Psych Eating Disorders Flashcards
What part of the brain regulates appetite?
hypothalamus
Primary characteristic of anorexia nervosa
Body image disturbance - belief that they’re fat when they’re obviously very thin.
What are the BMI ranges for mild-mod-severe anorexia?
Mild = 17kg Moderate = 16-16.99 Severe = 15-15.99 Extreme = less than 15
How does anorexia affect the family dynamic?
Focus is centered on the anorexic. Other people lose patience or get ignored.
Which is more common - bulimia or anorexia nervosa?
Bulimia
A binge is how many calories in how much time?
1000 cal in less than 2h
DSM V categories for bulimia
Mild: 1-3/wk
Moderate: 4-7/wk
Severe: 8-13/wk
Extreme: 14+/wk
Criteria for diagnosis of bulemia?
Binge/compensation 2x weekly for 3+mos
What are the compensatory behaviors for bulimia?
Vomiting
Laxatives
Diuretics
Fasting
NTs for bulimia vs NTs for anorexia?
Bulimia: Serotonin & norepinephrine
Anorexia: high endogenous opioid levels
Binge-eating disorder is characterized by
Large food binges
No attempt to rid the body of excess calories
Eating without hunger
Extremely rapid eating
Body Dysmorphic Disorder
Preoccupation with perceived flaws
Repetitive mirror-checking, grooming, skin-picking, comparing appearances
Distress d/t preoccupation
Not explained by concerns about fat/weight.
Not an eating disorder.
What kind of food do bulimics and binge-eaters prefer?
Carbohydrates/sweets
Possible meds for binge-eating disorder?
Venlafaxine/desfenlafaxine
Topiramate
Possible meds for obesity?
Prozac
CNS stimulants
Lorcarserin
Phentermine/topiramate
Meds with some success treating anorexia nervosa?
Aripiprazole
Maybe Olanzapine/Risperidone
Common themes between eating disorders
Low self-esteem
Fear of maturity
Conflict avoidance
Anxiety
What does elder abuse consist of?
Violation of personal rights
Abandonment
Material and financial exploitation
Neglect of care needed
Signs/Symptoms of child abuse
Disturbed growth/development
Ambivalence/denial
Sleep/eating disturbances
Bedwetting
Anxiety/depression/aggression
Sexualized play
Unexplained marks/bruises
Frightened of parents
Absence from school
Begs/steals food/money
Dirty, BO, insufficient clothes
saying “no one is home”
Refusing to change for gym
ACES predispose you to…
Depression Anxiety Substance Abuse Risk for Suicide Heart disease Hypertension
What is adjustment disorder?
Maladaptive reaction to a stressor (that can be identified) that affects functioning:
Can be with: -mood (depression) -anxiety (Or both) -conduct disturbance -emotional AND conduct disturbance
Happens w/in 3 months of stressor and ends w/in 6 months.
Define Acute Stress Disorder
Dissociative symptoms (amnesia, depersonalization, de-realization, numbing, detachment, lack of emotional response) occur during or w/in 4 weeks following event
Last for 2days-4weeks.
(Difference btw ASD and PTSD is onset and duration)
Both PTSD and ASD share what symptoms?
- avoidance of feelings/thoughts/people associated with trauma
- intense emotional reactions (fear, horror, helplessness)
- dissociation
- hyperarousal
- re-experiencing of trauma
What sorts of events can ASD and PTSD develop after?
One that threatens
- self
- others
- resources
- sense of control
- sense of hope
PTSD definition
After 1+months (and lasting for more than 1 month):
- social, interpersonal, occupational functioning are impaired
- person reduces involvement with external world
- goal is avoiding memories of the trauma
Arousal symptoms of PTSD - what are they caused by?
Increased noradrenergic and dopaminergic system activity
Decreased serotonergic activity
What are PTSD arousal symptoms?
- increased startle
- anxiety
- restlessness
- irritability
- sleep disturbances
- memory/concentration impairment
- anger outbursts
- survivor guilt
- hypervigilance
In what ways do PTSD sufferers re-live the flashbacks?
Intrusive memories
Nightmares
Illusions
Flashbacks
How is the hippocampus damaged in PTSD sufferers?
From high glucocorticoid levels and prolonged exposure to stress.
Alters stress response, memory and fear conditioning.
What causes blunting, physical analgesia and depersonalization in PTSD?
Increased endogenous opiate release
What causes the re-experiencing of trauma that PTSD sufferers experience?
Activation of amígdala, locus ceruleus, hypothalamus, thalamus and HPA axis …
Has to do with memory coding/retrieval
Will estrogen and testosterone increase or decrease in PTSD sufferers?
They’ll increase secondary to a down-regulation of corticotrophin-releasing harming release.
What are the characteristics of a healthy reorganization process after violence/trauma?
Gradual decrease in anxiety, fear, anger
Starts with review/organization of what happened and why (includes blame and justification)
Progresses to regaining a sense of control and self-protection
Progresses to resolution of grief.
Lasts from months to years.
If resolution doesn’t occur, anything that remains qualifies as PTSD.
What are the characteristics of Recoil?
Struggle to adapt
Periods of acting normal
As phase progresses, there’s a desire to talk about details/feelings about trauma.
Need for support and temporary dependence.
Last weeks to months.
Gradual awareness of full impact.
What are the goals for treating PTSD?
- reduce symptoms
- improve functioning
- strengthen resilience
- relieve comorbid symptoms
- integrate traumatic experience
- prevent relapse
Pharmacology: what would you use to reduce conditioned fear/anxiety?
Benzodiazapines
Maybe Buspirone
Pharmacology: what would you use to help diminish the peripheral autonomic response?
Clonidine
Propranolol
Pharm: what would you use do decrease hyperarousal, nightmares, mood swings, and explosive outbursts?
Valproic Acid
What would you use to decrease repetitive behaviors, images and somatic states?
SSRIs
- specifically
- Paroxetine*
- Sertraline*
What are risk factors for experiencing partner abuse?
- Witnessing parental violence
- prior victimization
- early puberty
- early use of drugs/alcohol
- exposure to media/internet violence
What are the 4 phases in the cycle of abuse?
- Tensions building
- Incident occurs
- Reconciliation
- Calm
Perpetrator behaviors in the tension-building phase?
- excessive expectations
- blaming
- doesn’t try to control behavior
- doesn’t acknowledge inappropriate behavior
- verbal & minor physical abuse increases
- controlling out of fear that partner will leave
- interprets partner’s withdrawal as rejection
What are the victim’s behaviors in the tension-building phase?
- tries to please
- denies seriousness
- thinks they can control abuser’s behaviors
- blames external factors
- thinks they deserve minor abuse
- gets scared, tries to hide
- calls for help if tension becomes unbearable
Perpetrator behaviors in serious battering incident?
- Trigger can be internal or external
- occurs in private
- threatens harm if victim tries to get help
- justifies behavior
- minimizes severity of abuse
- this relieves tension for abuser
Victim behaviors in a serious battering incident?
- might call for help
- shock, denial, disbelief
- fears more abuse if police arrive or arrest
- anxious, ashamed, humiliated, fatigued, depressed
- does not seek help for a day or more, lies about cause
Honeymoon phase, perpetrator behaviors?
- loving, charming, asks for forgiveness
- tells themselves they won’t do it again
- believes they’ve taught victim a lesson and that they won’t “act up” again
- guilt-trips victim to keep them trapped
Honeymoon phase victim behaviors?
- thinks loving behaviors are the real person
- wants to believe it won’t happen again
- believes that if they stay, abuser will get help
- feel guilty about considering leaving
- feels trapped in a permanent relationship
What interventions would you focus in the Impact stage?
-crisis intervention:
- simple directions
- avoid accusations
- provide physical safety
- provide emotional security
- provide phone number for crisis intervention
Interventions in recoil stage?
- Support groups
- Short-term counseling
- validation of victim and their rights
- referrals to therapies/victim groups
Interventions in Reorganization stage?
Long-term counseling for anxiety, PTSD, depression
What is the biological/psychological source of personality disorders?
There isn’t one that they know of.
What’s the difference between cluster A, B, and C (personality disorders)?
A: odd/eccentric
B: dramatic/emotional/erratic
C: Anxious/fearful
What cluster does Borderline PD fall into?
Cluster B (dramatic, emotional, erratic)
Why are you most likely to see BPD in an inpatient unit?
Self-harm
When would you see medication in a personality disorder?
When it is used for a comorbidity - doesn’t treat BPD.
What is BPD characterized by?
- instability in relationships
- alternating extremes of idealizing and devaluation
- frantic effort to avoid abandonment/feelings of emptiness
- emotional dysregulation
- transient stress r/t paranoia or dissociation
What would Naltrexone be used for in BPD?
Self-harm behaviors
What would Lithium, Depakote or Carbamazepine be used for in BPD?
Rapid mood swings
What would SSRIs be used for in BPD?
Emotionally dysregulation
What would antipsychotics be used for in BPD?
Aggressiveness, violence
Extreme impulsivity
Cognitive-perceptual symptoms (paranoia, etc…)
Antisocial Personality Disorder is characterized by…
Disregard for the rights of others from about age 15.
Illegal actions
Deceitful/cons others for pleasure/profit
Irritable, irresponsible, lack of remorse or guilt for behaviors
Impulsivity
Doesn’t assume responsibility for behaviors
Difficulty sustaining employment or maintaining relationships
What are risk factors for antisocial personality disorder?
ADHD/disruptive behavior disorder or conduct disorder in childhood
History of severe abuse
Absent/inconsistent discipline
Extreme poverty
Removal from home
Always being rescued when in trouble
Maternal deprivation
What are some nursing interventions for antisocial personality disorder?
Consistent limit setting
Fostering responsibility and accepting consequences
Identification of real feelings.
