Psychiatry and the GI tract

Question 1

what is globus?

Answer 1

sensation of a lump in the throat

can be due to anxiety

Question 2

what can cause globus?

Answer 2

foreign body
GORD
cancer

Question 3

what is globus commonly associated with?

Answer 3

intense emotional experience

Question 4

how is globus managed?

Answer 4

sometimes reassurance is enough
anti-reflux treatment
stop smoking
referral to SALT
treatment for stress

Question 5

How do you manage functional dysphagia?

Answer 5

reassurance

diet advice to avoid trigger foods/drinks

Question 6

psychotic symptoms?

Answer 6

can be bizarre

- eg people believing they are being poisoned, believe devil in throat etc

Question 7

how are psychotic symptoms managed?

Answer 7

depends on reason for symptoms (mood disorder, drug induced, organic cause, brain tumour, schizophrenia)
treat organic causes
consider admission
medication
CMHT support
drug/alcohol support
psychological therapy

Question 8

what does the mantal health act allow?

Answer 8

allows you to take the patient’s rights away

can keep a psychiatric patient in hospital/treating them etc against their will

Question 9

what is ECT?

Answer 9

electroconvulsive therapy

Question 10

what is available for alcohol addiction?

Answer 10

alcohol liaison service
TSMS (TAPS)
TCA
groups

Question 11

is there a link between IBS and emotional trauma?

Answer 11

yes

32-44% have history of physical or sexual abuse usually in childhood

Question 12

what are the red flags for IBS?

Answer 12

sever weight loss
passing blood
extreme tiredness

Question 13

how many GP appointments does MUS account for?

Answer 13

20%

Question 14

what is malingering disorder?

Answer 14

making up or exaggerating symptoms for external gain

avoid work, increase benefits, access drugs etc

Question 15

what is factitious disorder?

Answer 15

making up or exaggerating symptoms in order to occupy “sick role”
not for purpose of secondary gain

Question 16

what is the diagnostic criteria for anorexia?

Answer 16

BMI < 17.5 
self induced
core psychopathology
- intrusive idea that obesity = failure
- associated body image distorsion
widespread endocrine abnormality
Widespread endocrine abnormality

Question 17

what is russels sign?

Answer 17

calluses on fingers indicating self induced vomitting

Question 18

what is increased/decreased in anorexia

Answer 18

GH, cortisol and cholesterol increased

Na, K, Mg and PO4, insulin, glucose, Thyroid decreased

Question 19

what is atypical anorexia?

Answer 19

1 core feature is absent

Question 20

what is bulimia nervosa?

Answer 20

core psychopathology same as anorexia
attempt to restrict intake then fail and binge causing guilt
low/normal/increased weight
no endocrine abnormalities

Question 21

what are some signs of eating disorder?

Answer 21

russel’s sign (calluses on knuckles)
tooth decay
….

Question 22

how many anorexia or bulimia have depressive symptoms?

Answer 22

> 80%

Question 23

what are the signs of depression?

Answer 23

low mood, anhedonia, anergia
insomnia
social withdrawl
pessimism

Question 24

what psychiatric symptoms may people with anorexia or bulimia experience?

Answer 24

depression
obsessive compulsive symptoms (30% of female anorexia patients)
personality disorders (borderline, anankastic (working under strict rules), avoidant/anxious)

Question 25

which is more common in adolescent women, anorexia or bulimia?

Answer 25

bulimia = 2-3%
anorexia = 1%

Question 26

what is the lifetime risk of anorexia and bulimia in women?

Answer 26

AN = 3
BN = 8

Question 27

which gender is AN and BN more common in?

Answer 27

10X more in women

Question 28

what is associated with eating disorders?

Answer 28

socio-cultural pressures
family dysfunction
personal vulnerability
conflicts relating to sexual maturity
biological vulnerability

Question 29

how are AN and BN treated?

Answer 29

weight gain is essential
establish therapeutic alliance
psychological interventions - CBT etc (best)

Question 30

what are the psychiatric indications for admission in eating disorders?

Answer 30

high suicide/mortality risk
lasting >5 years
comorbidity (OCD/depression)
extreme social isolation
failure of OP treatment

Question 31

what drugs can be used for eating disorders?

Answer 31

antidepressants

- fluoxetine = best

Question 32

what is the outcome of AN and BN?

Answer 32

only 50% return to normal weight and menstruation
40% have normal eating behaviour
20% mortality after 20 years
50% of AN/BN deaths due to suicide

Question 33

how many AN sufferers develop BN?

Answer 33

25%

Question 34

what are MUS?

Answer 34

medically unexplained symptoms

Question 35

how may MUS remain unexplained at 12 months?

Answer 35

12%

58% are GI complaints

Question 36

how many MUS have an underlying psychiatric disorder?

Answer 36

30%

between 10 and 80%

Question 37

what is restricting type anorexia?

Answer 37

no evidence of binge eating/purging behaviour