrition affect the CNS?
Not fatal but might cause long term problems , including neuropsychiatric
What is the complication in understanding nutrition related psychiatry?
Disentangling of psychiatric problems from underlying condition and malnutrition (eg not eating due to mania)
Or situation and the malnutrition (eg concentration camps)
How does pyloric stenosis affect psychiatry?
Childhood pyloric stenosis associated with short term memory and attentional deficits
What did the Barbados nutrition study show?
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
Why does alcohol cause thiamine deficiency?
Affects both absorption and metabolism
What percentage of alcoholics are thiamine deficient?
30%
What other conditions might cause thiamine deficiency?
Associated with protracted vomiting
Anorexia/bulimia
Hyperemesis gravidarum
How does beriberi affect the nervous system?
Dry beriberi - peripheral nerve damage, muscle wasting, sensory and motor deficits
(Wet beriberi is dominated my cardiac failure and oedema)
How does Wernicke’s encephalopathy present?
Classic triad:
Confusion
Cerebellar ataxia
Ophthalmoplegia
But more variable than this: look for any acute change in mental status
Fatal if untreated
How is WE treated?
High dose parenteral thiamine.
What is the prognosis for WE?
85% of survivors of alcoholic WE progress to Korsakoff syndrome.
Outcomes are better in non-alcoholic WE
What is the rehabilitative outlook for Korsakoff’s syndrome?
No evidence for rehabilitation
What areas of the brain does WE affect?
Mammillary body atrophy to point of absence (still normal in 20%)
Thalamus
Superior colliculi
Cerebellar vermis
Pons, medulla, brainstorm
Walls of third ventricle
How does Korsakoff syndrome present?
Chronic amnesia
Confabulation
Not treatable and requires long term care
What are the postulated syndromes of cerebral folate deficiency
Autistic
Schizophrenic
Spastic ataxic
Epileptic
In what groups might you see scurvy?
Severe self neglect (dementia)
Refugee populations
What neuropsychiatric disorders is vitamin d deficiency associated with?
Depression
Schizophrenia
Parkinsonism
Dementia
(Reverse causality?)
How does calcium deficiency affect the nervous system?
Neuromuscular hyperexcitability triad:
Spasm
Tetany
Hyperreflexia
Depression and acute confusion states
What other deficit matches calcium deficiency in presentation?
Magnesium
