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Management of Disorders > Nutritional Psychiatry > Flashcards

Nutritional Psychiatry Flashcards

1
Q

What is malnutrition?

A

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

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2
Q

What are the two main routes to malnutrition?

A
  1. Insufficient or inappropriate food intake
  2. Normal intake but failures of digestion or metabolism
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3
Q

What are the two main categories of malnutrition?

A
  1. General malnutrition/calorie deficiency
  2. Deficiency of specific nutrients (e.g. protein)
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4
Q

What is kwashiorkor and what are it’s main features?

A

A protein deficiency, characterised by moon face, swollen legs, swollen abdomen, flakey skin, sparse hair, thin muscles but still fat present, little interest in surroundings

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5
Q

What is marasmus and what are it’s main features?

A

A calorie deficiency, characterised by very underweight body, old appearance, thin limbs with little muscles or fat

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6
Q

Can an individual have both kwashiorkor and marasmus?

A

Yes! - marasmic kwashiorkor

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7
Q

How does the Waterlow criteria (1972) classify malnutrition?

A

Height and weight compared to population norms

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8
Q

How does the WHO criteria (1999) classify malnutrition?

A

Number of SDs between observed and expected weight and height (-2 = moderate, -3 = severe)

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9
Q

What is chronic malnutrition?

A

Sustained, long-term malnutrition that is not severe enough to cause death but can lead to a variety of long-term problems, including neuropsychiatric

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10
Q

In acute starvation, when does the CNS usually become affected?

A

In the later stages

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11
Q

What might you see prior to coma in acute starvation?

A

Delirium and encephalopathy

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12
Q

What is the major challenge when investigating the neuropsychiatric sequelae of malnutrition?

A

Interpretation difficulties - most illnesses or situations that lead to malnutrition are very unpleasant so it can be difficult to tell which psychiatric effects are directly related to the malnutrition itself.

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13
Q

What is pyloric stenosis?

A

A condition where the pylorus muscles thicken, narrowing the passage between the stomach and the small bowel. This prevents food from passing through, leading to vomiting

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14
Q

What neuropsychiatric problems have been found to be associated with pyloric stenosis?

A

Short-term memory and attentional deficits

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15
Q

What was the Barbados Nutrition Study?

A

A 40 year longitudinal study following individuals with normal birth weight but a period of protein-energy malnutrition in first year of life

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16
Q

What did the Barbados Nutrition Study find early malnutrition was associated with in later life?

A

Mainly attentional deficits anf hyperactivity, but also lower IQ, increased prevalence of LD, and subtle motor deficits

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17
Q

What are macronutrients?

A

Nutrients we need in larger amounts such as proteins, fats, and carbohydrates

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18
Q

What are micronutrients?

A

Nutrients we need in small amounts such as vitamins, minerals, and trace elements

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19
Q

What category of vitamins is most relevant in psychiatry?

A

B vitamins

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20
Q

What is B1 and which foods are rich in it?

A

Thiamine - green peas, tomatoes, sunflower seeds, spinach, squash, brussel sprouts

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21
Q

How much thiamine is absorbed normally if taken orally?

A

~10%

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22
Q

What is thiamine (B1) deficiency associated with?

A

Alcohol dependency (~30% of alcoholics)

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23
Q

Why is thiamine deficiency associated with alcohol dependency?

A

Alcohol compromises the absorption and utilisation of thiamine (~1%), likely exacerbated by poor diet

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24
Q

What conditions, aside from alcohol dependency, have also been linked with thiamine deficiency?

A

Morning sickness (hyperemesis gravidarum) and malabsorption conditions that lead to protracted vomiting

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25
Q

What is Beriberi?

A

A condition caused by thiamine deficiency, characterised by weakness, lack of energy, myalgia and cardiac problems

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26
Q

What are of the nervous system is primarily affected in Beriberi?

A

The peripheral nervous system

27
Q

What are the main features of ‘wet’ Beriberi?

A

Cardiac failure, lower limb oedema, and lactic acidosis

28
Q

What are the main features of ‘dry’ Beriberi?

A

Neurological features such as peripheral nerve damage, sensory and motor deficits, and muscle wasting

29
Q

Deficieny in which nutrient is associated with Wernicke’s Encephalopathy?

A

Thiamine (B1)

30
Q

What is the classic triad of acute presentation Wernicke’s encephalopathy?

A
  1. Confusion
  2. Cerebellar ataxia
  3. Opthalmoplegia (eye muscle weakness)
31
Q

Why might Wernicke’s encephalopathy be hard to spot?

A

It’s presentation resembles being very drunk and only 30-40% present with the triad

32
Q

How is Wernicke’s encephalopathy treated?

A

High dose parenteral (IV) thiamine

33
Q

Which subtype of Wernicke’s encephalopathy has the best prognosis?

A

non-alcoholic WE

34
Q

Is Wernicke’s encephalopathy reversible?

A

Yes, if treated quickly enough

35
Q

Is high dose IV thiamine safe if not thiamine deficient?

A

Yes!

36
Q

What percent of alcoholic WE survivors develop Korsakoff syndrome?

A

85%

37
Q

Which brain areas are preferentjly affected in Wernick encephalopathy?

A

The mammillary bodies, as well as the thalamus, brainstem, and cerebellar vermis

38
Q

Which brain areas are typically unaffected by Wernicke’s encephalopathy?

A

The cortex

39
Q

What is Korsakoff syndrome?

A

A chronic amnestic state caused by severe thiamine deficiency and alcoholism, typically arising from untreated Wernicke’s encephalopathy

40
Q

What is the characteristic symptom of Korsakoff syndrome?

A

Confabulation - undeliberately generating false memories to fill in the gaps

41
Q

Is Korsakoff syndrome treatable with thiamine?

A

No, they will likely just need long-term specialist care

42
Q

What is the primary neurological finding in Korsakoff syndrome?

A

Atrophy of the mammillary bodies, seen in 80% of patients. The whole brain may also be atrophic

43
Q

What is vitamin B3?

A

Niacin

44
Q

What is Pellagra?

A

A disease caused by niacin deficiency

45
Q

What are the four D’s of Pellagra?

A
  1. Dermatitis
  2. Diarrhoea
  3. Dementia (variable psychiatric symptoms)
  4. Death
46
Q

What type of diet is associated with niacin deficiency?

A

A maize-based diet (caused a public health crisis in early 1900s America)

47
Q

How do we prevent niacin deficiency?

A

Food is now routinely fortified with niacin

48
Q

What foods are rich in niacin (B3)?

A

Poultry, meat, mushrooms, tomatoes, potatoes, liver, fish, peanuts, spinach

49
Q

What is B12 associated with?

A

Myelin production (alongside B9/folate)

50
Q

What symptoms might you get with B12 deficiency?

A

▪️ Loss of vibration sense
▪️ Subacute combined degeneration of spinal cord

51
Q

What is subacute combined degeneration of the cord?

A

▪️ Thinning of spinal cord
▪️ Dorsal and lateral columns
▪️ Sensory disturbance (tingling, numbness)
▪️ Untreated = motor deficits such as spasticity, paraplegia, ataxia

Potentially reversible with B12!!

52
Q

Why is there a current rise in cases of young, healthy people with subacute combined degeneration of the cord?

A

Nitrous oxide (NOS) inactivates B12

53
Q

Where is folate concentration naturally greater?

A

In the CSF compared to blood due to active transport across BBB

(Important because levels may look healthy in blood test but still have cerebral folate deficiency)

54
Q

How can you test for cerebral folate deficiency?

A

Lumbar puncture - look for low CSF 5-MTHF

NOT a nutritional deficiency - still getting enough it just isn’t reaching the brain

55
Q

What are the most common features of CFD?

A

▪️ Pyramidal spasticity
▪️ Cerebellar movement disorders
▪️ Intellectual disability

4 distinct syndrome? - autistic, schizophrenic, spastic-ataxic, epileptic

56
Q

What are the signs of vitamin C deficiency?

A

▪️ Poor wound healing
▪️ Severe joint and muscle pain
▪️ Dental avulsion (teeth fall out)
▪️ Oedema
▪️ Spontaneous haemorrhage
▪️ Fatigue, weakness, and parkinsonism
▪️ Scurvy! - rare in developed world, look for fatigue?

57
Q

What is vitamin D deficiency associated with?

A

▪️ Depression
▪️ Schizophrenia
▪️ Parkinsonism
▪️ Dementia

due to hypocalcaemia?

NOTE: many people have vit D insufficiency NOT deficiency

58
Q

What are the main features of calcium deficiency?

A

▪️ Poor development, fracture healing and brittleness of bones and teeth
▪️ Neuromuscular hyperexcitability triad (spasm, tetany, hyperreflexia)
▪️ Depression and acute confusional state

Similar to magnesium!

59
Q

What are the main signs of iron deficiency?

A

▪️ Microcytic anaemia
▪️ Weakness, fatigue, low mood
▪️ More common than change in mood disorder and neurodevelopmental conditions?

60
Q

What are the main signs of zinc deficiency?

A

▪️ Similar to vitamin C as act together but milder
▪️ Give zinc whilst treating vitamin C deficiency

61
Q

What are the main signs of iodine deficiency?

A

▪️ Now seen rarely due to fortification
▪️ Largely prenatal and infant: short stature, spasticity, deaf-mutism, mental retardation, hypothyroidism

Important for normal thyroid functioning!

62
Q

What are the main signs of selenium deficiency?

A

▪️ Anxiety
▪️ Depression
▪️ Dementia

BUT don’t need much. tied closely with iodine

63
Q

How might nutrients be used for treatment in neuropsychiatry?

A

▪️ B vitamins for schizophrenia symptoms?
▪️ Role yet to still be discovered?
▪️ Biomarkers?

Management of Disorders (28 decks)

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