Psychiatry and the GI tract

Question 1

What is anorexia nervosa?

Answer 1

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

Question 2

What causes weight loss in anorexia nervosa?

Answer 2

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

Question 3

What are some behavioural features of anorexia nervosa?

Answer 3

Extreme preoccupation with body weight or shape
Contant monitoring of food or body image
Avoidant behaviours (e.g. avoid seeing others or themselves)

Question 4

What are some clinical features of anorexia nervosa?

Answer 4

Emaciation (Abnormally thin)
Cold extremities
Hair loss
Growth of fine “Lanugo” hair
Oedema
Muscle weakness
Amenorrhoea
Osteoporosis
Bradycardia
Hypotension

Question 5

What are some possible consequences of anorexia nervosa?

Answer 5

Orthostatic hypotension
Hypothermia
Cardiac arrhythmia
Biochemical disturbances

Question 6

What is bulimia nervosa?

Answer 6

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

Question 7

What are some associated symptoms and conditions with bulimia nervosa?

Answer 7

Depressive symptoms such as low mood, anhedonia (Reduced pleasure), irritability and social withdrawal
Obsessive compulsive behaviours
Ritualised eating behaviours

Question 8

What is the most common cause of bulimia nervosa and anorexia nervosa?

Answer 8

Underlying personality disorders

Question 9

What are some common causes of personality disorders?

Answer 9

Stress of changed female roles in history
Family dysfunction
Inadequate parenting
Low self esteem

Question 10

What are the 3 main types of personality disorder which can present with eating disorders?

Answer 10

Emotionally unstable
Anankastic
Avoidant/Anxious

Question 11

How do patients with emotionally unstable personality disorder present?

Answer 11

Angry outbursts
Disregard for consequences of behaviour
Unstable relationship formation
Manipulation to avoid abandonment
Risk of self harm or suicide

Question 12

How do patients with anankastic personality disorders present?

Answer 12

Preoccupation with rules and lists
Perfectionism which interferes with task completion
Excessive doubt
Resistance to change

Question 13

How does avoidant or anxious personality disorder present?

Answer 13

Apprehensiveness
Worry of rejection
A deep sense of inadequacy
Avoidance of social situations

Question 14

What are some treatment options for eating disorders?

Answer 14

Non-judgemental therapeutic alliance
Treatment of underlying symptoms (e.g. malnutrition)

Question 15

What are some forms of psychological interventions available in eating disorders?

Answer 15

CBT - Cognitive Behavioural Therapy
Psychoanalytic psychotherapy
Family therapy

Question 16

Who is indicated for inpatient treatment in eating disorders?

Answer 16

• 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

Question 17

What are the outcomes of treatment in eating disorders?

Answer 17

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

Question 18

What is somatisation (Body distress disorder)?

Answer 18

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

Question 19

What are factitious disorders?

Answer 19

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

Question 20

What is an example of a condition leading to factitious disorders?

Answer 20

Munchausen syndrome

Question 21

What are some causes of munchausens syndrome?

Answer 21

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

Question 22

What is malingering?

Answer 22

This is the deliberate simulation or exaggeration of symptoms with an obvious gain such as money or days off work

Question 23

What are some GI symptoms of anti-depressants?

Answer 23

Dry mouth
Constipation
Nausea
Vomiting
Abdominal cramps

Question 24

What is globus?

Answer 24

This is a feeling of a lump or sensation of pressure in the throat, which is often increased with stress and worry

Question 25

What are some possible causes of globus?

Answer 25

Acid reflux
Dry mouth causing increased awareness of the oesophagus
Postnasal drip
Stress
Tiredness

Question 26

What are some investigations required in globus?

Answer 26

Referral to ENT
X-ray
Endoscopy
pH studies

Question 27

How is globus usually treated?

Answer 27

Reassurance
Anti-reflux treatment
Increased water intake
Referral to SALT (Speech and language therapist)
CBT or antidepressants for stress

Question 28

What is functional dysphagia?

Answer 28

This is defined as difficulty swallowing with no underlying structure abnormalities, resulting in the sensation that food is ‘sticking in the throat’

Question 29

What investigations are required in functional dysphagia?

Answer 29

FBC
ESR
Barium swallow and endoscopy
MRI scanning

Question 30

How is functional dysphagia usually treated?

Answer 30

Reassurance
Dietary adjustments
Advise careful chewing
CBT, Hypnosis, relaxation therapy