Psychiatry and the GI tract Flashcards
what is globus?
sensation of a lump in the throat
can be due to anxiety
what can cause globus?
foreign body
GORD
cancer
what is globus commonly associated with?
intense emotional experience
how is globus managed?
sometimes reassurance is enough anti-reflux treatment stop smoking referral to SALT treatment for stress
How do you manage functional dysphagia?
reassurance
diet advice to avoid trigger foods/drinks
psychotic symptoms?
can be bizarre
- eg people believing they are being poisoned, believe devil in throat etc
how are psychotic symptoms managed?
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
what does the mantal health act allow?
allows you to take the patient’s rights away
can keep a psychiatric patient in hospital/treating them etc against their will
what is ECT?
electroconvulsive therapy
what is available for alcohol addiction?
alcohol liaison service
TSMS (TAPS)
TCA
groups
is there a link between IBS and emotional trauma?
yes
32-44% have history of physical or sexual abuse usually in childhood
what are the red flags for IBS?
sever weight loss
passing blood
extreme tiredness
how many GP appointments does MUS account for?
20%
what is malingering disorder?
making up or exaggerating symptoms for external gain
avoid work, increase benefits, access drugs etc
what is factitious disorder?
making up or exaggerating symptoms in order to occupy “sick role”
not for purpose of secondary gain
what is the diagnostic criteria for anorexia?
BMI < 17.5 self induced core psychopathology - intrusive idea that obesity = failure - associated body image distorsion widespread endocrine abnormality Widespread endocrine abnormality
what is russels sign?
calluses on fingers indicating self induced vomitting
what is increased/decreased in anorexia
GH, cortisol and cholesterol increased
Na, K, Mg and PO4, insulin, glucose, Thyroid decreased
what is atypical anorexia?
1 core feature is absent
what is bulimia nervosa?
core psychopathology same as anorexia
attempt to restrict intake then fail and binge causing guilt
low/normal/increased weight
no endocrine abnormalities
what are some signs of eating disorder?
russel’s sign (calluses on knuckles)
tooth decay
….
how many anorexia or bulimia have depressive symptoms?
> 80%
what are the signs of depression?
low mood, anhedonia, anergia
insomnia
social withdrawl
pessimism
what psychiatric symptoms may people with anorexia or bulimia experience?
depression
obsessive compulsive symptoms (30% of female anorexia patients)
personality disorders (borderline, anankastic (working under strict rules), avoidant/anxious)
which is more common in adolescent women, anorexia or bulimia?
bulimia = 2-3% anorexia = 1%
what is the lifetime risk of anorexia and bulimia in women?
AN = 3 BN = 8
which gender is AN and BN more common in?
10X more in women
what is associated with eating disorders?
socio-cultural pressures family dysfunction personal vulnerability conflicts relating to sexual maturity biological vulnerability
how are AN and BN treated?
weight gain is essential
establish therapeutic alliance
psychological interventions - CBT etc (best)
what are the psychiatric indications for admission in eating disorders?
high suicide/mortality risk lasting >5 years comorbidity (OCD/depression) extreme social isolation failure of OP treatment
what drugs can be used for eating disorders?
antidepressants
- fluoxetine = best
what is the outcome of AN and BN?
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
how many AN sufferers develop BN?
25%
what are MUS?
medically unexplained symptoms
how may MUS remain unexplained at 12 months?
12%
58% are GI complaints
how many MUS have an underlying psychiatric disorder?
30%
between 10 and 80%
what is restricting type anorexia?
no evidence of binge eating/purging behaviour
