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Psychiatric disorders Flashcards

Psychotic disorders Mood disorders Neurotic disorders Personality disorders Eating disorders

1
Q

What does psychosis mean and what are the symptoms?

A

A person is experiencing a reality that is different to everyone else, they usually lack insight

  • Hallucinations - perception without an external stimulus. Auditory most common in psychosis and means they hear something that isn’t there (cf visual in delirium), olfactory may indicate frontal lobe issue
  • Delusions: a fixed firmly-held belief out of keeping with their social/cultural norms. E.g. persecutory, grandiose, reference, hypochondriacal
  • Formal thought disorder: problem with speech where each sentence/word/phrase doesn’t link from the next (cf flight of ideas where there are some connections)
  • Thought broadcast, passivity phenomenon, thought insertion
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2
Q

What is a pseudohallucination?

A

‘Hearing voices inside head’ not a hallucination; auditory hallucination is where they think it’s coming from outside (but isn’t actually there)

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3
Q

What causes schizophrenia (a chronic relapsing condition)?

A
  • Bio: overactivity of dopamine pathways - so antipyschotics block D2 receptors. Reduced serotonin + GABA + glutamate. May be a/w neurodevelopmental issues
  • Genetic: FH
  • Environmental: adverse life events, smoking cannabis, psychostimulants
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4
Q

What are the types of schizophrenia?

A
  • Paranoid: commonest, prominent hallucinations+/-delusions
  • Hebephrenic: thought disorganisation main thing, fleeting delusions/hallucinations
  • Catatonic: rare. Stupor, negatvisim
  • Simple: negative sx, no psychotic
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5
Q

What are the features of schizophrenia?

A

POSITIVE:

  • Thought interference: insertion (have you experienced thoughts that aren’t yours and have been put there by someone else?), broadcast (people overhear thoughts), withdrawal (are thoughts being taken out of your mind?)
  • Delusions: persecutory (someone trying to harm you), grandiose (special powers/abilities), reference (people doing/saying things that have special meaning to you)
  • Hallucinations: usually 3rd person auditory (talking about you, vs 2nd person talking to you), running commentary (make comments on what you’re doing)
  • Persistent delusions/hallucinations
  • Passivity phenomenon - feeling under control of an outside force
  • Formal thought disorder - incoherent/irrelevant speech that changes direction/goes off at tangents/odd words/loosening of associations
  • Catatonic behaviour: purposeless behaviour e.g. posturing, negativism, mutism

NEGATIVE (all begin with A)

  • Avolition
  • Asocial behaviour
  • Anhedonia
  • Alogia (poverty of speech)
  • Affect blunted
  • Attention deficits
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6
Q

What are Schneider’s 1st rank sx of schizophrenia?

A
  • delusional perception
  • 3rd person auditory hallucinations
  • hearing thoughts spoken aloud, thought broadcast
  • thought interference
  • passivity phenomenon
  • physical hallucinations
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7
Q

How is schizophrenia managed?

A

BIO

  • Investigate for organic causes
  • ECG as antipsychotics can cause long QTc
  • Antipsychotics: D2 antagonists. Usually try second generation first (so amisulpiride, olanzapine etc) then if resistant after 2 try clozapine
  • BZDs for short-term relief of behavioural changes
  • Antidepressants and/or lithium may be used
  • ECT when resistant to drug therapy, good for catatonic

PSYCHO

  • Psychosis early intervention teams for 1st presentation
  • CBT
  • Help with negative sx

SOCIAL

  • CPN
  • SW, living arrangements
  • Family/carer support
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8
Q

Give some organic causes of psychosis

A

Drugs - alcohol, cocaine, amphetamine, MDMA, mephredrone, cannabis, LSD, ketamine

Iatrogenic - levodopa, metyldopa, steroids, antimalarials

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9
Q

What are other psychotic disorders?

A
  • Schizoaffective disorder: sx of mood disorder + schizophrenia at the same time (so criteria for mania/depression plus couple of schizophrenic sx)
  • Schizotypal PD: partial expression of schizophrenia with eccentricity, unusual speech, deviations of thought but without hallucinations/delusions
  • Schizophreniform disorder: some sx of schizophrenia + reduced functioning but doesn’t meet diagnostic threshold
  • Acute transient psychosis: lasting <1m
  • Mood disorders with secondary psychosis
  • Puerperal psychosis: acute mania/psychosis soon after birth (usually within 2w)
  • Persistent delusional disorder: single/multiple delusions for at least 3m, without other prominent sx and function + think normally apart from this. Often related to life situation
  • Induced delusional disorder (Folie a deux): uncommon, similar delusions in 2 or more people
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10
Q

What is bipolar affective disorder?

A

Chronic, episodic mood disorder with at least 1 episode of mania/hypomania + another episode of mania/depression

RF: anxiety/depression, FH, substance misuse, adverselife events

Bipolar 1 - severe mood episodes
Bipolar 2 - milder form of hypomania and severe depression
Rapid cycling bipolar - >4 mood swings in 12m with no asymptomatic periods

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11
Q

What are the features of BPAD?

A
  • Mania:irritability, distractibility, disinhibted (sexual, social, spending), impaired insight, increased libido, grandiose ideas, flight of ideas/pressure of speech, high activity/energy, reduced sleep/concentration. Lasts 1w+
  • Mania + psychosis: severely elevated/suspicious mood, psychotic features, grandiose delusions, auditory hallucinations (mood-congruent)
  • Hypomania: mildly elevated/irritable mood, sx of mania but to a lesser extent, interferes with work/social life, may have partial insight. Lasts 4d+
  • Depression (at least 2w): depressed mood, anhedonia (at least 1 of these). May also have sleep increase/insomnia, WL/WG, psychomotor retardation/agitation, low energy, feeling of worthlessness/guilt, reduced concentration, preoccupation with death/suicide
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12
Q

What are the possible MSE findings in bipolar disorder (manic episode)?

A

Appearnace: flamboyant/unusual clothing, personal neglect
Behaviour: overfamiliar, disinhibited, psychomotor agitation, distractible, restless
Speech: loud, fast, PoS, puns + rhymes, neologisms
*Mood: elated, euphoric, irritable
*Thought: optimistic, pressured thought, FoI, LoA, circumstantiality, tangenitality, overvalued ideas, grandiose/persecutory delusions
*Perception: mood-congruent auditory hallucinations (may happen)
*Cognition: orientated, attention impaired
*Insight usually v poor

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13
Q

What investigations are useful for BPAD?

A
  • TFTs: high/low are a differential
  • U+E: baseline renal function for lithium
  • LFT: same reason
  • Glucose, calcium - disturbance can cause mood sx
  • Urine drug tests - can cause manic sx
  • CT head - space occupying lesions
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14
Q

How is BPAD managed?

A

BIO

  • Atypical antipsychotic- acute episodes of mania, consider long-term with olanzapine/quetiapine
  • Mood stabiliser - lithium in mania (if acute episode check levels to optimise, is also 1st line to prevent relapses), in bipolar depression can use lamotrigine, sodium valproate (not in women child bearing age)
  • BZD or rapid tranquilisation sometimes
  • Antidepressants usually avoided alone as can induce mania; may use fluoxetine + lithium
  • ECT can be used in refractory cases
  • Monitor lithium levels, weight, U+E, TFT

PSYCH

  • Risk assessment, may need MHAA
  • High intensity CBT for bipolar depression
  • Discuss how to recognise relapses

SOCIAL

  • Driving guidelines from DVLA
  • Financial support
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15
Q

What factors contribute to the development of depression?

A

BIO

  • female, postnatal, genetics, neurochemical (low serotonin, noradrenaline, dopamine), endocrine (HPA overactivity), physical co-morbidities, PMH depression
  • poor compliance with meds, corticosteroid use
  • chronic health issues

PSYCH

  • personality type, poor coping strategies, MH comorbidities e.g. dementia
  • acute stressful life events
  • poor insight, negative thoughts about self/world/future

SOCIAL

  • stressful life events, lack of social support
  • unemployment, poverty, divorce
  • alcohol/drugs, poor social support, reduced social status
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16
Q

What are the symptoms of depression?

A
  • Core sx: anhedonia, low mood for at least 2w (little variation + unresponsive to circs), lack of energy
  • Cognitive sx: low self-esteem, excessive guilt/feelings of worthlessness, negative thoughts about self/world/future, lack of concentration nearly daily, suicidal/self harm ideation, hypochondriacal thoughts, hopelessness
  • Biological sx: diurnal mood variation (esp morning worse), early morning wakening, hypersomnia, loss of libido, psychomotor retardation, weight loss (may also gain)
  • Psychotic sx: 2nd person auditory hallucinations, hypochondriacal/guilt/nihilistic/persecutory delusions
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17
Q

What organic problems may cause depression-like sx?

A
  • anaemia
  • hypothyroidism
  • biochemical - U+E, LFT, calcium, vit D, B12
  • anergia from DM
  • intracranial lesion
  • rare things like Addison’s, Cushing’s
  • parkinsonism
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18
Q

How is depression managed?

A

BIO

  • rule out organic problems
  • Antidepressants: usually if moderate-severe depression, or moderate recurrent. For first episode continue for 6-12m, for subsequent episodes continue at least 6m after relapse. Usually generic SSRI first, then may use an SNRI, don’t really use TCA/MAOI anymore. May be augmented with lithium or antipsychotics
  • Manage co-morbidities
  • ECT - if severe refractory, or things like catatonia

PSYCH

  • risk assessment
  • MHAA may be needed
  • mild-mod: low intensity/group CBT
  • high intensity psychological intervention - IAPT referral

SOCIAL

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19
Q

How is the severity of depression classified?

A

Mild depression = 2 core + 2 other symptoms

Moderate depression = 2 core symptoms + 3-4 other symptoms

Severe depression = 3 core symptoms + at least 4 other symptoms

Severe depression w psychosis = 3 core + at least 4 other symptoms + psychosis

20
Q

What are some other depressive mood disorders?

A
  • post-natal depression: common, usually 1-2m PP but can occur later. often worries about baby health/ability to cope, esp if PMH depression/lack of support/previous PND/difficult pregnancy or birth
  • baby blues: v common 3-7d PP, esp in primipare. anxious/tearful/irritable - reassure + support, monitor for PND
  • seasonal affective disorder: annual depressive episodes at a particular time
  • masked depression: depressed mood less prominent than other features of disorder like sleep disturbance
  • atypical depression: hypersomnia, weight gain
  • dysthymia: depressive state for at least 2y that doesn’t meet depression criteria and isn’t cos of partially-treated depression
  • cyclothymia: chronic mood fluctuation over at least 2y but don’t meet criteria for depression/bipolar
21
Q

Define anxiety

A

unpleasant emotional state involving subjective fear and somatic symptoms, if these are excessive/inappropriate it is an illness.

22
Q

Common symptoms of anxiety

A
  • Psych: fear of impending doom, worrying thoughts, exaggerated startle response, restlessness, poor concentration/memory, irritability, depersonalisation/derealisation, excessive fears, avoidance behaviours, co-existent depressive sx, insomnia, intermittent awakening + nightmares
  • General: dizziness, energy loss, hot flushes/cold chills, muscle tension/aches, restlessness, difficulty swallowing, feeling of lump in throat
  • Chest: palpitations, chest pain, hyperventilation, cough, tight chest, tachycardia
  • Abdominal: abdo pain, loose stools, N+V, dysphagia, dry mouth, urinary frequency, erectile dysfunction, menstrual disturbance
  • Neuromuscular: tremor, myalgia, headache, paraesthesia, tinnitus
23
Q

What are the differentials for anxiety?

A
  • medical: hyperthyroidism, hypoglycaemia, anaemia, phaeochromocytoma, Cushing’s disease, COPD/HF, malignancy
  • drugs: alcohol, cannabis, caffeine, withdrawal (alcohol, BZD, caffeine), side effects (excess thyroxine, steroids, adrenaline)
  • psychiatric: eating disorder, somatoform disorder, depression, schizophrenia, OCD, PTSD, adjustment disorder, anxious personality disorder
24
Q

Generalised anxiety disorder

A

Widespread worry about many events/thoughts, present most days for at least 6m

A/w stressful events, substances, neurophysiological

Questionnaires e.g. GAD-7, HADS.

Management:
BIO
*SSRI 1st line
*SNRI 2nd line
*pregabalin 3rd line
--> use meds for at least 12m. BZD shouldn't be offered except in short-term crises

PSYCH

  • education, active monitoring
  • low intensity psych things - self-help, group therapy
  • high intensity: CBT, applied relaxation
25
Q

Phobic anxiety disorders

A

Intense, irrational fear of something, recognised as excessive/unreasonable. co-existing A and/or D common

Types: agoraphobia (of public spaces-avoidance prevents deconditioning), social (due to fear of humiliation/criticism/embarrassment), specific isolated phobias of an object/situation (often related to events in early life or a learned behaviour)

Features include marked and consistent fear/avoidance of the situation or the object, sx of anxiety in the feared situation inc autonomic arousal, in SAD often blushing/fear of vomiting/urgency, sx not present/less prevalent out of the feared situation

Management:

  • agoraphobia: graded exposure techniques in CBT, SSRI if need pharm
  • social: CBT, SSRI (sertraline, escitalopram), SNRI (venlafaxine), psychodynamic psychotherapy
  • specific: exposure with self help or CBT, short term BZD anxiolytic (e.g. if claustrophic and needs a CT scan)
26
Q

Panic disorder

A

Recurrent episodic severe panic attacks, not restricted to a particular situation

Features: usually peak in 10m, rarely last >1h. Palpitations, abdo distress, nausea, numbness, intense fear of death, feeling of choking, chest pain, sweating, shaking, sob, depersonalisation, derealisation

Ddx:

  • psych: other anxiety disorders, dissociative disorder, BPAD, depression, schizophrenia, adjustment disorder
  • organic: phaeochromocytoma, hyperthyroidism, hypoglycaemia, carcinoid syndrome, arrhythmias, alcohol/substance withdrawal

M:

  • Bio: SSRI, consider TCA. continue for 6m. avoid provoking factors like alcohol and caffeine
  • Psych: CBT to recognise triggers, self-help reading
  • Social: support groups, encourage exercise
27
Q

Post-traumatic stress disorder

A

Intense, prolonged, delayed reaction to a traumatic event in which the pt was involved/witnessed. E.g. severe assault, major natural disaster, RTA, near-drowning, observer/survivor of civilian disaster e.g. terrorism/genocide/war, soldiers, violent death

Occurs when emotionally-charged events aren’t processed so memories persist and intrude into conscious awareness

Features (within 6m of the event)

  • Reliving situation e.g. flashbacks, vivid memories, nightmares, distress when exposed to similar circumstances
  • Avoidance of reminders, excess rumination, inability to recall aspects
  • Hyperarousal: irritability/outbursts, concentration/sleep issues, hypervigilance, exaggerated startle
  • Emotional numbing: negative thoughts about self, difficulty experiencing emotions, feeling detached from others, giving up previously-enjoyed activities

Management:

  • Within 3m: watchful waiting if mild, trauma-focussed CBT weekly, short-term drugs for sleep e.g. zopiclone, risk assessment
  • Persisting >3m: trauma-focussed psychological CBT/EDMR, drugs if not helping/pt prefers/also depressed (usually mirtazapine, paroxetine also licensed). continue for 12m if working
28
Q

What are the differentials for PTSD?

A
  • bereavement: stages of grief, anger, bargaining, depression, acceptance, shouldn’t last >6m (??)
  • abnormal bereavement: delayed onset >6m, impact of loss overwhelms coping capacity
  • acute stress reaction: abnormal reaction to sudden stressful events with immediate onset
  • adjustment disorder: significant distress + impaired functioning due to a non-catastrophic stressor (e.g. redundancy, divorce) within 1m of onset. similar sx to mood/neurotic disorders but not as severe + lasts <6m
  • mood/anxiety disorders, personality disorder, dissociative disorder
  • organic: head injury from traumatic event, alcohol/drugs
29
Q

Obsessive compulsive disorder

A

Obsessions - anxiety builds - compulsion - temporary relief but vicious cycle

Features:

  • Obsessions: unwanted thoughts/urges/images repeatedly enter the mind, distressing for pt, pt recognises them as absurd. e.g. contamination, fear of harm, excessive concern with symmetry, violence
  • Compulsions: repetitive stereotyped behaviour,/mental acts that pt feels driven to perform. overt or covert. e.g. checking, washing/cleaning, repeating acts, mental compulsions (e.g. words repeated in a set manner), hoarding
  • They must both have: failure to resist, orginate from pt’s mind, be repetitive + depressing, and carrying out the O/C isn’t pleasurable but reduces anxiety
  • O or C or both on most days for at least 2w
  • Interfere with social/individual functioning e.g. waste time

DDx:

  • O+C present: eating disorders, anankastic PD, BDD
  • Primarily O: anxiety, depression, schizophrenia, somatoform
  • Primarily C: Tourette’s, kleptomania
  • Organic: dementia, epilepsy, head injury

Management:

  • Bio: treat depression, SSRIs 1st like, clomipramine (TCA) sometimes used, antipsychotic can be added
  • Psych: CBT including exposure + response prevention, manage risk
  • Social: psychoeducation
30
Q

Somatoform disorders

A

Sx suggest a physical disorder but no cause so presumed psychological. Pt adopts sick role, provides relief from stressful/unachievable things, this offers attention/care/financial rewards

Types:

  • persistent somatoform pain disorder: at least 6m of severe pain without physical cause, don’t have other sx really
  • undifferentiated somatoform disorder: <6m, less severe, common
  • somatisation disorder: multiple recurrent evolving physical sx, F>M, lots of contact with medical services, analgesia dependence. Commonly abdo pain, N+V, regurgitation, loose BMs, swallowing difficulty, CP/SOB/palps, dysuria/frequency, incontinence, skin itch, arthralgia, paraesthesia, headaches. lasts at least 2y and can’t be explained by physical problems, preoccupation with sx causes distress, doesn’t accept reassurance, has 6+ sx. includes hypochondriacal disorder (things normal body sensations are serious disease, refuse reassuraqnce), BDD, somatoform autonomic dysfunction
31
Q

Dissociative (conversion) disorders

A

Sx cannot be explained by a medical disorder + a/w stressful events that are ‘converted’ to sx that are more bearable for the pt. Dissociation is separating off certain memories from normal consciousness (psych defence mechanism), conversion is when distressing events are transformed into physical sx

includes:
* dissociative amnesia: partial/complete amnesia of streessful events
* dissociatvie fugue: unexpected physical journey away from physical surroundings that they don’tremember, but self-care is maintained
* dissociative stupor: normal muscle tone but profound lack of voluntary movement
* trance + possession disorders
* dissociative motor disorders inc speech
* dissociative convulsions
* dissociative anaesthesia/sensory loss

32
Q

How are psychological problems p/w physical sx managed?

A
  • Bio: SSRI for mood disorder, encourage exercise
  • Psych: CBT
  • Social: stress-relief encouragement, reduce specific causes of stress e.g. marriage counselling
33
Q

What psychological problems may present with physical sx?

A
  • Somatoform disorders
  • Dissociative/conversion disorders
  • Factitious disorder: formerly Munchausen’s syndrome. Individual wishes to adopt the sick role to receive care, for internal emotional gain (primary gain)
  • Malingering: patient seeks advantageous consequences of being diagnosed with a medical condition e.g. evading criminal prosecution or receiving government benefits (secondary gain)
  • Other psychiatric disorders-mood, psychosis, anxiety, PD
  • Multi-systemic disease e.g. IBD, connective tissue disorders
34
Q

What is a personality disorder?

A

Deeply ingrained pattern of inner behaviour/perception of self/way they relate to others that deviates markedly from cultural expectation. Onset in adolescence/YA, stable over time, leads to distress

Common

Causes include genetic, neurodevelopmental, adverse social circs, dysfunctional family, abuse during childhood

35
Q

What are the types of personality disorders?

A

CLUSTER A (‘weird’, may be similar to psychosis but w/o hallucination/delusion):

  • Paranoid: suspicious, unforgiving, dislikes criticism, perceives attack, envious, excessive self-importance, cold affect, mistrusting, strong sense of personal rights
  • Schizoid: detached/flat affect. withdraw from affection/social, prefer solitary activities/fantasy/introspection, indifferent to praise/criticism, reduced libido, limited capacity to express feelings, aloof
  • Schizotypal: eccentric, odd behaviour + thinking, unconventional beliefs

CLUSTER B (wild):

  • Emotionally unstable (borderline): act impulsively without considering consequences, mood instability, para-suicidal behaviour, chronic emptiness, intense unstable relationships, poor control of anger, disturbed identity
  • Dissocial: callous, disregard for social obligations/other people’s feelings/safety, dissocial, impulsive, temper, remorseless
  • Histrionic: shallow + labile affectivity, provocative behaviour, influenced easily, exagerrated emotions, self-indulgence, egocentricity, superficial, lack of consideration for others
  • Narcissistic: grandiose, self-important, degrading of others

CLUSTER C (worriers):

  • Dependent: passive reliance on others to make all decisions, fear of abandonment, helpless, lack self-confidence, passive compliance, exaggerated fears, seeks companionship
  • Anxious (avoidant): tension, apprehension, insecurity, inferiority, continuous yearning to be accepted, hypersensitive to rejection/criticism, restrict lifestyle to maintain security
  • Anankastic (obsessional): doubt, perfectionism, stubborn, rigidity, higher sense of morality, unwelcome impulses but not as severe as OCD

ALSO MIXED PDs

36
Q

How are personality disorders managed?

A
  • Bio (all off-license): atypical antipyschotics for transient psychosis, AD in EUPD, mood stabilisers in EUPD
  • Psych: risk assess, treat other MH issues, other techniques instead of self-harm eg elastic bands, CBT, psychodynamic pyschotherapy, dialectical behavioural therapy
  • Social: psychotherapeutic environment to reduce tension, instil hope, support groups, substance misuse services, help with housing/employment
37
Q

What factors influence development of anorexia nervosa?

A
  • genetics, FH, female, early menarche, sexual abuse, dieting behaviours in adolesence, low self esteem, anxiety/depression, perfectionism, societal pressures, bullying, stressful events
  • adolescence, criticism of eating/weight, occupational pressures e.g. ballet
  • neuroendocrine changes in starvation
38
Q

What is anorexia nervosa?

A

ED characterised by deliberate weight loss, intense fear of fatness, distorted body image and endocrine disturbances

39
Q

What are the features of anorexia nervosa?

A

at least 3m + no recurrent bingeing

  • intense fear of WG, overvalued ideas about weight
  • endocrine disturbance (F-amenorrhea, M-loss of sexual interest/potency)
  • emaciated >15% below EBW/BMI <17.5
  • deliberate WL by reducing intake/increasing exercise
  • distorted body image - constant comparison to others, ‘feeling fat’, body checking/avoiding
  • Other features: fatigue, hypothermia, arrhythmia, bradycardia, peripheral oedema (low albumin),headache, lanugo hair, social isolation, depression, obsessions

Bloods may show: anaemia, thrombocytopenia, leukopenia, hypothyroid, low albumin, high cortisol, low sex hormones, low glucose, metabolic alkalosis (vomiting)/metabolic acidosis (laxatives)

40
Q

How is anorexia managed?

A

*Bio: check for physical complications, treat medical comps, SSRIs fluoxetine for OCD/depression co-morbid
–> hospitalisation if BMI<14/severe electrolyte issues
*Psych: risk assess. need to shift motivational position with CBT/analytic
therapy/interpersonal therapy
–>hospitalisation for suicidal ideation
*Social: voluntary organisations, self help groups

Slow recovery, best chance in first 3y, most make a partial recovery.

mortality 6%, half of these suicide

41
Q

What are the physical complications of anorexia?

A
  • refeeding syndrome
  • low K, glucose, phosphate, Mg, albumin, chloride, zinc, thiamine, calcium
  • high cholesterol
  • dehydration
  • deranged LFTs
  • low thyroid - sick euthyroid - reduced BMR, temperature + bradycardia
  • low sex hormones - amenorrhoea
  • GI: enlarged salivary glands, pancreatitis, constipation, peptic ucler, hepatitis, FLD
  • haem: iron def anaemia, thrombocytopenia, infection
  • CVS: HF, arrhythmia, hypotension, bradycardia, peripheral oedema, cardiomyopathy, MV prolapse
  • renal stones, renal failure
  • neuro: seizure, peripheral neuropathy, autonomic dysfunction
  • MSK: proximal myopathy, osteopenia, osteoporosis
  • dry mouth, brittle nails, lanugo hair
  • suicide
42
Q

What is refeeding syndrome?

A

When v malnourished pt fed with high carbohydrates –> body rushes to rebuild itself –> depletes trace elements/vitamins (phosphate, potassiumm, magnesium) + abnormal glucose metabolism

can cause HF cos of low phosphate (reduced cardiac muscle activity)

43
Q

What is bulimia nervosa?

A

repeated episodes of uncontrolled binge eating, compensatory weight loss behaviours and overvalued ideas about ideal body shape/weight

44
Q

What are the features of bulimia?

A
  • behaviours to prevent WG: self induced vomiting, starvation, drugs (laxatives, diuretics, appetite suppressants, amphetamines, thyroxine), excess exercise, omitting insulin in DM
  • preoccupation with eating: compulsion sense leads to binge, often in secret, often regret/shame after an episode
  • fear of fatness, perceive self as too fat
  • overeating

Usually good insight

Other features include: normal weight, depression, low self-esteem, irregular menses, signs of dehydration, hypokalaemia, dental issues

45
Q

How is bulimia manged?

A
  • Bio: SSRI fluoxetine high dose (can reduce frequency of binge/purging), treat medical complications of vomiting
  • Psych: psychoeducation, CBT-BN, interpersonal pyschotherapy
  • Social: food diary + analysis, regular eating, small regular meals, self help
  • Obv risk assess
46
Q

What are the complications of bulimia?

A
  • Hypokalaemia
  • Arrhythmias, MV prolapse, peripheral oedema
  • Mallory-Weiss tear, enlarged salivary glands
  • Renal stones/failure, dehydration
  • Dental: permanent enamel erosion due to gastric acid
  • Endocrine: amenorrhoea, irregular menses, hypoglycaemia, osteopenia
  • Russel’s sig - calluses on back of hand from repeated abrasion against teeth
  • Aspiration pneumonitis
  • Cognitive impairment, peripheral neuropathy, seizures

Psychiatry (5 decks)

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