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Key parts of bulimia diagnosis, DSM
How often does the king eating and inappropirate compensatory behaviours need to go on for
(1) Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
(2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Prevalence
anorexia
bulimia
anorexia one year prevalence: 0.4%
bulimia prevalence is 2-3%
(bulimia more common)
Anorexia diagnosis
- Restriction of energy intake relative to requirements, leading to a significantly low body weight (generally speaking a BMI < 18.5)
- Intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low weight (the intense fear is not usually alleviated by weight loss)
- Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
The condition is then further subdivided into:
a) Restricting type (weight loss attained through diet, fasting and exercise alone – in previous 3 months)
b) Binge eating / purging type (in previous 3 months has purged or engaged in binge eating)
Panic disorder management
SSRIs are first line.
If they fail imipramine or clomipramine can be used
Avoid Benzos
How long do you need for a diagnosis of GAD?
How many of the long list of somatic symptoms do you need?
6 months
A period of at least six months with prominent tension, worry and feelings of apprehension, about every-day events and problems.
At least four symptoms out of the following list of items must be present, of which at least one from items (1) to (4).
Prevalence OCD
Prevalence BDD
OCD - 1-2% prevalence, may be up to 2-3% (2-3% comes from NICE)
BDD - 0.5-0.7%
Treatment for PTSD?
When does PTSD become chronic?
PTSD treatment is:
(i) within 4 weeks; watchful waiting
(ii) within 3 months; CBT
(iii) over 3 months; CBT or EMDR
over 3 months = chronic PTSD
What four antipsychotics are suggested in tx of mania?
Risperidone
Olanzapine
Quetiapine
Haloperidol
Options for long term treatment of BPAD?
- Lithium
- Valproate
- Olanzapine or quetiapine
Options for mania in children
ARIPIPRAZOLE within marketing authorisation - that is, up to 12 weeks of treatment for moderate to severe manic episodes in bipolar I disorder in adolescents aged 13 and older
also consider adult regime
Bipolar Depression
- Stop antidepressant
- High intensity psychological intervention (CBT, IPT or behavioural couples therapy)
- If on nothing, fluoxetine + olanzapine, quetiapine on its own, lamotrigine on its own
- If these fail, try the others
- If on Lithium, optimise dose, consider adding olanzapine on own, olanzapine + flupoxetine, quetiapine or lamotrigine.
- If on valproate, then add fluoxetine + olanzapine or quetiapine. Or could add olanzapine alone or lamotrigine
Note that you can use SSRIs with mood stabiliser cover
Which SSRI is worse for vaginismus?
Paroxetine
What drugs are linked to retrograde ejaculation?
Older antipsychotics e.g. Thioridazine
What drugs are linked to anorgasmia?
SSRIs e.g. Fluoxetine
What is another name for obstructer sleep apnoea?
Pickwickian syndrome
