Psychiatry and GI tract Flashcards
what is a globus sensation?
= sensation of a lump in the throat
what are some causes of globus sensation?
- foreign body
- reflux
- inflammation of pharynx
- pharyngeal pouch
- cancers
- pollen food syndrome/oral allergy syndrome
- neurological conditions
what mental condition often goes alongside with globus sensation?
= nervousness/anxious
- dry mouth
- repeated swallowing
- enhanced awareness of throat
how would you manage a globus?
- 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
what is functional dysphagia?
= sensation of solid (or liquid) food ‘sticking’ on the way down oesophagus
how could you mange functional dysphagia?
- re-assurance
- dietary adjustments including avoidance of food that riggers dysphagia
- advising carefully chewing food
- avoiding fizzy drinks
what are the sort of symptoms that GI somatic expression of psychotic symptoms present with?
= bizarre symptoms
e.g. man believed his partner was poising him
what are different causes of psychosis?
- mood disorders
= depression
= mania
= bipolar - schizophrenia
- drug induced
- organic causes
= dementia
= delirium
= brain tumour
how would you treat psychotic symptoms?
- treat organic causes
- consider admission too psychiatric hospital
- medications
= anti-depressants
= anti-psychotics
= mood stabilisers - CMHT support
- drug/alcohol support
- psychological therapies
describe the symptoms of irritable bowel syndrome (IBS).
= abdominal discomfort
= bloating
= pain associated with defecation or change in bowel habits
- symptoms present for at least 6months
what are some pathophysiologies associated with IBS?
- 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
describe who is most likely to get IBS.
- 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
describe IBS and its link to psychological factors?
- 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
how would you manage IBS?
- 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
what is medically unexplained symptoms (MUS)?
= a condition where there is no evident cause, i.e. functional, somatic, somatoform, “pseudo”
how would you manage medically unexplained symptoms?
- good communication
= take patient seriously = re-assurance = treat the treatable = symptom management = screen for depressive illness
what tis anorexia nervosa?
= significant weight loss
BMI < 17kg/m2
OR
= in children: failure to make expected weight gain during growth
True or false.
Weight loss in anorexia nervosa is self induced?
= true
- avoid fattening foods
- progressive dietary restriction
- calorie counting/excessive weighing
- self induced vomiting (Russell’s sign)
- diuretics/laxatives/appetite suppressants
- excessive exercise
describe anorexia nervosa as a core psychopathological disease?
- intrusive/over-valued idea
= obesity represents failure
= sliminess represents success - fear of fatness
- associated body image distortion
= abdomen
= thighs
describe anorexia nervosa link to endocrine abnormality?
- 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
what is bulimia nervosa?
= attempts to restrict intake fail > binges
- no endocrine abnormalities
what are signs to look out for in bulimia nervosa?
= rotun teeth
= Russel’s sign (nucleus are cut and bruised)
what re psychiatric symptoms associated with anorexia/bulimia nervosa?
- depressive symptoms
- obsessive compulsive symptoms
- personality disorders
what are some causes of anorexia nervosa and bulimia nervosa?
- socia-cultural pressures
- family dysfunction
- conflicts relating to sexual maturity
- personal vulnerability factors
- biological vulnerability
how would you treat anorexia nervosa?
- establish therapeutic alliance
- weight gain is essential
- psychological interventions
- drugs
= anti-depressants (useful in Tx of co-morbid)
= anti-psychotics
