Psychiatry in GI Flashcards
What is a globus sensation and what can cause it?
Sensation of a lump in the throat.
Causes: Foreign body, GORD, Pharyngeal pouch, cancer, pollen/oral allergy.
What is globus?
Diagnosis of exclusion for globus sensation (functional)
Experienced with intense emotional expirience/nerveousness
How is globus managed?
Reassurance Stop smoking Antacid treatment Refer to Speech and language Stress treatment
What is functional dysphagia?
Sensation of solid or food sticking on the way down oesophagus (diagnosis of exclusion)
How is functional dysphagia managed?
Reassurance
Dietary avoidance including food which triggers dysphagia
Carefully chewing food.
What are some psychotic symptoms in GI and how are they managed?
Belief of poisoning Dead gut Tracking device in bowel Olfactory hallucinations. Go with their story/open questions and refer to psychiatry as it can be caused by lots of different causes. (Mood disorders, Schizophrenia, drug induced, organic (Dementia, delerium, brain tumours)
What is the criteria for IBS diagnosis?
Abdominal pain or discomfort that is:
- relieved by daefication
- associated with altered bowel frequency or stool form
AND at least two of the following:
1) Altered stool passage (straining, urgency, incomplete evaculation)
2) abdominal bloating, tenderness, distention, hardness
3) Symptoms made worse by eating
4) Passage of mucus
Symptoms for at least 6 months
What are common stimuli for IBS?
Acute gasteroenteritis
Emotional stress or abuse
What symptoms are seen in IDB but NOT is IBS?
Ulceration of bowel
Bleeding PR/dark stool
Increased risk of chron’s, UC or colon cancer
What is the typical demographic for IBS?
Female, western, 20-30s
Changes with menstruation.
What percentage of IBS is linked to trauma in the past?
30-40% (physical/sexual abuse, neglect, bereavement)
What is the management for IBS?
Diet modifications (low FODMAP diet)
Exercise
Reduce stress
Medication
Antispasmodics, laxatives, antimotility agents, low dose antidepressants
STOP opioid analgesics.
Psychological treatment eg CBT (common comorbidites include depression)
Medically unexplained symptoms accounts for ~20% of GP appointments. What percentage of these people have an underlying psychiatric disorder?
30% (10-80%)
What is the management for medically unexplained symptoms?
Good communication Take patient seriously Don't over simplify to one life event Reassure that this is common but don't normalise. Don't over investigate
Somethings we see can make us feel sick, ill or funny. Which part of the brain is interpreting this?
Visual cortex and Amygdala
What is a Malingering disorder?
Making up or exaggerating symptoms for external gain (court case, aviod work, increase benefits, access drugs)
What is a Factitious disorder?
Making up or exaggerating symptoms to occupy the sick role- not for purpose of secondary gain.
Want medication, oer investigation so they feel better. Common in women with chronic pelvic pain
What are the criteria for diagnosis of anorexia nervosa?
1) Significant weight loss (BMI<17.5)
2) Weight loss is self induced
3) Core psychopathology (fear of fattness, slimness represents success and control, body image distortion)
4) Widespread endocrine abnormality (Amenorrhea, osteoporosis, arrhythmias, decrease Na,K, Mg, PO4, Insulina dn glucose, thyroid. Elevated Cortisol/cholesterol
What is the difference between the restricting and binge eating/purging anorexia nervosa?
Restricting- no evidence of binge eating and purging
Binge eating and purging- either or both present.
What is Bulimia Nervosa?
COre psychopathology identical to anorexia. Atemts to restrict intake fail =? binges Low/normal/increased weight No endocrine abnormalities 30% past history of annorexia.
What are the systemic signs of bulimia Nervosa?
Russels sign- calices on knuckles
Bad teeth from acid attack.
What percentage of anorexia nervosa patients have additional psychiatric symptoms and what are these?
80%
1) Depressive symptoms
Low mood, low energy, social withdrawal, insomnia, concentration difficulties
2) Obsessive compulsive symptoms: food, cleaning
3) Personality disorder
Prevalence of anorexia and bulimia in young women/adolecents?
Anorecia =1%
Bulimia =3%
What are the causes of eating disorders?
Socio-cultural pressures
Family dysfunction
Personal vunrabilit factors- low self esteem
Conflicts in sexual maturity- sexual abuse
Biological vunerability- 7% have an effected 1st degree relative
What is the treatment for eating disorders?
Weight gain: obsessional features and depression
Establish a therapeutic alliance: self esteem, perfectionism and alternative strategies for stress.
Psychological interventions eg CBT
What are the indications for in patient treatment of eating disorders?
High suicidicity Chronicty >5 years Comorbidity- OCD or depression Family dysfunction Social isolation Failure of out patient treatment.
What drugs can be used in eating disorders?
Antidepressants (weight gain side effect) Fluoxetine 60mg
Antipsychotics have NO impact.
What are the outcomes for eating disorders?
50% return to normal weight 40% develop normal eating behaviour Mortality is 20% after 20 years of illness Suicide accounts for 50% of deaths. Earlier onset => worse outcome
