Personality , Somatic, and Eating Disorders Flashcards
Differentiate between cluster A, B, and C personality disorders.
A: pt. viewed as weird or peculiar –> associated with psychotic disorders
B: pt. viewed as emotional or inconsistent –> associated with mood disorders
C: pt. is fearful / anxious –> associated with anxiety disorders
Name and describe the types of cluster A personality disorders.
Schizotypal: magical thinking (superstitious, clairvoyance, etc.), metaphoric speech, aloof, isolated
Schizoid: few friends, loner, indifferent to praise/criticism, do not enjoy/desire close relationships
Paranoid: suspicious, emotionally cold, humorless, blame others, appear hostile & angry, holds grudges
Name and describe the types of cluster B personality disorders.
Borderline: self-destructive, erratic emotions, impulsive, sexual, always in a crisis
Antisocial: breaks laws, violates rights of others, no remorse or guilt, appears friendly on surface
Histrionic: false emotions, dramatic, center of attention, excitable, seductive.
Narcissistic: can’t apologize, grandiose, lacks empathy, inflated self-image but fragile self-esteem
Name and describe the types of cluster C personality disorders.
Dependent: lacks self-confidence, constantly needs reassurance, will not initiate things
Avoidant: awkward in social situations, desires relationships but avoids them s/p inferiority complex
OCD: perfectionist, preoccupied with details
Which personality disorder is most likely to progress to schizophrenia?
Schizotypal
What is important for the therapist to keep in mind when managing paranoid personality disorder?
The paranoia manifested is often a by-product of a fragile self-concept.
Which childhood disorder is antisocial personality disorder most similar to?
Conduct disorder –> DSM-V requires patient to have characteristics of conduct disorder prior to age 15 in order to diagnose anti-social personality disorder.
Which personality disorders are significantly more prevalent in women than in men?
Borderline personality disorder
What is the most promising treatment for borderline personality disorder?
Dialectic behavioral therapy (DBT)
Describe a patient with body dysmorphic disorder.
Pt. feel self-conscious and fear humiliation, go to great lengths to hide or correct perceived anomaly, stress from external expectations and cultural norms
What is the most common body part area of fixation in body dysmorphic disorder?
Face
What is the most common age of onset and what is the treatment for body dysmorphic disorder?
Age: 15-20
Treatment: high dose SSRIs
Define egosyntonic and describe which personality disorder it relates to.
Def: condition not distressing to the patient.
OCD patients are egosyntonic
Describe factitious disorder.
Intentionally fake signs/symptoms of medical or psychiatric conditions
What is the term formerly used to describe factitious disorder imposed on self?
Munchausen Syndrome
What is the term formerly used to describe illness anxiety disorder?
Hypochondriasis
Describe illness anxiety disorder.
Preoccupation with belief of having or fear of contracting serious illness.
What is the most common age of onset of illness anxiety disorder?
Early to middle adulthood
What comorbid psychiatric conditions are commonly present with illness anxiety disorder?
Anxiety and depression
T/F: Patients with illness anxiety disorder should avoid regular appointments with medical providers.
False: Regular appointments provide reassurance.
Describe somatic symptom disorder.
Patient presents with vague physical complaints that can’t be explained by a medical condition or substance use. But patient is not being intentionally deceptive about their symptoms.
Describe the DSM-V criteria for diagnosis of somatic symptom disorder.
6+ months of 4 pain symptoms - 2 GI complaints, 1 sexual symptom, and 1 pseudoneurological symptom - not explained by a medical condition.
Define malingering.
Purposefully feign physical symptoms for external gain with the most common goal being to obtain drugs or shelter (ED) or financial gain (clinic).
Classify anorexia nervosa based on BMI.
Mild: BMI > 17
Moderate: BMI 16 - 17
Severe: BMI 15 - 16
Extreme: BMI < 15
Describe two types of anorexia nervosa.
Restricting - eats very little with no binge and purge
Binge and purge
Describe S/S commonly associated with anorexia nervosa.
emaciation, bradycardia, orthostatic hypotension, peripheral edema, amenorrhea, salivary gland enlargement, dental erosion, lanugo (soft, feathery hair)
What electrolyte and serum lab abnormalities are common in anorexia nervosa?
Leukopenia, metabolic alkalosis, increased BUN, dec estrogen, inc cortisol, dec vitamin D, inc amylase, hypokalemia, hypocalcemia, hyponatremia.
Why are patients with anorexia nervosa at higher risk of fractures?
Dec estrogen, Ca, vitamin D, and inc cortisol
What is the first goal in the treatment of anorexia nervosa and how is it accomplished?
Restore nutrition –> done gradually to avoid refeeding syndrome. Requires hospitalization if patient is < 20% expected body weight.
What antidepressant medication is contraindicated in anorexia nervosa and why?
Bupropion –> decreases seizure threshold and anorexia patients are already at increased risk of seizures s/p hyponatremia.
What anti-psychotic medication may be used in the treatment of anorexia because of its propensity to cause weight gain?
Olanzapine (Zyprexa)
Describe the pathophysiology of refeeding syndrome if the restoration of nutrition in an anorexia patient is not handled properly.
Phosphate stores are depleted during starvation. If carbohydrates are introduced aggressively, insulin triggers cellular uptake of phosphate leading to hypophosphatemia leading to cardiac arrhythmias.
What is the general treatment approach for anorexia nervosa?
Requires a multi-disciplinary approach
Describe what is required for the diagnosis of bulimia nervosa.
Binge eating + vomiting, laxatives, diuretics, excessive exercise, etc 1 day per week for 3+ months.
Describe the typical weight of a patient with bulimia nervosa.
Rapid fluctuations in weight are noted but they typically maintain a normal or near normal BMI.
How is the severity of bulimia nervosa classified?
Mild: 1 - 3 episodes per week
Moderate: 4 - 7 episodes per week
Severe: 8 - 13 episodes per week
Extreme: 14+ episodes per week
What is the first line therapy for bulimia nervosa?
CBT - hospitalization usually not required unless SI.
Describe the diagnostic criteria for binge eating disorder.
1+ episode per week for 3+ months. Episode defined as eating more in a two hour period than an average person would. Not followed by any weight loss efforts.
How is the severity of binge eating disorder classified?
Same as bulimia... Mild: 1 - 3 episodes per week Moderate: 4 - 7 episodes per week Severe: 8 - 13 episodes per week Extreme: 14+ episodes per week
What eating characteristics are associated with binge eating disorder?
Eating faster than normal, eating until uncomfortably full even when not hungry, eating alone out of embarrassment, guilty or depressed after episode.
