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Phase 2 > Public Health > Flashcards

Public Health Flashcards

1
Q

What social factors can influence health and disease

A 
Occupation 
Stress 
Living conditions (Pollution)
Education 
Wealth 
Social isolation 
Access to healthcare (Inverse care law)
Cultural differences
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2
Q

What lifestyle factors influence health and disease?

A 
Food 
Exercise 
Alcohol
Smoking 
Drugs
Genetics
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3
Q

What 4 mechanisms did the black report 1980 use to explain inequality

A
  1. Artefact
  2. Social selection - people in poorer health are in lower social classes so unable to to do higher class jobs
  3. Behaviour - people are responsible for their own health
  4. Material circumstances
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4
Q

What did the Acheson report 1988 recommend

A
  1. Evaluate all policies likely to affect health in terms of their impact on inequalities
  2. Give high priority to health of families with children
  3. Government should reduce income inequalities and improve living conditions in poor households
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5
Q

What are the three theories of causation

A
  1. neo-materialist
  2. Pyschosocial
  3. life course
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6
Q

Describe the Neo-materialist theory of causation

A

Material circumstances cause poor health

Disadvantaged people more likely to be born into areas harm

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7
Q

Describe the psychosocial theory of causation

A

Stresses are intensely social

Greater inequality heightens peoples social anxieties

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8
Q

Describe the life course theory of causation

A

Critical periods have greater impact at certain points in your life (Measles or early bereavement)
Accumulation of hazards and impacts add up
(Hard blue collar work leads to injuries which leads to reduced work opportunities which leads to more injuries

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9
Q

How can doctors close the social inequality gap

A
  1. Changer perspectives
  2. Change systems
  3. Change education
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10
Q

What are the 4 main reasons for why men have higher mortality rates than women

A
  1. Men more likely to have a high risk occupation
  2. Risk taking behaviour
  3. Men tend to smoke more than women
  4. Men tend to drink more than women
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11
Q

Define patient compliance

A

Extent to which the patients behaviour coincides with medical or health advice

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12
Q

Give three disadvantages of patient compliance

A
  1. its passive, patients must follow doctors orders
  2. Professionally focused and assumed doctors know best
  3. ignores problems patients have managing their health
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13
Q

Define patient adherence

A

The extent to which the patients actions match agreed recommendations - more patient centred

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14
Q

What is the difference between patient adherence and patient compliance

A

Adherence is more patient centred, empowers patients and considers them as equals in care

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15
Q

What are the 6 key principles of adherence

A
  1. Improve communication
  2. Increase patient involvement
  3. Understand patients perspective
  4. Provide and discuss information
  5. assess adherence
  6. review medicines
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16
Q

Describe the necessity-concerns framework

A

Looks at what influences adherence - adherence increases when necessity beliefs are high and concerns are low

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17
Q

Give 2 factors that patient centred care encourages

A
  1. Focus on the patient as a whole person

2. Shared control of the consultation so decisions are made by patient and doctor together

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18
Q

What is concordance

A

Expectation that patients will take part in treatment decisions and have a say in the consultation

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19
Q

Give 5 barriers to concordance

A
  1. Patient may not want to engage in discussions with doctor
  2. May lead to worry
  3. Patients may just want their doctor to tell them what to do
  4. Time, resources and organisational constraints
  5. Challenging, patient choice may differ from medical advice
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20
Q

Give 4 advantages of doctor patient communications

A
  1. Better health outcomes 3
  2. higher compliances to therapeutic regimes
  3. higher patients and clinician satisfaction
  4. Decrease malpractice risk
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21
Q

Name 6 examples of non-adherence

A
  1. Not taking prescribed medication
  2. Taking bigger/smaller doses than prescribed
  3. Taking medication more/less often than prescribed
  4. Stopping medicine without finishing course
  5. Modifying treatment to accommodate other activities
  6. Continuing with behaviours against medical advice (Diet, alcohol, smoking)
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22
Q

What are some unintentional reasons for non adherence

A 
Difficulty understanding instructions 
Problems using the treatment 
Inability to pay 
Forgetting 
Capacity and resource
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23
Q

What are some of the intentional reasons for non-adherence

A

Patient beliefs about their health and condition
Beliefs about treatments
personal preferences
Perceptual barriers

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24
Q

Why is diabetes a public health issue

A 
Mortality 
Disability 
Co-morbidity 
Reduced quality of life 
Increasing prevalence particularly in younger age groups
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25
Q

What are the public health approaches to managing diabetes

A
  1. identify those at risk
  2. Prevent the diabetes with early effective interventions
  3. Diagnose diabetes earlier
  4. Effective management and supporting self-management
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26
Q

Which groups are most at risk of diabetes

A
  1. Sedentary job
  2. Sedentary leisure activities
  3. Diet high in calorie dense food and low in fruit and vegetables
  4. Obesogenic environment
  5. Age, Sex, Ethnicity and fam history
  6. Weight, BMI
  7. Hypertension/vascular disease
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27
Q

What is IGT

A

Impaired glucose test

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28
Q

What is IFT

A

Impaired fasting glucose test

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29
Q

What screening tests are currently available for testing IGT and IFT

A

HbA1c
Random capillary blood glucose
Fasting venous blood glucose
Oral glucose tolerance test

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30
Q

What is the diagnostic range for IGT

A

7.8-11.0 mmol/l

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31
Q

What is the diagnostic range for IFG

A

6.1-6.9mmol/l

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32
Q

What is the WHO threshold for diabetes

A

FBG >7.0 or 2hr Glucose >11.1mmol/l

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33
Q

What factors contribute to an obesogenic environment

A

Physical environment ie. TV remotes, lifts and car culture

Economic Environment ie. Cheap TV, expensive fruit and veg

Sociocultural environment ie. safety fears and family eating patterns

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34
Q

What are the physical mechanisms that cause people to remain overweight

A

More weight means it is difficult to exercise (Arthritis, stress and incontinence)

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35
Q

What are the psychological factors that cause people to remain overweight

A

Low self-esteem and guilt leading to comfort eating

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36
Q

What are the socioeconomic factors that cause people to remain overweight

A

Reduced employment opportunities
Relationships
social mobility

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37
Q

What are three effective interventions for preventing diabetes

A

Sustained increase in physical activity
Sustained change in diet
Sustained weight loss

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38
Q

What are three approaches to diagnosing diabetes earlier

A
  1. Raise awareness of diabetes and symptoms in the community
  2. Raise awareness of diabetes and symptoms in health professionals
  3. Use clinical records to identify those at risk or use blood tests to screen before symptoms develop
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39
Q

How is NHS England investing in T2 diabetes

A

Healthier you diabetes prevention programme aimed a lifestyle education, weight loss support and group physical exercise

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40
Q

Define obesity

A

Abnormal or excessive fat accumulation that presents a risk to health

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41
Q

Define BMI

A

A crude measure of obesity determined by patients weight (Kg) over height squared

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42
Q

Waist circumference can be used to assess health risks in individuals with a BMI less than what?

A

35kg/m2

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43
Q

What is a low waist circumference for a male

A

<94cm

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44
Q

What is a very high waist circumference for a male

A

> 102cm

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45
Q

What is a low waist circumference for a female

A

<80cm

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46
Q

What is a very high waist circumference for a female

A

> 88cm

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47
Q

What are the BMI categories

A 
Normal 18.5 - 25
Overweight 25 - <30 
Obese 30 - <35
Severe obese 35 - <40
Morbid Obese >40
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48
Q

What percentage of adults In England are either overweight or obese

A

64.3%

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49
Q

What are some of the associated obesity health implications

A 
T2 diabetes 
Hypertension 
Some cancers 
HEart disease 
Stroke 
Liver disease
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50
Q

What are the individual factors that affect obesity

A 
Lifestyle 
Biological 
Demographics 
Skill and behaviours 
Cognitions
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51
Q

What are the social environment affects on obesity

A

Family,
friends
social networks

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52
Q

Describe the obesity care pathway

A

Tier 1 = Universal prevention
tier 2 = lifestyle intervention
tier 3 = specialist services
Tier 4 = Surgery

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53
Q

In terms of the obesity care pathway, what does universal prevention tier 1 involve

A

Preventing future occurrences through information giving

Environmental health promotion

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54
Q

In terms of obesity care pathway, what does lifestyle intervention tier 2 involve

A

Encourage people with obesity to have healthier lifestyles

Multicomponent weight management

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55
Q

in terms of the obesity care pathway, what does specialist services tier 3 involve?

A

Management of severe obesity through multidisciplinary intervention

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56
Q

In terms of the obesity care pathway, what does surgery tier 4 involve

A

Bariatric surgery only considered for people with morbid obesity

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57
Q

What steps have been taken at an national level to reduce obesity

A
  1. Labelling of food
  2. Sugar reduction- tax system for milk based drinks and ban on sale of energy drinks to kids
  3. Schools - review physical activity, adopt active mile, introduce standards for school food
  4. Marketing - introduce 9pm watershed on advertising HFSS products
  5. Retail - Ban on price promotion of unhealthy, ban promotion of unhealthy by location such as ends of aisles
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58
Q

What is deontology

A

Belief that we owe a duty of care to each other

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59
Q

What is consequentialism

A

Consequences matter

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60
Q

What is virtue

A 
Character of the person is central 
Trustworthiness 
Compassion
Integrity 
Discernment 
Conscientiousness
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61
Q

What are the positive of virtue ethics

A

Centres ethics on person

Includes whole of a persons life

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62
Q

What are the negatives of virtue ethics

A

No clear guidance on moral dilemmas
No general agreement on what virtues are
Virtues relative to culture

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63
Q

What are the 4 principles of medical ethics

A

Autonomy
Beneficence
Non maleficence
Justice

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64
Q

What are the 4 quadrants approach

A
  1. medical indications (Beneficence and non maleficence
  2. Patient preference (Autonomy0
  3. Quality of life
  4. Contextual features
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65
Q

The large community of Slovakians in Sheffield has a high prevalence of what disease

A

Hepatitis B

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66
Q

What is major concern in the Somalian population in Sheffield

A

Female genital mutilation

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67
Q

Why Is FGM carried out?

A
  1. Control over women’s sexuality
  2. Infibulation assumed to reduce women’s sexual desire
  3. Hygiene
  4. Gender based factors - FGM deemed necessary for girl to be considered a women
  5. Removal of labia and clitoris thought enhance a girls femininity
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68
Q

What are the immediate consequence of FGM?

A
  1. Pain
  2. Bleeding
  3. Shock
  4. Difficulty passing urine
  5. Infection
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69
Q

What health problems might an illegal immigrant be suffering with?

A 
PTSD
Depression/Suicide
Anxiety 
Sleep disorder 
Stigmitisation 
panic 
Somatisation
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70
Q

What is somatisation

A

Chronic pain
Dizziness
Tired all the time
Headache

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71
Q

What are the issues with using family members as interpreters?

A

Agenda/bias
Not confidential
Family members English may be poor
May limit what is interpreted

72
Q

What are the positives of using family members as interpreters

A

Accessible
Cheap
Know the patient

73
Q

When might a teacher be worried about FGM in a school girl?

A
  1. Family members may take girls off for FGM without consent
  2. When doing travel advice for families taking young girls for long holidays in Somalia
  3. Recurrent UTIs
  4. Withdrawn or long periods in the toilet
74
Q

What is the inverse care law

A

Availability of good medical care tends to vary inversely with the need for it in the population served

75
Q

Define race

A

Classification based on physical characteristics into which human kind was divided

76
Q

Define ethnic group

A

A group of people whose members identify with each other through a common heritage often consisting of a common language, religion or ideology that stresses common ancestry

77
Q

Define vulnerable

A

Indicates an inability to cope with a hostile environment

78
Q

Define social exclusion

A

Inability of an individual group or community to participate effectively in economic, social, political and cultural life

79
Q

Define drug misuse

A

Ingestion of a substance affecting the CNS which leads to behavioural and psychological changes, implicitly non-therapeutic use

80
Q

Name two types of opiate and their effects

A

Heroin and morphine

Euphoria and pain relief

81
Q

Name two types of depressants and their effects

A

Alcohol, benzodizepines ie. Valium and Xanax

Sedation, relaxation, slow down thinking and acting

82
Q

Name three types of stimulants and their effects

A

Caffeine, nicotine and cocaine

Increased alertness and activity and elevate mood

83
Q

Name three hallucinogens and their effects

A

Ectasy, ketamine and mushrooms

Alter sensory perception and thinking patterns, loss of sense of reality

84
Q

What are new psychoactive substances

A

Legal highs that mimic the effects of other substances but less predictably

85
Q

Name some psychoactive substances

A

Synthetic cannaboids
Stimulant type drugs
Downer/tranquiliser
Hallucinogenics

86
Q

What are the effects of new psychoactive substances

A

Increase in body temperature, heart rate, coma and risk to internal organs, intense comedown leading to sucicidal thoughts, hallucination and vomiting, aggression and violence

87
Q

What are the mental health issues associated with new psychoactive substances

A 
Psychosis
Paranoia 
Anxiety 
Psychiatric complications 
Depression
88
Q

Define addition

A

Physical and psychological dependance

89
Q

Describe the 4 tiers of UK drug treatment

A

Tier 1 = non specialist generic substitution treatment = wean patient off the drug

Tier 2 - Open access services

Tier 3 - specialist community based drug services

Tier 4 - specialist inpatient services (Detoxification –> Naltrexone) residential rehabilitation

90
Q

How do we prevent drug misuse?

A

Prevent substance abuse by reducing risk factors and increasing protective factors

91
Q

What are the family risk factors for drug misuse

A

Family history of substance misuse
Family management problems ie. poor parenting
Family conflict including domestic abuse
Being in care

92
Q

What are the school and community risk factors for drug misuse

A

Low academic attainment and commitment

Availability of drugs

Community norms favourable to drug use

Community disorganisation

Transitions/mobility

Low neighbourhood attachment

93
Q

What are the individual and peer risk factors for drug misuse

A

Sensation seeking risk factors

Rebelliousness and alienation

Friends who use drugs and peer recognition

Favourable attitudes towards anti-social behaviour

Experience of trauma

94
Q

What are the protective factors for drug misuse

A

Family attachment

Academic achievement

opportunities, recognition and reward for positive involvement

Opportunities to develop self-confidence, feelings of self-worth and resilience

95
Q

Define physical dependence

A

Body adapts to the presence of the substance over time and needs more and more of the same effect (tolerance)

Stopping leads to withdrawal symptoms (Runny nose, stomach cramps and muscle aches)

96
Q

Define psychological dependence

A

Feeling that life is impossible and challenges cannot be overcome without the drug

Emotional effect of fear, pain, shame, guilt and loneliness if not on drug

97
Q

Describe the ICD-10 diagnostic code for drug misuse

A
  1. Acute intoxication = disturbances in level of consciousness, cognition, perception
  2. Harmful use = pattern of use that is causing damage to health (Physical and mental)
  3. Dependence = cluster of hehavioural, cognitive and psychological phenomena that includes a strong desire to take the drug, persisting in use despite harmful consequences
98
Q

What is community prescribing for drug misuse

A

Delivered by GPs and specialist services

Substitution treatment to help the patient come off the drugs gradually or long term replacement

Goal is to stop patient using illicit drugs and enable a more stable life

99
Q

Describe detoxification

A

Patient gradually reduces the drug dose, medication to ease the withdrawal symptoms

100
Q

What is residential rehabilitation

A

Treatment for those who wish to maintain abstinence

Duration 3-12 months gives opportunity to address underlying issues and work on solving social, employment, financial and legal problem

101
Q

What are benefits of alcohol consumption

A
  1. mildly euphoriant
  2. Socialisation
  3. Cardioprotective in low doses
102
Q

What are the psychosocial effects of excessive alcohol consumption

A

Interpersonal relationship problems (Violence, rape, depression)

Criminality/violence

Problems at work and unemployment

Social disintegration (Poverty )

Driving offences

103
Q

What are the withdrawal symptoms of alcohol misuse

A 
Tremulousness
Activation syndrome (Tremulousness, agitation, rapid heart beat, high Bp)
Seizures 
Hallucinations 
Delirium tremens
104
Q

What are the UK alcohol limits

A

14 units a week for both men and women ideally spread over three days or more if you drink as much as 14 units a week

105
Q

How much alcohol does one unit of alcohol contain

A

8g/10ml of pure alcohol

106
Q

How do you calculate the amount of alcohol in a drink

A

Strength of drink (%ABV) x amount of liquid (ml) /1000

107
Q

Describe the consequences of foetal alcohol syndrome

A

Pre-post natal growth retardation

CNS abnormalities (Mental retardation, irritability, incoordination, hyperactivity)

Craniofacial abnormalities

Congenital defects of the eyes, ears, mouth, cardiovascular system, GIT and skeleton

Increase in incidence of birthmarks and hernias

108
Q

Describe the alcohol harm paradox

A

Low socio-economic status groups consume less alcohol than higher social economic groups but experience greater alcohol related harm

109
Q

What are the acute effects of excessive alcohol/ethanol

A 
Accidents and injury 
Coma and death from respiratory depression 
Aspiration pneumonia 
Oesophagitis/gastritis 
Pancreatitis 
Cardiac arrhythmias 
Cerebrovascular accidents 
Hypoglycaemia
110
Q

What are the chronic effects of excess alcohol intake

A 
Pancreatitis 
CNS toxicity 
 - dementia 
 - Wernicke-korsakoff syndrome 
- cerebellar degeneration 
- Central pontine myelinolysis 
Liver damage 
 - Hepatits 
 - Cirrhosis 
 - Hepatic carcinoma 
Hypertension 
Peripheral neuropathy 
Cardiomyopathy 
Malabsorption 
Skin Disorders 
Coronary heart disease
111
Q

What is the primary prevention (Health promotion) of alcoholism

A

Drinkaware = alcohol labelling
THINK! - drink driving campaign
Know your limits - binge drinking campaign
Restriction on alcohol advertising
Minimum pricing
Legislation - age limit and opening hours

112
Q

What is the secondary prevention of alcoholism

A

Screening and intervention - ask about drinking routinely using screening questions and tools - includes lab tests

113
Q

What can doctors do for alcoholics

A

Screening = CAGE

Alcohol use disorders identification tests = AUDIT

Brief interventions = FRAMES

FAST alcohol screening test

114
Q

What is the CAGE questionnaire

A
  1. Have you ever felt you should cut down
  2. Have people annoyed you by criticising your drinking
  3. Have you ever felt bad or guilting about your drinking
  4. Have you ever taken a drink in the morning (Eye-opening) to steady your nerves or get rid of a hangover

2< positive responses = problem

115
Q

Name the criteria that defines alcohol abuse

A 
Any 1 or more from 
1. Role failure 
2 relationship problems 
3. Run in with law 
4. Risky of bodily harm
116
Q

Name the criteria that defines alcohol dependence

A

3 or more in the last 12 months

  1. Withdrawal symptoms
  2. Tolerance
  3. Keep drinking despite problems
  4. Cannot keep within drinking limits
  5. Spend lot of time drinking/recovering from drinking
  6. Spend less time on other important matters
117
Q

Name some alcohol dependency treatments

A

medical

  • Acamprosate calcium (Campral)
  • Disulfiram (Antabuse)
  • Nalmefene (selincro)
  • Naltrexone

Psychosocial

  • Therapy - cognitive and behavioural
  • Social support
118
Q

Describe FRAMES motivational interviewing for alcoholism

A
  1. Feedback - risk of personal harm or impairment
  2. Stress personal responsibility for making change
  3. Advice - cut down/stop drinking
  4. Provide a menu of alternative strategies for changing drinking patterns
  5. Empathetic interviewing style
  6. Self-efficacy - leaves patient enhanced feeling able to cope with the goals they have agreed
119
Q

How does naltrexone treat alcoholism

A

Competitive antagonist for opioid receptors = rapid detox

120
Q

How does disulfiram treat alcoholism

A

Produces sensitivity to alcohol - worse hangover

121
Q

How does acamprosate treat alcoholism

A

Stabilises chemical balance

122
Q

Define medical ethics

A

Critical evaluation of assumptions and arguments

Inquiry into norms and values - what is good, bad, right or wrong in the context of medical practice

system of moral principles and branch of philosophy which defines that is good for individuals and society

123
Q

What is clinical truth

A

Contextual, circumstantial and personal

  • Cannot ignore objective truth
  • Must not be relegated to it either
124
Q

What is deontology

A

based on the belief that we own a duty of care to each other

125
Q

What is consequentialism

A

Consequences are what matters, the means are unimportant
- Hard to know what the consequences will be
SOme actions are evidently wrong even if consequences are good

126
Q

What is virtue

A

Virtues are characteristics that promote Human flourishing
(Compassion, patience, kindness, fidelity)
Derived from the notion that it is the character of a person that is central

127
Q

What are the positive of virtue ethics

A

It centres ethics on the person and what it means to be human

It included the whole of a person’s life

128
Q

What are the negatives of virtue ethics

A

Doesn’t provide clear guidance on what to do in moral dilemmas

No general agreement on what virtues are

Any list of virtues may be relative to the culture in which it is being drawn up

129
Q

What are the 4 principles of medical ethics

A
  1. Autonomy
  2. Non maleficence
  3. Beneficence
  4. Justice
130
Q

Define autonomy

A

Right to self determination and must be respected

131
Q

When may autonomy not apply

A

lack of mental capacity or children

132
Q

What is beneficence

A

Medical practice always seeks to benefit patient and diligence must be shown in avoiding harm

133
Q

What is non-maleficence

A

Medicine aims to do no overall harm to patients but reasonable harms are justified including drug side effects, surgical wounds and infection risks

134
Q

What is justice

A

Our efforts should be directed without reference to our likes or dislikes

Discrimination is unlawful on basis of race, gender and disability

moral obligation to act on the basis of fair adjudication between competing claims; utility, need vs benefit

135
Q

What are a doctors obligations

A

Duty to patient
Accountable to employer and regulator
Responsible to each other, profession and matters of public health
Moral obligations

136
Q

What are the 5 C’s of ethics in practice

A 
Candour 
Consent 
Capacity
Confidentiality 
Communication
137
Q

What should you do if you make a mistake on a patient

A

Put matters right if possible
Offer an apology
Explain fully and promptly what has happened and likely short term and long term effects

138
Q

What are the end of life decisions for a patient

A 
Euthanasia (Active or passive)
DNAR
Advance directives 
Withholding and withdrawing treatment 
Assisted suicide
139
Q

What is whistleblowing

A

Raising concerns about a person, practise or organisation

140
Q

What is teamwork

A

Work done by several associates with each doing a part but all subordinating personal prominence to the efficiency of the whole

141
Q

What are some teamwork problems

A
  1. Lack of team work
  2. Lack of leadership
  3. Lack of effort
  4. Lack of communication
  5. Lack of a challenge
142
Q

What is SBARR

A 
Situation 
Background 
Assessment 
Request 
Recommendation
143
Q

What are the components of teamwork

A 
Communication - SBARR
Leadership
Authority gradient 
Situational awareness 
Declaring an emergency 
Training together
144
Q

What are the 5 virtue ethics

A
  1. Compassion
  2. Discernment
  3. Trustworthiness
  4. Integrity
  5. conscientiousness
145
Q

What is distributive justice

A

Fair distribution of scarce resources

146
Q

What is rights based justice

A

Respect for people’s rights

147
Q

What is legal justice

A

Respect for the law

148
Q

What are the factors affecting patient compliance

A

Socioeconomic - long distance from healthcare

Health system - supply of medication

Condition - memory impairment

Therapy - complex treatment regimes

Patient - denial of diagnosis

149
Q

What are the steps for sharing decision making with patients

A
  1. define problem
  2. Convey professionals may not have a set opinion about the best treatment
  3. Outline the options
  4. Provide information in preferred format
  5. Check patient’s understanding of the options
  6. ICE
    • Ideas, concerns and expectations
  7. Check patient accepts decision sharing process
  8. Involve patient in decision to the extent they wish
  9. Review needs & preferences
  10. Review treatment decisions over time
150
Q

What is population attributed fraction

A

Proportion of the incidence of a disease in the exposed and non-exposed population that is due to exposure

Exposure eliminated = disease incidence eliminated

151
Q

Describe the 4 quadrants approach

A
  1. Medical indications
    - Beneficence and non-maleficence
  2. Patient preferences
    - autonomy
  3. Quality of life
    - beneficence and non-maleficence
  4. Contextual features
    - Loyalty and fairness
152
Q

How do you challenge authority

A

Express concern
Enquire or offer a solution
Seek explanation
Direct challenge

153
Q

What is Wernicke’s encephalopathy

A

Deficiency in thiamine as metabolism of alcohol depends on thiamine

154
Q

What are the symptoms of wernicke’s encephalopathy

A

Ataxia
Confusion
Nystagmus

155
Q

What is anorexia nervosa

A

Restriction of energy intake leading to low body weigh in the context of age, sex, developmental trajectory and physical health
BMI <17.5

Fear of gaining weight even though already underweight

156
Q

What are the subtypes of anorexia nervosa

A

Restricting

Binge eating-purging

157
Q

What is bulimia nervosa

A

Episodes of binge eating characterised by

  • Eating large amounts of food within a small amount of time (Within 2 hour period)
  • Lack of control over eating during an episode

This is followed by compensatory recurrent behaviour to prevent weight gain (Purging)

158
Q

In bulimia nervosa, how often do the binge eating and purging behaviours occur

A

At least once a week for three months

159
Q

What is binge eating disorder

A

Recurrent episodes of binge eating in a discrete period of time more than most would eat during a similar period
- a lack of sense of control over eating during the period = subjective binges

160
Q

What are episodes of binge eating disorder associated with

A

Rapid eating
Eating until uncomfortably full
Eating large amounts of food when not physically hungry
Eating alone because of embarrassment by how much one is eating
Feeling guilty afterward

161
Q

Does binge eating disorder come with purging or compensatory behaviour

A

No

162
Q

What are other specified feeding and eating disorders

A

Presents with symptoms of other eating disorders but do not meet full criteria for diagnosis

  • Atypical anorexia nervosa (Wt loss but within normal range for above range for individual)
  • Bulimia nervosa or binge eating disorder (Low frequency/duration )
  • Purging
  • Night eating syndrome
163
Q

What is the prevalence of eating disorders

A 
Highest among females between 14 and 40 
Atypical cases most common (3-4%)
Anorexia (0.5-1%)
Bulimia nervosa (1-2%)
Similar levels across ethnic groups and socioeconomic groups
164
Q

What are the causes of eating disorders

A 
Gene/temperament 
Family interaction 
Social pressures 
Trauma 
Core model (Slade, 1982)
165
Q

Describe the core model (Slade, 1982)

A

Combination of low self-estee and perfectionism lead to a need for control
- Trigger to use food as a mans of self control so they restrict their food intake which provides them with positive reinforcement but then you become hungry or starve and develop fear of loss of control leading to physical consequences

166
Q

What factors maintain and progress the eating disorder

A

Initially +ve comments about weight loss which enhances the over evaluation of eating, shape and weight

Terror of losing control when

  • Physiological reaction to starvation
  • Forced to eat
  • Body image disturbance
  • Emotional instability
  • Cognitive rigidity
  • Own body, family, professionals try and take control and make you eat
167
Q

What are the important things to look out for when managing someone with an eating disorder

A
  1. Severe restriction of food/fluid
  2. Electrolyte imbalance
  3. Bone deterioration
  4. Physical damage (Oesophageal tear, blood in vomit)
  5. Alcohol/drug intake
168
Q

What are the urgent signs to look out for when managing someone with an eating disorder

A 
Muscular weakness 
Breathing problems, cardiac signs (Ectopic beats, tachycardia, bradycardia and low blood pressure) 
Deterioration of consciousness 
Rapid weight loss 
Suicidal
169
Q

What is the management of someone with eating disorder

A

Motivation interventions - explore the pros and cons of staying ill
CBT
Specialist supportive clinical management
Family therapy
No evidence based medicines

170
Q

What 3 things are required for valid consent

A

Voluntary
Informed
Made by someone with capacity

171
Q

What do you need to tell patients about their treatment

A 
What 
How 
Risks 
Benefits 
Alternatives and their risks and benefits 
Duty to answer questions
172
Q

Describe the mental capacity act 2005

A

Person must be presumed to have capacity unless it is established they lack capacity

Act done or decision made under this act on behalf of a person who lacks capacity must be made in best interest

Mental capacity is not blanket statement and is task/decision focussed

173
Q

When is someone unable to make a decision

A

if they cannot

  • Understand the relevant information (Consequences)
  • Retain information for long enough to decide
  • Use or weight it to make a decision
  • Communicaate the decision
174
Q

If someone is unable to make a decision, how do you treat them?

A

Check if there is someone who can make the decision on the patients behalf (Lasting power of attorney or advanced directive)

S5 of act allows healthcare progessfional to act in patients best interests

175
Q

The best interests (section 4) of the MCA requires consideration of what

A
  1. Whether the patient could have capacity and when
  2. Patients past and present wishes and feelings
  3. Patients beliefs and values that may influence a decision
  4. Other factors they might consider
  5. Consultation about points 2-4 with anyone needing to be consulted
176
Q

When does the healthcare professional have to the right to act in the patients best interests

A

Relatives are not providing/refusing consent

No one is consenting to the treatment

177
Q

How does consent work in children under 16

A

Gillick competence - does the child understand the consequences of the decision including the emotional and social implications - if yes then they can consent to treatment - if no then parents consent in best interests

Phase 2 (16 decks)

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