Psych 3a Flashcards
Treating Depression
Medical
Adults: SSRI (Sertraline) SNRI (Venlafaxine)
Children: SSRI (Fluoxetine)
Elderly: Mirtazapine - also given to Warfarin Pts
SSRIS: citalopram, paroxetine SNRIS: duloxetine. Careful with Fluoxetin
When starting SSRI, prescribe for 6mths at least, avoid triptans
Medical treatments
Non Medical Treatments for Depression
Non medical 1st line: CBT, IAPT Fam therapy in CAMHS
Encourage resuming old activities
Side FX SSRIs
Sertraline, Citalopram, Fluoxetine
SSRI can increase risk of suicide so double check
GI symptoms (most common)
Sexual Impotence
Hyponatremia
Agitation, Weight gain
Upon Discontinuation: Restless, Sweating, Parasthesia, GI symptoms
Interactions: NSAID (Give PPI), Sumatriptan, Warfarin/Heparin
Fluoxetine and Paroxetine risks of interactions
Medical treatments
Other Treatments for Depression
other than SSRi and SNRI
Generally avoided
MAOI - Tranylcypromine, phenelzine Side FX: HTN crisis when taken with cheese, pickles etc.
TCAs - Amitriptyline Side Fx: Urinary retention, dry mouth, lethargy, blurry QT interval increased
These both are avoided due to side fx profile
MAOI treate atypical depression TCA commonly used for neuropathic pain and chronic TTH
Assesment and management Frontal Lobe Syndrome
Hx
- Developmental, Trauma & Social Hx
- Check B12. TFT, Syphilis screen
Management - General Supportive Care
- Speech therapy
Treatment Acute Mania
- Stop Anti-Depressants
- 1st line antipsychotics
Haloperidol, Olanzapine, Queitapine, Risperidone
Li can be used short term & Benzodiazepnes
Chronic Management of Bipolar Disorder
- CBT
- Mood stabilisers: Lithium
- 2nd Line: Na Valporate, Carbamezipine Olanzipine
Pregnancy use antipsychotic: Haloperidol
Lithium is teratogenic causing Ebsteins Foetal Anomaly
Treating Depression in Bipolar
- Avoid antidepressant (Can cause Mania)
- 1st line Antipsychotic: Quietapine
If you are to prescribe SSRI such as Fluoxetine then prescribe Mood stabiliser alongside it
Olanzapine can be used as Mood Stabiliser although it is a antipsychotic
Side FX Lithium
Due to narrow Therapeutic Index you must check LI bloods evry wk for 3w
Then check every 3m
Leukoytosis (Excess WBC)
Insipidus Diabetes
Tremors
Hydration (Dehydrates)
Increased GI motility
Underactive thyroid
Metallic Taste
Long-term lithium use can result in hyperparathyroidism and resultant hypercalcaemia (stones,bones, abdominal moans & psychic groans)
Wt gain, hypoparathyroidism
Think of a drunk man
Lithium Toxicity
Conc of LI in blood above 1.5mM
NEPHROTOXICITY
Reduced renal function due to Li accumulation leading to
- Dehydration
- D&V
- Sleepy
- Motor signs: Coarse Tremor + Hyperflexia
- Neuro: Confusion, seizures
Mild Toxicity: Stop Li & Rehydrate
Avoid with Li: NSAIDS, THiazide diuretics, ACEi, ARBs, metronidazole
Severe: Haemodialysis, Gastric Lavage, Diuretics
What is Dysthymia?
Not severe enough to be classed as something (Hint)
Treated with SSRI (Sertraline) + CBT
Chronic, midly depressed mood and diminished enjoyment
Presence of low grade symptoms for around 2y
Not severe enough to be classified as severe illness
What is Alogia
poverty of speech.
Refers to difficulty with speaking or the tendency to speak little due to brain impairment.
Treatment Schizophrenia
Antipsychotics
Extrapyramidal Side Fx caued by Typical Antipsychotics
1st line: Atypical (Quietapine, Olanzapine, Risperidone)
2nd Line: Typical (Haloperidol, Chlopromazine)
3rd Line: Clozapine
Treatment steps: 6mths -> 5Y -> Lifelong
Regular monitoring of: Wt, Lipids, Glucose, & ECG
Psycho: CBT Social: Housing, Financial Advice
4 Extra Pyramidal side Fx of Typical antipsychotics
Haloperidol Chlorpromazine
Increased risk of stroke and VTE
- Acute Dystonic Rxn (Hours)
Muscle spasms, acute torticolis, Eyes rolling back - Parkinsonism (Days)
Tremor, bradykinesia - Akathisia (Days to weeks)
Inner restlessness, agitation, suicide risk in young - Tardive Dyskinesia (Months to Years)
Grimacing, tongue protrusion, lip smacking
Difficult to treat Tardive Dyskinesia as Dr Receptors upregulated
Torticolis: Neck spasms Bradykinesia: slow movement
Side Fx Profile Antipsychotics
Apart from Extrapyramidal
Atypical (Clozapine, Queitapine, Olanzapine, Aripiprazole, Risperidone)
Typical (Haloperidol, Chlorpromazine)
Typical : Dry mouth, Galactorrhoea, Urinary retention, blurred vision, constipation, QT interval increase
Clozapine: Agranulocytosis
Olanzapine: Dyslipidaemia, Hyperlipidaemia
Agranulocytosis: Severe reduction in the number of white blood cells
Monitor clozapine evry week for 18wks
Treatment for Extrapyramidal Symptoms
Caused by Typical Antipsychotics like Haloperidol and Chlorpromazine
Procyclidine for Acute Dystonic Rxn
Tetrabenazine may be used to treat moderate/severe tardive dyskinesia
Young Age Dementia
Define Frontal Lobe Syndrome & Causes
fronto-temporal dementia
- Damage to prefrontal regions of frontal lobe
important in Motivation, planning, social behaviours, speech production - Damage leads to speech problems, reduced attention and abstract thoughts
Ubiquitin Deposits
Causes: Head Injury, CVA, Infection, Picks Disease (neurosyphillis)
Endocrine disorders causing Psych symptoms
DM, Thyroid, Parathyroid, Adrenal
- T1DM: Anorexia, Bulimia
- T2DM Bipolar, Schizo
- HyperThy: GAD, Depression, Thyroid storm -> Mania
- HypoThy: Depression, Myoxydema -> Psychosis
- HyperCalc: Depression, apathy, irritation
- HypoCalc: Anxiety, mania
- Cushings: Depression, anxiety, mania
- Addisons: Fatigue
Cushings: hyperaldosteronism: More cortisol
Addisons is opposite
Panic Disorder Vs GAD
generalised anxiety disorder
GAD: Constant worry with external stimulus of particular thing
Panic: Discreet episodes of anxiety w/out stimulus (spontaneous
RF for OCD
- FH
- Parental Overprotection
- PANDAS (Paediatric neuropsychiatric disorders associated with strep infection)
Dopamine
Pathophysiology of Schizophrenia
4 main dopaminergic pathways in the brain
- Mesolimbic Reward, excess dopamine here leads to +ve symptoms (Delusions, Hallucinations etc)
- Mesocortical Pre Frontal: low dopamine here -> -ve symptoms (anhedonia, blunted effect, alogia)
- Nigostriatal Basal Ganglia: excess dopamine -> motor movements
- Tuberoinfundibular: Excess dopamine -> rise in PRL (nipple leaks)
3 & 4 refer to Sid Fx of Antipsychotics
Dopamine in mesocortical needed for executive functioning such as emotion, speech
ALCOHOLISM
Investigation & Treatment for Drinking problem
Questionaiire
CAGE questionaire
- Have you ever tried to CUT down
- Have you been ANNOYED at the fact that you may have alcoholism
- Have you ever felt GUILTY
- Have you ever had an EYE OPENER first thing in morning
Alcohol dependence treatment
- Acute detox
- Psycho therapies
- Meds
Stepwise Detoxification from Alcohol
Alcohol dependence 4 drugs
- Benzos (Diazepam, Lorezepam, Chlordiazepoxide)
- Rehydration with correct electrolytes
- Thiamine
Disulfram - Prevents alcohol metabolism - causes nausea if you drink
Acamprostate - Reduce cravings
Naltrexone - Opiod antagonist
Treatment for Delirium Tremens
Acute withdrawal from alcohol
First line: Lorezepam or chlordiazepoxide
Treat with Thiamine
or Antipsychotics (Haloperidol)
Treatment for Delirium Tremens
Acute withdrawal from alcohol
Treat with Thiamine
Lorezepam or Antipsychotics (Haloperidol)
What is Korkasoff
Think Thiamine
Due to Alcohol misuse
- Short term memory loss + Cofabulation
Thiamine deficiency due to alcohol misuse
Damage to hypothalamus mamiliary bodies
Other Cause: Head Injury, Post anasthesia, Encephalitis CO poisoning
Treatment for Korkasoff Psychosis
- Oral Thiamine replacement therapy for up to 2Y
- Treat psychiatric co morbidities
- Cognitive Rehab
Caused by Thiamine B1 deficiency
Triad of Wernickes Encephalopathy
& Treatment
Develops further on from Korkasoff
- Opthalmoplegia (eye muscle paralysis)
- Ataxia
- Confusion
High risk Pts: prophylactic vit(s)
Treat with IV Pabrinex (vit)
Can also present alongside Korkasoff: Wernicke’s Korkasoff
Delirium Screening & Symptoms
- 4 AT assesment
Symptoms - Confusion
- Disorientation
- Hallucinations
- Agrresion
- Labile mood (yoyo)
ICD 10: cognitive, attention disturbance over short period of time
Delirium: evidence of physical cause
4A’s of Alzheimers
- Amnesia; Poor recent memory
- Apraxia: unable to button up
- Agnosia: unable to recognise body parts
- Aphasia: Struggle with language
Diagnosing Alzheimer’s
CT
- Brain atrophy, sulcul widening, large ventricles
- Amyloid Plaques
- Neurofibilary tangles
- Shrinkage of cortex
- Alzheimer’s disease causes widespread cerebral atrophy mainly involving the cortex and hippocampus
Use ACE III for diagnosis
Medical Management Alzheimer’s
Non Pharm:
Acitivities promoting wellbeing & group cognitive simulation therapy
1st: Ach inhibs: Donepezil, Rivastigmine, Galantamine
2nd NMDA antagonist: **Memantine ** (when 1st line contraindicated)
Mild-Moderate AD: 1st
Severe AD: 1st + 2nd line
Donepezil: insomnia, contraindicated bradycardia
Related to Parkinsonism
Lewy Body Dementia Features
Common in 50-80y
Same Treatment as AD
- Caused by Lewy bodies (alpha-synuclein cytoplasmic inclusions) in the substantia nigra
- Early impairments in attention and executive function rather than memory
- Parkinsonism
- Visual Hallucinations
- Fluctuating cognition (Confused for delirium)
Baby Blues
1st
- 60-70% women
- 3-7 days post birth
- Anxiety & Fearful
Treatment: Reassurance from Health Visitor
Post Natal Depression
2nd
- 10% Women
- Start at 1m peak at 3m
- Symptoms of Depression
- Reassurance + CBT
- SSRI (Sertraline)
SSRI can come in breast milk so be mindful
Puerperal Psychosis
3rd (most critical of the lot)
- 0.2% of Women
- 2wk Post Partum
- Bipolar 1 - Mania
- Disordered Perceptions
- Psych emergency
What is ECT?
What treatment is it used in?
Catatonia: a disorder that disrupts a person’s awareness of the world around them
- Treatment in Depression with catatonia
- +/- Psychotic Symptoms
- contraindicated in Raised ICP
Side Fx: Headache, nausea, arrythmias. Long term: Impaired memory
Schizoid Personality
Cluster A
- Indifferent to praise and criticism
- Prefers solitary activities
- No interest in sex
- cold
- few friends
What are the four Ps
- Predisposing
- Precipitating
- Perceptuating
- Protective
e.g. 1. Genetics 2.Particular event 3. Drinking 4. Support network
Depression and its Core 3 symptoms
Other symptoms: Sleep deprived, apetitie change, agitation, labile mood
- Pervasive Lowering of mood
1. Anhedonia
2. Low of mood
3. Loss of energy
ICD classification for Depression
Time frame + mild/moderate/severe
- At least 2/3 core symptoms
- over 2wks
Mild: Core + 2/3 symptoms
Moderate: Core +4 symptoms
Severe: Several symptoms +/- Suicide risk
also marked loss of functioning
Signs & Investigations of Depression
Hx, Risk Assesment
- Wt loss
- Psychomotor retardation
- Lack of eye contact
- Slow + Quiet
Take a full Hx and blood test
Risk Assesment: Self neglect/harm, suicidal thoughts
RF & DD For depression
RF: FH, History of Abuse, Socio-economic status, Drugs and alcohol, trauma
DD: Bereavement, Schizophrenia, Substance Withdrawal
RF & DD For depression
RF: FH, History of Abuse, Socio-economic status, Drugs and alcohol, trauma
DD: Bereavement, Schizophrenia, Substance Withdrawal
Downsides of Antidepressants
Time, Symptoms, Exacerbation of other symtoms
- Take time to work - 4wks
- Can initially increase suicide tendencies
- Improve some symptoms but not all
Important to assess Pts after 2wks and 1wk if they have suicide risk
Define Bipolar Affective Disorder
And Risk factors
Recurrent episodes of altered mood and activity
- Hypomania/Mania + Depression
- Onset early 20s
- M:F 1:1
RF
- FH
- Trauma
- Sleep deprivation
- Cannabis use in adolescence
- BAME
- History of Abuse
What is Cyclothymia
Think Bipolar
Chronic Mood fluctuations over last 2 years
Episodes of Depresssion and Hypomania
Rapid Cycling lasting only a few days
Bipolar 1 vs Bipolar 2
Bipolar 1: Most common: Mania + Depression
Bipolar 2: More symptoms of Depression + Mild Hypomania
Bipolar 2 is often harder to spot
Hypomania Symptoms
Lasts 4 days
- Elevated mood
- Increased Energy & Talkativeness
- Poor concentration
- Mild Reckless behaviour (Overspending)
- Increase in Libido and confidence
- Little need for sleep
- Change in apetite
No Psychotic Symptoms
Psychotic Symptoms
Mania Symptoms
Last >7days
- Extreme uncontrollable reaction
- overactivity
- pressure of speech
- impaired judgement
- Very reckless (Spending spree, Jumping buildings)
- Social Disinhibition
- Increase in Self esteem and Gradiosity
- Absent insight - Hallucinations
Psychotic Symptoms
Mania Symptoms
Last >7days
- Extreme uncontrollable reaction
- overactivity
- pressure of speech
- impaired judgement
- Very reckless (Spending spree, Jumping buildings)
- Social Disinhibition
- Increase in Self esteem and Gradiosity
- Absent insight - Hallucinations
pressure of speech: words can’t get out quick enough
DD Bipolar Disorder
- Substance Abuse (Amphetamines, Cocaine)
- Endocrine Disease (Cushings - Steroid Induced Psychosis)
- Schizophrenia
- Schizoaffective disorder
- ADHD
- Personality disorder
Investigations & Signs for Bipolar
History and Signs
Perform Full History and MSE
Signs
- Pressure of speech
- Restlessness
- Flight of ideas
Look out for endocrine signs like purple striae (Cushings)
Define Schizophrenia
- A spiltting/dissociation of thoughts
- Loss of contact with reality
- Affects person’s thoughts and perceptions
Most common type is paranoid schizophrenia
RF for Schizophrenia
In order of strongest to weakest
- FH (Twin>Parent>Sibling)
- Black ethnicity
- Migration
- smoking ganga in youth
- adverse life event
- bullying
1st Rank Symptoms
Schizophrenia
- 3rd person auditory hallucinations
- Thought disorders
- Passivity phenomena (somebody controlling thoughts)
- Delusional perceptions
Second Rank Symptoms
Schizophrenia
- Delusions
- 2nd Person Auditory hallucinations
- Formal thought disoder (FMD)
- Catanoic behaviour
- -ve Symptoms
FMD: When words come out wrong because of muddled up thoughts
Diagnosing Schizophrenia
Rank Symptoms
- 1 first rank symptoms
or - 2 second rank symptoms
For at least a month
+ve Symptoms
Delusions Persecutory (think they’re being watched)
Delusions of Reference (Things being placed in a certain way to highlight they are evil)
Hallucinations
Thought Disorders
-ve Symptoms
Poverty of speech
Flat affect
Poor motivation
Social Withdrawal
Treatment Acute Transient Psychosis
- Haloperidol
Typical Antipsychotics
Charles Bonnet Hallucinations
Akhaaaaaa
Visual Hallucinations in a person with partial or severe blindness
Visual impairtments promote sensory deafferentiation leading to disinhibition thus resulting in sudden neural findings of the visual cortical regions
Cotard Syndrome
maree gaya
False belief of death
Dangerous as Pts may no longer eat or drink thinking they are dead
De Clerambault’s Syndrome
Erotomania
Seen in young women
Falsely believing that a famous person has fallen in love with them
Othello’s
Pt believes spouse is being unfathful without any solid proof
Folie a Deux
Symptoms of delusional belief transmitted from one individual to another
Schizoaffective disorder
Schizophrenia symptoms plus depression
Treat with antpsychotics, mood stabilisers etc
GAD
Generalised Anxiety Disorder
- Persistent worry (excessive)
- About a nr of events (School, work, bills)
- Individualised; find it difficult to control worry
- 3mths ICD 10
- 6mths DSM
RF for GAD
- Alcohol
- Benzo use
- Co-existing depression
- FH
- History of abuse
- Pushy parents
*
Excessive salbutamol use is also another factor
Symptoms GAD
- Unpleasant emotional state
- bodily discomfort
- palpitations
- chest pain
- tachycardia
- tremor
- insomnia
- increased vigilance
Treatment for GAD
Bio Psycho Social
Bio: SSRI, Pregablin, Benzo
Psycho: CBT, Relaxation therapy
Social: arrange for housing etc
Beno used in acute settings
Sertraline is SSRI of choice
Agoraphobia Vs Social Phobia
Both Very similar
Treatment: CBT, Exposure therapy
Agoraphobia: Fear of crowded places & places without easy escape route
Social Phobia: Fear of situastions (social) where individual isn’t familiar with the people around them
Obsessive Compulsion Disorder
Obsessions which lead to compulsive behaviour
Obsessions: reflected by intrusive, unwelcome, unpleasant thoughts/images doubts
Compulsions: A repetitive, purposeful, physical or mental behaviour performed in response to obsession
Presentation & Investigations OCD
P/ Time consuming obsessions present most days for 2 weeks
Distressing & interferes with daily life
I/-Detailed History + MSE
Treatment OCD
PsychoEducation
CBT
SSRI
Somatisation Disorder
Leads to needless surgeries
Common in Females
- Physical Symptoms without physical explanation
- Persistent for 2Y
- Common in Women
- GI & Skin Related
Important to rule out organic causes using detailed history
Conversion Disorder
Neuro
Pt presents with neurological signs such as: Paralysis, Weakness, Amnesia
- Examination is inconsistent
- Pt is not faking it
Alcohol Abuse
Alcohol dependence Syndrome
- Regular binge consumption of alcohol
- Sufficient to cause physical, neuro, social damage
- Alcohol dependence Syndrome inability to control intake of substance, oft used to avoid withdrawals
Signs of Alchol dependence
CANT STOP
Compulsion to drink
Aware of harm but persists
Neglect of ther activities
Tolerance to alcohol
Stopping causes withdrawal
Time preoccuppied with alcohol
Out of control use
Persistent
medical emergency
Delirium Tremens
- Acute confusional state secondary to alcohol withdrawal
- Occurs 1-7 days after last drink
- Clouding of consciousness
- disorientation
- amnesia of recent events
- psychomotor agitation
- tremors
- visual, auditory + tactile hallucinations
- Risk of CVD collapse
Causes of Delirium
Delirium: Acute confusional state
Infection, Toxic, Vasc, Metabolic, Meds, Vit
Infection: UTI, Septicaemia
Toxic:Substance misuse,opiods
Vascular: Stroke, Head trauma
Metabolic: Thryoid, Diabetes, Hypoxia
Meds Anticholinergics, benzo, polypharmacy
Vitamin Deficiency
Symptom of Delirium
Hypoactive Vs Hyperactive
Hypoactive:Withdrawn, sleepy, quiet behaviour, (less likely to be recognised so dangerous)
Hyperactive: Restless, Agitated, aggresive
management: treat cause + hydration & nutrition
Dementia
Define, late onset vs early onset
- Decline in higher cortical function
- no clouding of consciousness (Delirium)
- Usually irreversible
- Deterioration present for 6mths
- Decrease in memory, orientation, language, comprehension
- Resulting in impairment in activities of daily living
- Late onset: >65Y
- Early onset: <65Y
Most common form of Demetia
Alzheimer’s Disease
genes involved different in early v late onset
Unknown Aeitiology
- Insidious onset of dementia due to deterioraton of brain
- Early Onset: APP gene, Preslin 1+2
- Late Onset: Apoliprotein E
50% off Downsyndrome Pts develop AD
2nd Most common form of dementia
Vascular Dementia
Dementia caused by infarction(s) in the white matter
- Stroke related VD
- Subcortical VD (Small vessel disease)
- Mixed Dementia (VD+AD)
VD can be inherited: CADASIL
Sudden stepwise deterioration of cognition : NINDS-AIREN criteria
PTSD Vs Acute Stress Disorder
Time, Symptoms, Treatment
PTSD Symptoms: >1mth Flashbacks, nightmares, avoid certain people or situations. Treatment: CBT & EMD
ASD Symptoms: within 4 wks, same as above. Treatment: CBT, Benzodiazepene
Histrionic Personality type
Cluster B
- Inappropriate sexual seductiveness
- centre of attention
- impressionistic spech lacking detail
- self dramatization
- Relationships considered more intimate than they are
Narcisstic Personality type
Cluster B
- Grandoise sense of self importance
- Arrogant and lack empathy
- Pre-occupied wuth fantasy of self power
- taking advantage of others
Schizotypal Personality
Cluster A
- Idead of Reference Odd beliefs + magical thinking
- Unusual perceptual disturbance
- paranoid
- Odd eccentric behaviour
- Odd speech
- Inappropriate affect
Paranoid Personality
Cluster A
- Hypersensitivity and unforgiving
- Question loyalty of friends
- Reluctance to confide
- Conspiratorial
Antisocial Personality
Cluster B
- Common in Men
- Disrespectful of Law
- Lying deceipt, conning, assault, irresponsible all common traits
- Lack of remorse
Borderline
Emotionally unstable personality disorder
- Unstable relationships alternating b/ween idealization and devaluation
- Unstable self image
- Impulsive and suicidal
- Feel empty
Learning Disabilty
Different to Learning Difficulty
IQ Below 70
Intelectually delayed in every aspect of life.
Onset before the age of 18.
Downsyndrome
goes hand in hand with AD
- Trisomy 21
- RF Mother above 40
- Characteristics: Short, fat with hypotonia
- Congenital Heart Defects very common
Fragile X Syndrome Features
- Common in men
- Large testes, ears, etc
- CGG triplet defect
Symptoms of common LDs
Aspergers Rett’s Heller’s Tourettes Enuresis
Aspergers: Autisim spectrum disorder
Rett’s: Affects brain develpment common in girls
Heller’s: Similar to autism
Tourettes: Motor and vocal tics
Enuresis: Involuntary urination
Excess Serotonin in body
Serotonin Syndrome
Treated using Chlorpromazine
- Caused by SSRI. MAOI, Ecstasy, psycho active stimulants
- Rapid onset
- Increased Reflexes, Clonus, Dilated pupiils
- Youn Pts, Tachycardia, Hypertensive, Pyrexia, Diaphoresis (sweating)
Lifethereatening reaction to Antipsychotics
Neuroleptic Malignant Syndrome
Treatment: Dantrolene (muscle relaxant)
- Slow onset
- Decrease reflexes, rigidity, diaphoresis (sweating) confusion
- Normal pupils
Eating Disorder
Anorexia Nervosa Features
Suicide affects 1/5 mortality due to AN
MARSIPAN used to treat sick patients from AN
- Least common in adults
- most common in children
- Failure to gain weight/ weight loss
- overvaluead ideation regarding weight/shape
- Lagune hair common symptom
Two types
1. Anorexia Nervosa Restricting
Consumption of less than 500kcals daily
2. Anorexia Nervosa Binge purging
Low wt but engages in binge eating/purging
Bulimia Nervosa Features
- Recurrent binge eating followed by compensatory behaviour to avoid wt gain
- at least once a week for 3mths
- Self induced vomitting, laxatives, diuretics
- Look out for cavities from vomit acid damage and marks on knuckels/hands
Binge Eating Disorder
Different to Bulimia as no compensatory mechanisms
- BED episode once a week for 3mths
OFSED
Other specified feeding and eating disorder
Features of all three: AN, BN and BED
ARFID syndrome
Eating
Avoid certain foods due to sensitiveity to particular foods i.e. might not like texture of one food so will avoid or PTSD of a choking incident
- Seen often in autistic children
- general disinterest in food
