Paediatric Psychiatry

Question 1

ADHD

Answer 1

REFER TO PSYCH

Question 2

AUTISM

Answer 2

REFER TO PSYCH

Question 3

what is anorexia nervosa?

Answer 3

pt thinks overweight but normal/low body weight.

obsessively restrict calorie intake to lose weight.

exercise excessively
may use diet pills/laxative to limit food absorption

Question 4

features of anorexia nervosa

Answer 4

wt loss
amenorrhoea
lanugo hair - fine soft hair across most body
hypotension
hypothermia
mood changes - anxiety depression
Parotidomegaly

G and c high everything else low : corticosteroids cortisol growth hormone glucose salivary glands cholesterol Carotinaemia

Question 5

why do you get amenorrhoea in anorexia?

Answer 5

disruption of hpa axis.
lack of gonadotrophins (lh, fsh) from pituitary.
reduced activity of ovaries (hypogonadism)

Question 6

what other complications other than amenorrhoea can you get from anorexia?

Answer 6

cardiac complications - arrhythmia , cardiac atrophy and sudden cardiac death.

Question 7

how would you diagnose anorexia nervosa?

Answer 7

DSM5 criteria.

1. restriction of energy intake relative to requirements leading to significantly low body weight in context of age,sex,developmental trajectory, and physical health.
2. intense fear of gaining weight or becoming fat, even though underweight.
3. disturbance in the way in which ones body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of seriousness of the current low body weight.

Question 8

How would you manage anorexia nervosa?

Answer 8

CBT- ED : eating disorder focused

maudsley anorexia nervosa tx for adults (MANTRA)

specialist supportive clinical management (SSCM)

children and young people : anorexia focused family therapy - 1st line.
2nd line: cbt

Question 9

prognosis of anorexia nervosa

Answer 9

remains poor.

10% of pts die because of the disorder

Question 10

blood results for restrictive eating disorders?

Answer 10

anaemia - low Hb
leucopenia - low wcc
thrombocytopenia - low platelets

hypokalemia - low potassium - due to vomiting or excessive laxatives

reduced bm activity causes normocytic normochromic anaemia, leucopenia (with low neutrophils and low lymphocytes) and thrombocytopenia.

Question 11

what is bulimia nervosa?

Answer 11

binge eating followed by intentional vomiting or other purgative behaviours eg: laxatives or diuretics or exercising.

Question 12

what is the DSM 5 diagnostic criteria for diagnosis of bulimia nervosa?

Answer 12

recurrent episodes of binge eating. - eating more than most ppl would eat

sense of lack of control over eating during the episode.

recurrent inappropraite compensatory behaviour to prevent weight gain : vomiting self induced, misuse of laxative , diuretics, fassting.

self-evaluation is unduly influenced by body shape and weight.

disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 13

specific tx for bulimia nervosa?

Answer 13

bulimia focused guided self help - if ci’d then CBT-ED

children: bulimia nervosa focused family therapy (FT-BN)

pharma limited role: trial of high dose fluoxetine licensed but long term data lacking.

Question 14

tell me some features of bulimia nervosa

Answer 14

erosion of teeth - recurrent vomiting
swollen salivary glands
mouth ulcers
gastro-oesophageal reflu
calluses on knuckles where theyve scraped across teeth (Russell’s sign) - recurrent teeth

alkalosis - after repeated vomiting of HCL from stomach.

Question 15

how long must bulimia exist for , for it to be bulimia?

Answer 15

binge eating and compensatory behaviours both occur at least once a week for 3 months

Question 16

What is refeeding syndrome?

what happens in terms of electrolytes?

Answer 16

pt with extreme nutritional deficit resumes eating.
lower the bmi and longer period of malnutrition higher the risk.

• intracellular potassium phosphate and magnesium depleted.
• move from inside cell to serum .
• sodium/potassium atp pump slows - normally pumps potassium into cell and sodium out of cell.
• in refeeding magnesium,potassium,phosphate out of blood and sodium into blood.

carbs increase in insulin, drives glucose potassium and phosphate into cells.
insulin causes extra sodium reabsorption in the kidneys

Question 17

tell me the overall effect of treatment of refeeding syndrome

Answer 17

hypomagnesaemia
hypokalemia
hypophosphataemia
fluid overload

risk of arrhythmia and hf.

Question 18

how would you manage refeeding syndrome?

Answer 18

slowly reintroduce food

magnesium,potassium,phosphate,glucose

fluid balance

ecg monitor

supplement with electrolytes and vitamins, particularly b vits and thiamine