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Interviewing Techniques II > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

What are some functions of serotonergic pathways in the brain?

A

mood, appetite, sleep, cognition, memory, thermoregulation, nausea

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2
Q

What cells make 90% of the serotonin in the body?

A

Enterochromaffin cells in GI

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3
Q

What is the effect of serotonin on the GI?

A

increases GI motility, may cause nausea, gut immune response

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4
Q

What is the function of serotonin stored in platelets?

A

vasoconstriction, platelet aggregation, clot formation

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5
Q

What conditions are treated with therapies that increase serotonin?

A

depression, anxiety, insomnia, OCD, migraines,

aggression

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6
Q

What are the symptoms of serotonin syndrome?

A

Cognitive effects: headache, agitation, hypomania, mental confusion,
hallucinations.
Autonomic effects: hypertension, hyperthermia, shivering, sweating, nausea,
diarrhea
Somatic effects; tremor, hyperreflexia, myoclonus

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7
Q

What is carcinoid syndrome?

A

Caused by tumors of enterochromaffin cells secreting excess serotonin Symptoms: diarrhea, flushing, dyspnea, abdominal pain

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8
Q

What is the rate-limiting step in serotonin synthesis? What is this most dependent upon?

A

Tryptophan → 5-HTP

Tryptophan Concentration

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9
Q

Why might giving someone tryptophan result in a decrease in catecholamines?

A

Dopa decarboxylase is used in serotonin synthesis and catecholamine synthesis. These pathways compete for the same enzyme.

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10
Q

How is 5-HT neurotransmission terminated?

A

reuptake from synaptic cleft into presynaptic neuron

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11
Q

Why should MAO inhibitors not be given at the same time as selective serotonin uptake inhibitors (SSRIs)?

A

MAO inhibitors increase serotonin levels and used in conjunction may cause serotonin syndrome

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12
Q

What are some conditions that are treated with 5-HT receptor agonists?

A

migraines

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13
Q

What are some conditions that are treated with 5-HT receptor antagonists?

A

nausea and vomiting

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14
Q

What is the main inhibitory neurotransmitter in the CNS?

A

GABA

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15
Q

What are effects of GABA?

A

sedative/hypnotic, anti-anxiety, and anti-convulsive effects

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16
Q

How are substances that increase GABA activity used?

A

seizure disorders, anxiety disorders, and insomnia

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17
Q

How are substances that decrease GABA activity used?

A

to counteract the effects of

overdose of GABA agonists. Historically, they were used to induce seizures for anti-depressant therpy

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18
Q

What amino acid is the precursor for GABA?

A

Glutamate

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19
Q

In addition to the binding site for GABA, what other binding sites exist on the GABA receptor?

A

binding sites for benzodiazepines, barbiturates, and ethanol

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20
Q

Where do many of the nervine herbs bind on the GABAA receptor?

A

At the benzodiazepine site

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21
Q

What is the main excitatory neurotransmitter in the CNS?

A

Glutamate

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22
Q

What is the excitotoxicity theory?

A

prolonged or repeated depolarization of a neuron due to stimulation by glutamate (or other excitatory NT) leads to cell damage and death

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23
Q

What is the immediate precursor for glutamate in the brain?

A

Glutamine

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24
Q

How is glutamate neurotransmission terminated?

A

taken back up into neurons and astrocytes

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25
Q

What are some endogenous opioids?

A

endorphins, enkephalins,

and dynorphins

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26
Q

What are endogenous opioids involved in?

A

“Runner’s high”, pain suppression, reward, mood, motor coordination,
feeding, body temperature, immune response, and response to stress

27
Q

What are effects of opioid overdose?

A

cardiovascular and

respiratory depression, nausea, vomiting, constipation and pupillary constriction

28
Q

What is the relationship between beta-endorphin and ACTH? How is this important in the stress response?

A

They come from the same propeptide (pro-opiomelanocortin POMC). In the stress response, when CRF stimulates ACTH production, β-endorphin is also
produced

29
Q

From what molecule are endogenous cannabinoids derived?

A

arachidonic acid

30
Q

What are functions of endogenous cannabinoids?

A

analgesia, eating behavior, immune function, mood,

sleep and memory

31
Q

Why are endogenous cannabinoids not stored in membrane vesicles?

A

Because they are lipid soluble

32
Q

How is obesity defined?

A

BMI > 30kg/m2.

33
Q

What BMI is associated with the lowest point of all-cause mortality?

A

23-24 kg/m2

34
Q

What health condition is responsible for most of the increased mortality with obesity?

A

CHD

35
Q

What other health conditions are associated with obesity?

A

All the things.

36
Q

What waist circumference in men is associated with increased risk of cardiovascular disease? In women?

A

Men > 40in

Women >35in

37
Q

What factors determine what a healthy weight is for a particular patient?

A

clinical picture, diet and exercise history, laboratory biomarkers, and family history.

38
Q

What are some causes of obesity?

A

Genetics, microbiome, physical activity, diet, environmental toxins, stress, sleep-disorders

39
Q

What are some things to consider in the medical interview when discussing weight loss with a patient?

A

motivation to lose weight, hx of eating d/o, ROS, medications, sleep d/o, stress level, gut health, family hx, diet, physical activity, weight hx, dieting hx, readiness for change

40
Q

What are some effects of weight cycling?

A

o Increased total body fat and central adiposity
o Increased food efficiency
o Decreased energy expenditure
Increased BP, insulin resistance, and blood lipids

41
Q

What are some things to consider when coming up with a treatment plan for obesity?

A

individualization

Treatment goals such as wt. loss goal, reducing bp, glucose, etc., treating GERD, improving mood

42
Q 
What is necessary for a diagnosis of:
Anorexia nervosa (AN)
A

Persistent restriction of energy intake leading to
significantly low body weight
• Either an intense fear of gaining weight or of becoming
fat, or persistent behavior that interferes with weight
gain (even though significantly low weight).
• Disturbance in the way one’s body weight or shape is
experienced, undue influence of body shape and weight
on self-evaluation, or persistent lack of recognition of the
seriousness of the current low body weight.

43
Q 
What is necessary for a diagnosis of:
Bulimia nervosa (BN)
A

• Recurrent episodes of binge eating, which are
characterized by:
– Eating excessive amounts rapidly usually as a hidden, possibly
planned, behavior
– Lack of control
• Recurrent compensatory behavior to prevent weight
gain: vomiting, laxatives, diuretics, other medications,
fasting, or excessive exercise.
• Behaviours occur at least once a week for three months.
• Self-evaluation is unduly influenced by body shape and
weight.
• The disturbance does not occur exclusively during
episodes of Anorexia Nervosa.

44
Q

What is necessary for a diagnosis of:

Binge eating disorder (BED)

A

Recurrent episodes of binge eating ( > weekly for 3 months)
• The binge eating episodes are associated with >/= 3:
– eating much more rapidly than normal
– eating until feeling uncomfortably full
– eating large amounts of food when not feeling physically hungry
– eating alone because embarrassed by how much one is eating
– feeling disgusted with oneself, depressed or guilty afterward
• Marked distress regarding binge eating is present
• Binge eating not associated with BN or AN

45
Q 
What are physical effects of 
Anorexia nervosa (AN)
A

Poor circulation, dry or chapped lips, glossitis brittle fingernails, lanugo, amenorrhea, low libido, abdominal pain, constipation, edema, kidney damage

46
Q 
What are physical effects of 
Bulimia nervosa (BN)
A 
Chronic sore throat
Heartburn and reflux
Abdominal pain and bloating
Dysregulated bowel patterns:
constipation, diarrhea
Erosion of dental enamel from
vomiting, tooth decay
Mental: mood swings, selfharm,
anxiety, depression
47
Q

What are physical effects of

Binge eating disorder (BED)

A
  • Weight gain, often leading to obesity
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Stroke
  • Gallbladder disease
  • Heart disease
  • Osteoarthritis
  • Irregular menstrual cycle
  • Certain types of cancer
  • Chronic kidney problems or kidney failure
  • Skin disorders – acne, candida, eczema
48
Q

What is avoidant/restrictive food intake disorder (ARFID)? What are some examples of ARFID?

A

Basically malnutrition from difficulty eating.

Pts with IBD, interstitial cystitis, picky eaters, people with allergies, anxiety d/o, autism

49
Q

What are some common psychiatric issues associated with eating disorders?

A

Depression, anxiety, bipolar, addiction, OCD, PTSD, borderline personality d/o, intentional self-harm, schizophrenia

50
Q

When should you consider screening for an eating disorder?

A

• Patients who want a restrictive diet or have restrictive
dieting history
• Patients who have OCD and perfectionist behaviors
surrounding food or diets you give them
• Weight loss or gain in someone with other mood
disorder or recent trauma
• Incidental finding of poor oral health and beat up
knuckles, frequent pharyngitis (purging)
• Observation of cutting behaviors or scars
• Other issues of alcoholism or addiction
• Patients overly preoccupied with their weight
• Children with weight loss or food restrictive behaviors

51
Q

If a patient has an eating disorder as the primary complaint, what other professionals should be involved in his or her care?

A

dietician, therapist, psychiatrist, eating d/o program, support groups

52
Q

When is inpatient hospitalization indicated with an eating disorder? What are some other possible levels of care?

A

– Unstable or depressed vital signs
– Laboratory findings presenting acute health risk
– Complications due to coexisting medical problems such as
diabetes, particularly type 1 diabetes
– Rapidly worsening symptoms
– Suicidal and unable to contract for safety

Residential treatment, partial hospitalization, intensive outpatient

53
Q

Why is it important to know whether a patient has a history of an eating disorder? In these patients, what are some things you should not consider doing until you know them well?

A

They may have a condition that require dietary changes/restriction and these pts may not be good candidates for such diets dt the potential for relapse.

Avoid food sensitivity testing, elimination diets, other highly restrictive diets

54
Q

Why should drugs and herbs be used in small doses in patients with eating disorders?

A

low weight, low protein
(more drug unbound), and possibly altered
metabolism associated with starvation and
dehydration

55
Q

What is the standard treatment for AN?

A

nutritional rehabilitation
and psychotherapy, which are supported by far more
evidence than pharmacotherapy.

56
Q

What are some treatments for bone loss with AN?

A

Supplement vitamin d, ca, mg, HCl, low dose e/p

57
Q

What drugs are useful in BN?

A

SSRIs, NO bupropion

58
Q

What antidepressant should not be used with AN or BN?

A

Bupropion

59
Q

What is the first line treatment for BED?

A

cognitive behavioral therapy

60
Q

Why is it important not to let patients with AN see their weight?

A

People with AN may become suicidal when their

weight increases and they find out.

61
Q

What types of exercise are especially helpful for patients with eating disorders?

A

yoga, tai chi, qi gong, breathing exercise, fun

62
Q

What are some possible digestive issues in patients with eating disorders?

A

maldigestion d/t stress, dysbiosis

63
Q

What are some counseling techniques that might be useful with eating disorder patients?

A

EFT, EMDR, CBT

Interviewing Techniques II (1 decks)

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