Psychological aspects

Question 1

Psychological aspects of organic disease?

Answer 1

• Fears/confusions

- Prejudice against having a stoma/IBS/D and anything in the GI

Question 2

Psychological aspects of functional disease?

Answer 2

One of the most common causes of functional disease

Question 3

How to assess whether a problem is related to Psychological problems?

Answer 3

1-History:
Weight loss
Use of drugs 
Pregnancy 
2-Physical examination including nutritional and MENTAL assessment 
In nutritional assessment include BMI, weight loss, whether they have eaten anything in the past 5 days 
3-Investigation 
4-Expanation to patient and REASSURANCE

Question 4

Psychological problems which are caused by GI disorders?

Answer 4

• diarrhoea
• Vomiting
• Stress
• Sexual related problems

Question 5

Psychological problems which present as GI problems?

Answer 5

• Stress
• Anxiety
• Depression
• Eating disorders

Question 6

What is referring syndrome?

Answer 6

Disorder which occurs when food is given to a person who has been starved or malnourished for a long period of time.

Question 7

When is there a risk of refeeding?

Answer 7

When they have 1 of the following:

• have not eaten anything in 10 days
• BMI is less than 16kg/m2
• unintentional weight loss greater than 15 % in the last 3-6 months
• low levels of phosphate, magnesium and potassium prior to feeding

When they have 2 of the following:

• BMI less than 18kg/m2
• Little or no food intake in the last 5 days
• unintentional weight loss of 10% in the past 3-6 months
• History of alcohol, drug abuse- this may include insulin, chemo drugs

Question 8

How does referring syndrome develop?

Answer 8

Adaptive starvation: Low energy use, atrophied gut and heart and muscles,Low micronutrient reserve and low intracellular phosphate

e. g.
- Feeding with carbohydrates
- Will rapidly increase insulin production
- will rapidly increase ATP
- phosphate will rapidly move into cells
- hypophosphotemia- serum phosphate rapidly drops to less than 2.5mg/dL

Question 9

Treating Refeeding syndrome?

Answer 9

• Correct fluid imbalance
• Replace micronutrients they are low in e.g. K, Phosphate..
• Thiamine
• Feed 5-10Kcal/Kg over 24 hours

Question 10

How to approach eating disorders?

Answer 10

• Be empathetic
• Team approach
• NG feeding- though be aware of re-feeding syndrome

Question 11

Examples of eating disorders

Answer 11

• Anorexia nervosa
• Bulimia nervosa
• Binge eating

Question 12

Signs which eating disorders may feature?

Answer 12

• eating disorder
• altered exercise patterns
• stress/depression/anxiety

Question 13

What is somatisation?

Answer 13

Manifestation of a psychological stress as a bodily symptom