Psychiatry and the G.I tract

Question 1

Globus sensation

Answer 1

a sensation of a lump in the throat

Question 2

Causes of globes sensation

Answer 2

foreign bodies
cancers
neurological conditions

Question 3

Management for globus

Answer 3

Reassurance 
anti-reflux treatment 
stopping smoking 
referral to SALT 
Treatment for stress - antidepressants, CBT

Question 4

Functional dysphagia

Answer 4

Bizarre symptoms

Question 5

Causes of psychosis

Answer 5

Mood disorders 
-depression
-mania
-bipolar 
Schizophrenia 
Drug induces 
Organic causes 
-dementia 
-delirium 
-brain tumours

Question 6

What does the mental health act do

Answer 6

Takes patients rights away as patient cannot determine what is best for them

Question 7

What is ECT

Answer 7

Electroconvolusive therapy

Electrical signals sent through the brain

Question 8

How is IBS related to psychiatry

Answer 8

Link to trauma - especially physical or sexual abuse in childhood
Stress, and anxiety

Question 9

How to manage IBS

Answer 9

Dietary advice
Watch out for red flags
Psychological treatments

Question 10

MUS accounts for what percent of GP appointments

Answer 10

20%

Question 11

factitious disorder

Answer 11

Patients not honest about symptoms
Many reasons for this
Diagnosis is based on the intent behind the deceit
To occupy ‘sick role’ and not for external gain

Question 12

Malingering disorders

Answer 12

Making up or exaggerating symptoms for external gain eg. influencing upcoming court case, avoid work, increase benefits, access to drugs

Question 13

Anorexia nervosa

Answer 13

Due to psychological distress 
Significant weight loss 
Weight loss is self induced 
Feels that obesity represents failure and chaos whereas being skinny is successful and controlled 
Widespread endocrine abnormality

Question 14

What are the endocrine abnormalities are caused by anorexia nervosa

Answer 14

Decreased Na, K, Mg, PO4, insulin, glusoucse, thyroid

increased cortisol

Question 15

Bulimia nervosa

Answer 15

Attempts to restrict intake fails, leading to bungee
low, normal or increased weight
No endocrine abnormalities
30% past history of anorexia

Question 16

Signs of bulimia

Answer 16

Russels sign - calluses on nuckles from inducing vomiting

Teeth eroded by acidic vomiting

Question 17

OCD symptoms

Answer 17

Ritualised behaviour
-food related (eating behaviour)
-non-food related (obsessional cleaning ect)
May resolve with weight gain
Female OCD patients - 30% history of anorexia

Question 18

Personality disorders

Answer 18

Borderline traits
Anakastic - OCD personality disorder
Avoidant/anxious - hide at the end of the day

Question 19

Causes of eating disorders

Answer 19

Socio-cultural pressures 
Family dysfunctions 
Personal vulnerability factors 
Conflicts relating to sexual maturity 
Biological vulnerability

Question 20

Treatment for eating disorders

Answer 20

Weight gain is essential 
Psychological interventions 
-CBT
-psychoanalytic psychotherapy 
-family therapy 
Drugs 
-antidepressants
-antipsychotics -no impact

Question 21

What is the mortality for eating disorders

Answer 21

20% motility after 20 years illness
Suicide amounts for 50% of all deaths
Onset before puberty - poorer outcome