Psychology in GI disorders Flashcards
Learning Points:
- Psychological factors arise in many GI disorders and may be secondary to an organic disease.
- They may also complicate and drive functional disorders such as IBS
- Psychiatric conditions can trigger gut symptoms, e.g. depression, anxiety and eating disorders
- Even if the precise cause of a persons symptoms isnt clear keep them safe and nutritioned
- REMEMBER REFEEDING SYNDROME
What are the psychological aspects of an organic disease?
- Patient fears/confusions
- Prejudices against having stoma, IBS/D or anything visibly GI.
Examples of functional GI disease?
Reflux Functional dyspepsia (Non-ulcer Dyspepsia) Nausea Vomiting syndromes IBS Sphincter of Oddi Dysfunction
How do we explain a functional disorder to a patinet?
The hardware/software is a good analogy.
Remember to stress that its a real diagnosis and the symptoms are genuine.
Whats the aetiology of functional GI disorder?
Multifactorial:
- Motility
- Hormones
- Microbiota
- Diet
- Psychological Factors
- Altered Visceral Sensation e.g. gut hyperawareness
How do we assess someone with a suspected functional disorder?
Histroy
Exam
Investigate to exclude organic disorders
Nutritional and mental state assessments, thinking about eating disorders
What kind of psychological problems can arise from a GI disorder?
- Loss of appetite
- Stress/anxiety/depression
- Sexual problems
- Conditioning
What kind of psychological problems can present with GI manifestations
Stress
Anxiety
Depression
Eating Disorders
This is called somatization, the manifestation of psychological stress as a bodily symptom
Define Refeeding syndrome
Normal feeding after a period of starvation causes massive electrolyte shifts that can lead to MI & other deaths
How does refeeding syndrome occur?
Adaptive starvation = Low energy use, atrophied gut, heart and muscles, low micronutrient reserves and low intracellular phosphate.
Example:
Carb refeeding –> Rapid insulin spike -> Rapid ATP generation –> Phosphate moves into cells for use –> Hypophosphataemia.
However many such imbalances occur during refeeding that can cause harm.
How do we determine if some is at risk of refeeding syndrome?
One of:
- BMI <16
- unintentional 15% weight loss in 3-6 months
- Low K, phosphate or Mg.
OR Two or more of:
- BMI<18.5
- 10% unintentional weight loss in 3-6 months
- Little -> no nutritional intake in 5 days
- History of alcohol or drug abuse, chemo, antacids or diuretics.
How do you treat someone to avoid refeeding syndrome?
- Start slowly by correcting the fluid depletion
- Replace their low micronutrients e.g. K, phosphate, Mg, Thiamine
- Feed 5-10Kcal/Kg over 24 hours, gradually raising to normal over a week.
List some eating disorders
Binge eating disorders
Bulimia nervosa
Anorexia
Explain the difference between binge eating disorders and bulimia nervosa
Binge eating disorders involves binging on food and not compensating so they gain weight.
Bulimia involves binging and compensating by vomiting out of fear of gaining weight. So they tend to maintain a normalish body weight.
Explain anorexia nervosa
The patient has an obsessive fear of gaining weight so restricts food and uses other measures to control weight.
They have body dysmorphia i.e. see themselves differently to how they are.
They often have SIDMA (Significatnly Impaired Decision making) specific to their weight, they may be very intelligent in every other respect.
Due to tiny weight they may have amenorrhoea (lack of menstruation)
