Psych Eating DOs/Abuse/Dementia Flashcards
what is the definition of obesity
BMI 30 kg/m2 or greater OR body weight 20%> over the ideal weight
about 50% of patients with obesity experience what?
binge eating episodes
what are the four different management options for obesity?
1) . behavior modification
2) . medical therapy: depends on condition, i.e. antidepressants if underlying depression
3) . anti-obesity meds: ORLISTAT or LORCASERIN
4) . surgical options
how does orlistat work?
decreases GI fat digestion
how does Lorcaserin work?
serotonin agonist
obesity screening guidelines
screen all adults and children age 6 years and older
what is bulimia nervosa?
eating disorder characterized by frequent binge eating combined with compensatory behaviors to prevent weight gain
patients with bulimia usually maintain a __________ weight and compensatory behaviors are ________
normal weight
ego-dystonic = troublesome to the patient
3 possible signs on exam for a pt with bulimia
1) . Teeth pitting or enamel erosion (from vomiting)
2) . russell’s sign: calluses on the dorsum of the hand from self-inducing vomiting
3) . parotid gland hypertrophy
what is a lab finding indicative of bulimia?
increased amylase (salivary gland hypertrophy and vomiting) *maybe metabolic alkalosis from vomiting
diagnostic criteria for bulimia (3)
1). recurrent episodes of someone eating more than a normal person would in 2 hr period- occurs AT LEAST WEEKLY FOR 3 MOs
2). purging vs non-purging:
purging: self-induced vomiting, diuretic/laxative abuse
non-purging: reduced calorie intake, dieting, fasting
3). perception of self-worth is excessively influenced by shape and body weight
management of bulimia
- psychotherapy + pharm
- pharm: FLUOXETINE/PROZAC (reduces binge-purge cycle)
definition of anorexia
failure to maintain a normal body weight, fear and preoccupation with body weight/image
**BMI <17.5 OR body weight <85% of ideal weight
which psych DO has the highest mortality rate?
Anorexia
people with anorexia are often at a ________ weight and behavior is ________
low weight
ego-syntonic: behaviors are acceptable to them and in harmony with self-image
what are the two main types of anorexia?
1) . restrictive type: strict, reduced calories, dieting, fasting
2) . binge eating/purging: self induced vomiting and diuretic/laxative abuse
PE signs of anorexia
emaciation, hypotension, bradycardia, skin or hair chages, dry skin, salivary gland hypertrophy, amenorrhea, ostepenia
3 diagnostic criteria for anorexia
1) . restriction of calorie intake leading to significantly low body weight
2) . intense fear of fatness or gaining weight
3) . distorted body image
4 ways to manage anorexia
1) . medical stabilization: hospitalization for <75% expected body weight or pts with medical complications
2) . nutritional rehab: refeeding syndrome can occur with this (LOW Phosphorus)
3) . psychotherapy
4) . pharmacotherapy: if depressed, SSRIs (may also help with weight gain)
what is child neglect? signs of it?
failure to provide the basic needs of a child (supervision, food, shelter, affection, education)
-signs: malnutrition, withdrawal, poor hygiene, and failure to thrive
how many females under 18 have experience sexual abuse?
1/4-1/3 of female children
what is the normal age range for sexual abuse?
9-12
who are the most common perpetrators for sexual abuse?
most commonly males and most are relatives to the child or known to child
signs of child abuse
children that exhibit sexual knowledge, initiate sex acts with peers, show knowledge of sexual acts or injury to genital areas
what is Munchhausen by proxy?
mental health problem in which a caregiver makes up or causes an illness or injury in a person under his or her care, such as a child, an elderly adult, or a person who has a disability
The caregiver with MSBP may lie about the child’s symptoms, change test results to make a child appear to be ill, or physically harm the child to produce symptoms.
what percent of women and men will experience intimate partner violence?
1/4 for women and 1/7 for men
a women who leaves an abusive partner has a ____% greater risk of being killed by the abuser compared to staying
70%
management of intimate partner violence
screening for it in healthcare facilities
assessing patients
referring patients for violence if the patient ACCEPTS help
what is delirium?
acute, abrupt TRANSIENT confused state due to an IDENTIFIABLE cause
* usually a full recovery within 1 week
what are some causes of delirium
I- infections
W- Withdrawal A- acute metabolic T- trauma C- CNS injury H- hypoxia
D- deficiencies E- endocrine A- Acute vascular T- Toxins/Drugs H- heavy metals
most common type of dementia and risk factors for it
ALZHEIMER’S
risk factors: AGE, family hx, genetics
pathophys for alzheimers
UNKNOWN- some theories
- amyloid protein deposition
- neurofibrillary tangles (tau proteins)
- ACh deficiency
S/S of alzheimers
short term memory loss appears first
progresses to long term memory loss and cognitive deficits: disorientation, behavior and personality changes, language difficulties, loss of motor skills
how to diagnose alzheimers
CLINICAL
- do workup to rule out other causes
- MRI is PREFERRED neuroimaging (medial temporal lobe atrophy)
Medications for Alzheimers
Acetylcholinesterase inhibitors for improving memory and symptom relief: donepezil, tacrine, rivastigmine, galantamine
In moderate to severe dz, monotherapy or in adjunct: MEMANTINE (NMDA antagonist- blocks receptor, inhibiting excitatory glutamate receptor that normally causes cell death)
what causes vascular dementia?
brain disease due to chronic ischemia and multiple infarctions (LACUNAR INFARCTS)
what is the most important risk factor for vascular dementia?
HTN
how do symptoms present in vascular dementia?
SUDDEN decline in functions with a stepwise progression of symptoms
how to diagnose vascular dementia?
CLINICAL
workup similar to alzheimer’s
can do MRI- white matter lesions, cortical or subcortical infarcts
how do you prevent vascular dementia?
strict BP control
what is frontotemporal dementia?
“Pick’s Disease”
localized brain degeneration of the frontotemporal lobes
symptoms of frontotemporal dementia
- marked changed in social behavior, personality, and language are early signs
- executive and memory dysfunction are advanced disease
- behavioral changes: DISINHIBITION or SOCIALLY inappropriate behaviors, apathy, hyperorality
when is average onset for frontotemporal dementia?
EARLIER than alzheimers (usually 6th decade)
what skill is preserved in frontotemporal dementia
visuospatial skills
what is typically seen on histology for frontoemporal dementia?
Pick bodies (round or oval aggregates of Tau protein
what is Lewy body dementia?
PROGRESSIVE dementia characterized by DIFFUSE presence of lewy bodies (abnormal neuronal protein deposits), compared to parkinsons where lewy bodies are LOCALIZED
symptoms of lewy body dementia
Early: visual hallucinations, episodic delirium, Parkinsonism and REM sleep DO
Late: Dementia
Also, autonomic dysfunction
management of lewy body dementia
tx of parkinsonism symptoms MAY WORSEN the neuropsychiatric symptoms
what is Parkinson’s disease?
movement disorder due to idiopathic loss of dopaminergic neurons in the substantia nigra
pathophys for parkinson’s
loss of dopaminergic neurons leads to failure of ACh inhibition in the basal ganglia (ACh is excitatory)
*also affects dopamine’s ability to initiate movement
average age range for symptom onset
45-65 yo
Clinical triad for parkinson’s
resting tremor: often the first sign, “pill-rolling”, WORSE at rest, IMPROVES with voluntary movement
bradykinesia: slowness of voluntary movement and decreased automatic movements
muscle ridgidity: increased resistance to passive movement (“cogwheeling”)
what kind of facial features appear in parkinsons?
fixed facial expressions
Myerson’s sign: tapping the bridge of the nose repeatedly causes a sustained blink
seborrhea of the skin common
how to diagnose parkinson’s and what is found on post mortem histology?
CLINICAL dx
histology: LOCALIZED lewy bodies and loss of pigment cells in substantia nigra
what is the most effective medication for parkinsons?
Levodopa-carbidopa
what medications for parkinson’s are 2nd line? when are these used versus Levodopa?
Dopamine agonists (Bromocriptine, Pramipexole, Ropinirole) *have less motor ADRs than Levodopa, but not as effective; use these drugs in younger patients to delay use of Levodopa
when are anticholnergics used to tx parkinson’s?
when the patient is under 70 yo and TREMOR is the predominant symptom, use this as MONOTHERAPY
*may worsen glaucoma or BPH
