Psychiatry and GI tract

Question 1

what is a globus sensation?

Answer 1

= sensation of a lump in the throat

Question 2

what are some causes of globus sensation?

Answer 2

• foreign body
• reflux
• inflammation of pharynx
• pharyngeal pouch
• cancers
• pollen food syndrome/oral allergy syndrome
• neurological conditions

Question 3

what mental condition often goes alongside with globus sensation?

Answer 3

= nervousness/anxious

• dry mouth
• repeated swallowing
• enhanced awareness of throat

Question 4

how would you manage a globus?

Answer 4

• re-assurance
• anti-reflux treatment
• stop smoking
• refer to SALT (speech and language therapy)
  = neck/shoulder relaxation techniques & exercise
  = vocal hygiene
• treatment for stress
  = anti-depressant medications
  = CBTT

Question 5

what is functional dysphagia?

Answer 5

= sensation of solid (or liquid) food ‘sticking’ on the way down oesophagus

Question 6

how could you mange functional dysphagia?

Answer 6

• re-assurance
• dietary adjustments including avoidance of food that riggers dysphagia
• advising carefully chewing food
• avoiding fizzy drinks

Question 7

what are the sort of symptoms that GI somatic expression of psychotic symptoms present with?

Answer 7

= bizarre symptoms

e.g. man believed his partner was poising him

Question 8

what are different causes of psychosis?

Answer 8

• mood disorders
  = depression
  = mania
  = bipolar
• schizophrenia
• drug induced
• organic causes
  = dementia
  = delirium
  = brain tumour

Question 9

how would you treat psychotic symptoms?

Answer 9

• treat organic causes
• consider admission too psychiatric hospital
• medications
  = anti-depressants
  = anti-psychotics
  = mood stabilisers
• CMHT support
• drug/alcohol support
• psychological therapies

Question 10

describe the symptoms of irritable bowel syndrome (IBS).

Answer 10

= abdominal discomfort
= bloating
= pain associated with defecation or change in bowel habits

• symptoms present for at least 6months

Question 11

what are some pathophysiologies associated with IBS?

Answer 11

• some motor/sensory dysfunction in GI tract, changes in gut reactivity
  = can be due to emotional stimuli e.g. stress or abuse
• dys-regulation of brain-gut axis
  = may be associated with greater stress reactivity and with modulation/perception of afferent signals from ENS

Question 12

describe who is most likely to get IBS.

Answer 12

• twice as common in women
  (symptoms in women often change with their menstrual cycle)
• seen in all adult age groups, but onset >50years old is unusual

Question 13

describe IBS and its link to psychological factors?

Answer 13

• link to trauma
  = history of physical or sexual abuse
  = most trauma during childhood (abuse, neglect, bereavement or serious illness)
• these types of experiences may sensitise some people to stress, pain and discomfort.
• stress and anxiety can trigger chemical changes that affect normal workings of digestive system

Question 14

how would you manage IBS?

Answer 14

• diet modification
  = fibre, caffeine, regular melas
• exercise
• reducing stress (psychological interventions)
• medication
  = anti spasmodics, reduce pain and cramping
  = laxatives, relieve constipation
  = anti-motility, relieve diarrhoea
  = low dose anti-depressants, reduce stomach pain and cramping
  = reducing/stopping opioid analgesics

Question 15

what is medically unexplained symptoms (MUS)?

Answer 15

= a condition where there is no evident cause, i.e. functional, somatic, somatoform, “pseudo”

Question 16

how would you manage medically unexplained symptoms?

Answer 16

• good communication

= take patient seriously 
= re-assurance
= treat the treatable 
= symptom management 
= screen for depressive illness

Question 17

what tis anorexia nervosa?

Answer 17

= significant weight loss

BMI < 17kg/m2

OR

= in children: failure to make expected weight gain during growth

Question 18

True or false.

Weight loss in anorexia nervosa is self induced?

Answer 18

= true

• avoid fattening foods
• progressive dietary restriction
• calorie counting/excessive weighing
• self induced vomiting (Russell’s sign)
• diuretics/laxatives/appetite suppressants
• excessive exercise

Question 19

describe anorexia nervosa as a core psychopathological disease?

Answer 19

• intrusive/over-valued idea
  = obesity represents failure
  = sliminess represents success
• fear of fatness
• associated body image distortion
  = abdomen
  = thighs

Question 20

describe anorexia nervosa link to endocrine abnormality?

Answer 20

• Decreased Na, K, Mg, PO4, Insulin, Glucose, Thyroid (Secondary to starvation)
• Cardiovascular / arrhythmias
• Bone health
• Amenorrhoea / Loss of sexual interest/potency (Hypothal/Pituitary/Gonadal)
• Elevated GH / Cortisol / Cholesterol

Question 21

what is bulimia nervosa?

Answer 21

= attempts to restrict intake fail > binges

- no endocrine abnormalities

Question 22

what are signs to look out for in bulimia nervosa?

Answer 22

= rotun teeth

= Russel’s sign (nucleus are cut and bruised)

Question 23

what re psychiatric symptoms associated with anorexia/bulimia nervosa?

Answer 23

• depressive symptoms
• obsessive compulsive symptoms
• personality disorders

Question 24

what are some causes of anorexia nervosa and bulimia nervosa?

Answer 24

• socia-cultural pressures
• family dysfunction
• conflicts relating to sexual maturity
• personal vulnerability factors
• biological vulnerability

Question 25

how would you treat anorexia nervosa?

Answer 25

• establish therapeutic alliance
• weight gain is essential
• psychological interventions
• drugs
  = anti-depressants (useful in Tx of co-morbid)
  = anti-psychotics