Nutritional Psychiatry Flashcards
What is malnutrition?
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
What are the two main routes to malnutrition?
- Insufficient or inappropriate food intake
- Normal intake but failures of digestion or metabolism
What are the two main categories of malnutrition?
- General malnutrition/calorie deficiency
- Deficiency of specific nutrients (e.g. protein)
What is kwashiorkor and what are it’s main features?
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
What is marasmus and what are it’s main features?
A calorie deficiency, characterised by very underweight body, old appearance, thin limbs with little muscles or fat
Can an individual have both kwashiorkor and marasmus?
Yes! - marasmic kwashiorkor
How does the Waterlow criteria (1972) classify malnutrition?
Height and weight compared to population norms
How does the WHO criteria (1999) classify malnutrition?
Number of SDs between observed and expected weight and height (-2 = moderate, -3 = severe)
What is chronic malnutrition?
Sustained, long-term malnutrition that is not severe enough to cause death but can lead to a variety of long-term problems, including neuropsychiatric
In acute starvation, when does the CNS usually become affected?
In the later stages
What might you see prior to coma in acute starvation?
Delirium and encephalopathy
What is the major challenge when investigating the neuropsychiatric sequelae of malnutrition?
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.
What is pyloric stenosis?
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
What neuropsychiatric problems have been found to be associated with pyloric stenosis?
Short-term memory and attentional deficits
What was the Barbados Nutrition Study?
A 40 year longitudinal study following individuals with normal birth weight but a period of protein-energy malnutrition in first year of life
What did the Barbados Nutrition Study find early malnutrition was associated with in later life?
Mainly attentional deficits anf hyperactivity, but also lower IQ, increased prevalence of LD, and subtle motor deficits
What are macronutrients?
Nutrients we need in larger amounts such as proteins, fats, and carbohydrates
What are micronutrients?
Nutrients we need in small amounts such as vitamins, minerals, and trace elements
What category of vitamins is most relevant in psychiatry?
B vitamins
What is B1 and which foods are rich in it?
Thiamine - green peas, tomatoes, sunflower seeds, spinach, squash, brussel sprouts
How much thiamine is absorbed normally if taken orally?
~10%
What is thiamine (B1) deficiency associated with?
Alcohol dependency (~30% of alcoholics)
Why is thiamine deficiency associated with alcohol dependency?
Alcohol compromises the absorption and utilisation of thiamine (~1%), likely exacerbated by poor diet
What conditions, aside from alcohol dependency, have also been linked with thiamine deficiency?
Morning sickness (hyperemesis gravidarum) and malabsorption conditions that lead to protracted vomiting
