Revision - Anorexia, Personality Disorders, Anxiety Disorders, Learning Disabilities & Affective Disorders Flashcards
What BMI anorexia nervosa (AN)?
<17.5
What metabolic disturbance is typically seen in AN?
Metabolic alkalosis
Blood test results in AN?
1) Low sex hormones
2) Hypercholesterolaemia
3) Metabolic alkalosis
4) Raised GH & cortisol
5) Deranged electrolytes – typically low calcium, magnesium, phosphate and potassium
6) Leukopenia
What drug can be administered as a preventative method for refeeding sydrome?
Pabrinex
What 2 ECG signs are seen in AN?
1) bradycardia
2) prolonged QTc
What age at presentation is a negative prognostic marker for AN?
> 20
1st line mx of BN?
CBT
How is age of menarche implicated in EDs?
Younger age of menarche linked to increased risk
What are the 3 clusters of personality disorders?
A, B & C
What typically defines a Type A personality disorder?
Odd or eccentric behaviours
You find it difficult to relate to other people.
What are the 3 types of Type A personality disorder?
1) paranoid
2) schizoid
3) schizotypal
What characterises a paranoid personality disorder?
Irrational suspicion & mistrust of others
Hypersensitivity to criticism
Reluctance to confide in others due to fear of information being used maliciously against them
Preoccupied with unfounded beliefs about perceived conspiracies against themselves
What typically defines a Type B personality disorder?
Cluster B personality disorders are grouped based on those who find it difficult to control their emotions. You might be viewed as unpredictable by others.
Characterised by dramatic, emotional, or erratic behaviors
What are the 4 types of Type B personality disorders?
1) Antisocial
2) Borderline
3) Histrionic
4) Narcissistic
What characterises hisitrionic PD?
Predominantly characterized by attention-seeking behaviors and excessive displays of emotion.
- Individuals may display inappropriate sexual behaviors.
- Their emotional expressions tend to be shallow, dramatic, and often perceived as exaggerated.
- They often perceive relationships as being more intimate than they truly are, reflecting a distorted perception of interpersonal boundaries.
Which type of PD features the need to be at the centre of attention and having to perform for others to maintain that attention?
Histrionic
Which type of PD features feelings that they are special and need others to recognise this or else they get upset?
Narcissistic
What typically defines a Type C personality disorder?
People with cluster C personality disorders have strong feelings of fear or anxiety.
What are the 3 types of Type C PD?
1) Dependent
2) Avoidant
3) Obsessive compulsive
OCPD vs OCD?
OCPD:
- The patient perceives them as rational and desirable
- Not associated with recurrent, intrusive thoughts or rituals
OCD:
- The symptoms are distressing for the patient
- Is associated with recurrent, intrusive thoughts or rituals
What type of PD features unrealistic expectations of how things should be done by themselves and others, and catastrophising about what will happen if these expectations are not met?
OCPD
What is ‘trait anxiety’?
Your propensity to experience the anxiety response when exposed to a stressor.
What is ‘state anxiety’?
Simply the state of feeling anxious
What are 5 processes thought to drive a spiral of anxiety?
1) Avoidance
2) Attentional and cognitive bias
3) Anxious rumination
4) Low self-worth
5) Poor sleep
How long must symptoms be present for for a diagnosis of GAD?
6 months
What is the key feature of phobic anxiety disorders?
Avoidance of that situation
What phobia is concurrent in 30-50% of panic disorder cases?
Agoraphobia
Stepwise treatment algorithm for mx of anxiety disordes?
1) Psychoeducation, sleep hygiene, and self-guided cognitive-based therapy (CBT)/ relaxation techniques
2) CBT
3) Pharmacological (equal 1st line with CBT)
What drug is 1st line in management of anxiety disorders?
SSRIs
4 key features of PTSD?
1) hyperarousal (i.e. heightened perception of threat)
2) re-experiencing/flashbacks
3) avoidance
4) distress
Management options for PTSD?
1) Trauma focused CBT
2) Eye-Movement Desensitization and Reprocessing (EMDR) therapy
3) Pharmacological: SSRI or venlafaxine (possible adjunctive antipsychotic)
When should you not diagnose panic disorder?
If 2ary to depression
How long must symptoms be present for to make a diagnosis of PTSD?
4 weeks
What is the SSRI of choice in people with unstable angina or recent myocardial infarction?
Sertraline
If CBT or EMDR therapy are ineffective in PTSD, what are the first line drug treatments?
venlafaxine or an SSRI
What SSRI is 1st line in GAD?
Sertraline
2nd line in GAD if 1st SSRI not effective?
Try another SSRI, or SNRI
What are 4 predisposing conditions for autism?
1) Fragile X syndrome
2) Infantile spasms/West syndrome
3) Congenital rubella
4) Tuberous sclerosis
What % of people with autism also have ADHD?
50%
What IQ defines a learning disability?
<70
What is the most common cause of learning disability?
Down’s syndrome
Potential complications of Down’s Syndrome?
- Abnormalities of internal organs e.g. ASD, VSD, oesophageal atresia
– Cataracts
– Hypothyroidism
– Chest infection
– Transient leukaemia
– Epilepsy
– Alzheimer’s Dementia
What is the leading preventable non-genetic cause of LD?
Foetal alcohol syndrome
What are the characteristic facial features in FAS?
Low nasal bridge
Thin upper lip
Flat midface and short nose
Short palpebral fissures
Epicanthal folds
Indistinct/smooth philtrum
Micrognathia
What is the most common inherited cause of LD?
Fragile X syndrome
What genetic mutation is seen in Fragile X syndrome?
CGG trinucleotide repeat on the FMR1 gene on the X chromosome
What signs and symptoms are seen in FXS?
Long, narrow face
Large, protruding ears
Intellectual impairment (mild to profound)
Post-pubertal macroorchidism (large testes)
Social anxiety
Autistic spectrum features
Delayed motor milestones
Speech and language delay
Prominent jaw & forehead
Mitral valve prolapse
What cardiac defect is seen in Fragile X?
Mirtal valve prolapse
What may depressive features in people with LD also indicate the onset of?
Dementia
What cancer can notably cause low mood?
Pancreatic cancer
If antidepressants alone do not work in severe depression, what can they be augmented with?
Lithium
What can a ‘manic switch’ sometimes be induced by?
1) Someone with BAD taking antidepressants to treat a depressive episode
2) Stressful life events
3) Physical illness
4) Illicit substance misuse
What is the gold standard medication for bipolar disorder?
Lithium
What PHQ-9 score indicates ‘more severe’ depression?
≥16 –> combination of CBT & antidepressants
How can lithium affect WCC?
Can cause a benign leucocytosis
1st line mx of ‘less severe’ depression? (i.e. PHQ-9 <16)
Guided self help interventions (then CBT)
Mx of symptoms of hypomania in primary care?
Routine referral to CMHT
