personality disorders + eating disorders Flashcards
personality disorders epidimeiology
1 in 20
reluctance to diagnose in <18yrs - personality still developing
peak frequency of symtpoms (partiularly emotionally unstable) = 14yrs
3 clusters of personality disorder
cluster A = odd + eccentric
cluster B = dramatic, emotional, erratic
cluster C = anxious + fearful
investigation personality disorders
largely clinical
assessment is complex, takes lots of appointments
several rating scales
- ZAM-BPD
PAS
PDQ4
management of personality disorders
avoidant
- social skills training, maybe antidepressants
emotionallly unstable
- dialectial behavioural therapy
- mentalisation based therapy + STEPPS
antisocial
- CBT, pharma not routinely used
mx difficulties with impulse control
1 - SSRI
2 - olanzapine, sod val, carbamezepine, low dose antipsychotic
cluster A personality disorders (odd + eccentric)
paranoid - hypersensitivity + unforgiving attitude when insulted
schizoid - indifferent to praise or critiscism, preference of solitary, emotional coldness
schizotypal - ideas of reference, odd beliefs + magical thinking, odd speech, lack of close friends
cluster B personality disorders (dramatic, emotional or erratic)
antisocial - failure to conform to social norms, repeatedly lying, impulsiveness, lack of remorse, reckless disregard for others
borderline (emotionally unstable) - unstable relationships which alternate between idealisation + devaluation, unstable self image, impulsive, recurrent suicidal behaviour
histronic - inappropriate sexual seductiveness, need to be centre of attention
narcissistic - grandiose self importance, sense of entitletment, lack of empathy
cluster C personality disorders (anxious + fearful)
obsessive-compulsive - meticulous about etiquettes of ethics morals or values, unwilling to pass on tasks
avoidant - preoccupied with ideas that they are being criticised or rejected in social situations, fear of embarrassment, social isolation accompanied by craving for social contact
dependent
- difficultly making everyday decisions without excessive reassurance from other, lack of initiative/responsibility, cant disagree in fear of losing support
management of personality disorders
“untreatable”
dialectial behaviour therapy
assessment of eating disorders
medical emergencies in eating disrders (MEED) risk assessment - traffic light system
psych hx + MSE
dietary history
SUSS test -> sit ip, stand from squat
ECG
bloods
water low scale - used to assess kin integrity
abnormal blood results in eating disorders
- almost all have bradycardia + hypotension
- low WCC
- elevated cholesterol - due to fat breakdown in starvation
low T4 - sick euthyroid
features of bulimia nervosa
- Alkalosis – vomiting HCl from stomach
- Hypokalaemia
- Erosion of teeth
- Swollen salivary glands
- Reflux
- Calluses on knuckles – Russell’s sign
Teenage girl, normal body weight, swelling on face under jaw, calluses on knuckles, alkalosis on blood gas -> presenting complaint = abdominal pian or reflux
management of bulimia
CBT +/- fluoxetine
mx complications - hypokalaemia, hyponatraemia
whos most at risk of refeeding syndrome
severely undereight
minimal intake preceding 7-14days
rapid weight loss
low WCC <3.5
comorbid conditions - pneumonia, serious infection
pathophysio of refeding syndrome
intracellular mineral become depleted but serum levels may remain normal
- refeeding stimulates insulin production which causes potassiium/magnesium + phosphate to be taken into the cells whilt serum levels fall
-> rapid change in BMR with serum electrolyte depletion causes the physical symptoms of re-feeding syndrome
