Psychiatry and the GI Tract

Question 1

Psychological factors associated with GI disorders

Answer 1

Burdensome life events, abnormal relationship with parents, history or present abuse, anxiety, depression or low mood, neuroticism, inadequate social support, difficulties in interpersonal relationships

Question 2

Globus

Answer 2

Sensation of feeling lump in throat

Question 3

Causes of globus

Answer 3

Foreign body, reflux, inflammation of pharynx, pharyngeal pouch, cancer, pollen food syndrome/oral allergy syndrome, neurological conditions

Question 4

Management of globus

Answer 4

Reassurance, anti-reflux, stop smoking, referral to speech and language therapy, treatment for stress

Question 5

Functional dysphagia

Answer 5

The sensation of solid (or liquid) food ‘sticking’ on the way down the oesophagus

Question 6

Management of dysphagia

Answer 6

Reassurance, dietary adjustments including avoidance of food that triggers dysphagia, advising careful chewing of food, avoid fizzy drinks

Question 7

Psychological factors linked to irritable bowel syndrome

Answer 7

Trauma, physical or sexual abuse, abuse, neglect, bereavement, serious childhood illness

Question 8

Anorexia nervosa

Answer 8

Significant weight loss: BMI <17.5, below 15% of expected

Question 9

Anorexia nervosa in children

Answer 9

Failure to make expected weight gain during growth

Question 10

Self-induced weight loss

Answer 10

Avoidance of fattening foods, progressive dietary restriction, calorie counting/excessive weighing, self-induced vomiting, diuretics, laxatives, appetite suppressants, excessive exercise

Question 11

Pathophysiology of anorexia nervosa

Answer 11

Intrusive, overvalued idea that obesity represents failure and chaos and slimness represents success and control. Morbid fear of fatness and preoccupation with weight and shape

Question 12

Consequences of anorexia nervosa

Answer 12

Decreased Na, K, Mg, PO4, insulin, glucose, thyroid, cardiovascular issues, arrhythmias, bone health, amenorrhoea, loss of sexual interest, elevated GH, cholesterol and cortisol

Question 13

Signs of bulimia nervosa

Answer 13

Low/normal/increased weight, Russel’s sign, decaying enamel/teeth from stomach acid

Question 14

Core pathophysiology of bulimia nervosa

Answer 14

Preoccupation with weight/shape, morbid fear of fatness

Question 15

Prevalence of anorexia nervosa and bulimia nervosa in girls/young women

Answer 15

1% for anorexia nervosa, 2-3% for bulimia nervosa

Question 16

Aetiology for anorexia nervosa and bulimia nervosa

Answer 16

Socio-cultural pressures, family dysfunction, personal vulnerability factors, conflicts relating to sexual maturity, biological vulnerability

Question 17

Treatment for anorexia nervosa and bulimia nervosa

Answer 17

Establish therapeutic alliance, weight gain essential, psychological therapies, drugs (e.g. antidepressants and antipsychotics)