Obsessions, Personality / Eating / Psychosexual Disorders Flashcards
Types of obsessions
Thoughts - sex / violence / numbers / contamination
Images - vivid, morbid or violent scenes
Impulses - Eg fear of jumping in front of train
Ruminations - continuous pondering
What do you need to distinguish obsesssions from? What are they ? How are they different from obsessions ?
Volitional fantasies - pleasurable thoughts
Obsessions - unwelcome, instructive senseless and uncomfortable for the individual
What are compulsions?
Repetitive, purposeful physical/mental behaviours
Example of compulsions
Hand washing, counting, hoarding, tidiness, rearranging for symmetry
Usual age of onset for OCD?
Adolescence
Example of a linked obsessions and compulsion
Hand washing as concerned with contamination
Obsessions without compulsive acts Eg. Hoarding and difficulty discarding items that may appear worthless to others
Checking compulsions in responses to obsessive thoughts about potential harm Eg. Keep checking gas
How long do people with OCD spend on their O/C ?
> 1HR
Aetiology of OCD
Genetics (Fx of OCD, tics, Tourette’s)
- > Parental over protection
- > may occur post strep infection in children (PANDA subtype)
- > *Decreased serotonin, abnormalities in cortico-striato-thalamic circuit, operant conditioning
What is operant conditioning
Type of learning where the strength of the behaviour is modified by the consequences
Complications of OCD
Depression
Abuse of alcohol / anxiolytics
Severe -> functional impairment / psychotic illness
What is body dysmorphic disorder?
Obsessional preoccupation with imagined / mild physical defects
Management of OCD ? Eg? Pharmacological?
CBT - exposure followed by response prevention Eg wipe toilet seat and not wash hands
Drugs - SSRIs / clomipramine (tricyclic)
ECT
What is anakastic personality disorder ? Common feature?
Concern with order ness, perfectionism, excessive attention to details
Emotional coldness
Aetiology of eating disorders
Genetics
- > troubled family relationships
- > media
- > sexual / physical abuse
- > altered serotonin function
What does PANDAS stand for / what is it?
Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections
Children develop ocd shortly after infection with group A b-haemolytic streptococcal infection
What is anorexia? What BMI?
Distorted body image & FEAR OF FATNESS
Deliberate weight loss Eg restricted eating / excessive exercise
BMI <17.5
Signs of anorexia
Amenorrhea
Dry/yellow skin, bradycardia, hypotension, anaemia, lanugo hair
Vomiting - > hypokalaemia, alkalosis, pitted teeth, Russell’s sign
What is lanugo hair
Growing of fine hair all over (usually arms and chest)
What is Russles sign
Calluses on the knuckles or back of hand due to repeated self induced vomiting
DDs of anorexia
Diabetes, depression, psychotic disorders with delusions about food
Long term complication of anorexia
Osteoporosis
DEATH - has the highest death rate of ant psychiatric disorder
Management of anorexia in adolescents? Adults?
What can you do in emergencies?
Adolescents - family intervention
Adults -CBT , IPT (interpersonal psychotherapy)
May need NG feeding without consent under MCA
What is bulimia ?
Intense cravings, secretly over eat
Prevent weight gain Eg vomiting / laxatives
Fear of fatness - fluctuating weight
Signs of bulimia
Amerhhorea - >50%
Hypokalamia
Signs of vomiting - Eg acute oesophageal tears