Psychiatry and the GI tract Flashcards
What is anorexia nervosa?
This is a psychiatric eating disorder resulting in a significantly low body weight for the persons height, age, developmental stage or weight history, with rapid weight loss
What causes weight loss in anorexia nervosa?
This is caused by a persistent pattern of restrictive eating or other behaviours aimed at maintaining an abnormally low body weight due to an extreme fear of weight gain
What are some behavioural features of anorexia nervosa?
Extreme preoccupation with body weight or shape
Contant monitoring of food or body image
Avoidant behaviours (e.g. avoid seeing others or themselves)
What are some clinical features of anorexia nervosa?
Emaciation (Abnormally thin)
Cold extremities
Hair loss
Growth of fine “Lanugo” hair
Oedema
Muscle weakness
Amenorrhoea
Osteoporosis
Bradycardia
Hypotension
What are some possible consequences of anorexia nervosa?
Orthostatic hypotension
Hypothermia
Cardiac arrhythmia
Biochemical disturbances
What is bulimia nervosa?
This is a psychiatric eating disorder resulting in frequent, recurrent binge eating, followed by compensatory behaviours, aimed at preventing weight gain, including starvation or forced vomiting
What are some associated symptoms and conditions with bulimia nervosa?
Depressive symptoms such as low mood, anhedonia (Reduced pleasure), irritability and social withdrawal
Obsessive compulsive behaviours
Ritualised eating behaviours
What is the most common cause of bulimia nervosa and anorexia nervosa?
Underlying personality disorders
What are some common causes of personality disorders?
Stress of changed female roles in history
Family dysfunction
Inadequate parenting
Low self esteem
What are the 3 main types of personality disorder which can present with eating disorders?
Emotionally unstable
Anankastic
Avoidant/Anxious
How do patients with emotionally unstable personality disorder present?
Angry outbursts
Disregard for consequences of behaviour
Unstable relationship formation
Manipulation to avoid abandonment
Risk of self harm or suicide
How do patients with anankastic personality disorders present?
Preoccupation with rules and lists
Perfectionism which interferes with task completion
Excessive doubt
Resistance to change
How does avoidant or anxious personality disorder present?
Apprehensiveness
Worry of rejection
A deep sense of inadequacy
Avoidance of social situations
What are some treatment options for eating disorders?
Non-judgemental therapeutic alliance
Treatment of underlying symptoms (e.g. malnutrition)
What are some forms of psychological interventions available in eating disorders?
CBT - Cognitive Behavioural Therapy
Psychoanalytic psychotherapy
Family therapy
Who is indicated for inpatient treatment in eating disorders?
- Those with a high risk of suicide
- Those with an ED lasting >5 years
- Those with a comorbidity (e.g. depression)
- Those with intolerable family disfunction
- Those with extreme social isolation
- Those who have failed in outpatient treatment
What are the outcomes of treatment in eating disorders?
50% will return to normal weight
40% will return to normal eating
20% after 20 years will die
10% after 20 years will commit suicide
What is somatisation (Body distress disorder)?
This is an unconscious process in which psychological disturbances produce physical symptoms without any known mechanism
Examples include non-organic abdominal pain due to anxiety or headaches due to stress
What are factitious disorders?
These are disorders which are simulated with no obvious gain, with patients making then selves sick due to a pathological need to occupy a sick role
This can lead to ingestion of products in order to cause hospitalisation
What is an example of a condition leading to factitious disorders?
Munchausen syndrome
What are some causes of munchausens syndrome?
Parental abuse, neglect and abandonment or early experiences of chronic illnesses can cause this, as the patient may want to gain the care they missed as a child or regain the care they received
What is malingering?
This is the deliberate simulation or exaggeration of symptoms with an obvious gain such as money or days off work
What are some GI symptoms of anti-depressants?
Dry mouth
Constipation
Nausea
Vomiting
Abdominal cramps
What is globus?
This is a feeling of a lump or sensation of pressure in the throat, which is often increased with stress and worry
