Substance abuse and eating disorders Flashcards
What are the eating disorders
Anorexia nervosa- low body weight from restriction of food
Bulimia nervosa- episodes of uncontrolled eating followed by compensatory behaviours
Binge eating disorders- where eat excessively but no compensatory behaviours
Atypical eating disorders- closely resemble other disorders but do not meet criteria
Diagnostic criteria for bulimia nervosa
Binge eating episodes with compensatory behaviour to prevent weight gain at least once a week for 3 months
Feel as if have no control over episodes
Physical signs may be present
Examples of compensatory methods in bulimia
Excessive exercising
Diet pill
Diuretics
Self induced vomiting
Laxatives
Physical signs of bulimia nervosa
Erosion of teeth
Russels sign- calluses on knucjles or back of hand
From induced vomiting
Management of bulimia nervosa
Refer immediately to eating disorder specialist
First line is BN focused guided self help for 4 weeks
If ineffective then ED-CBT
Can cosider high dose fluoxetine
Classifying bulimia nervosa
Mild
- over 1 episode a week
Moderate
- over 2 episodes a week
- no other abnormalities
Severe
- electrolyte abnormalities
- daily purges
When would admit someone with eating disorder
CVD instability
Concurrent infection
Generally unwell
Hypothermia
Electrolyte abnormality
Reduced muscle power on sit-up squat stand test
BMI under 16
Hypoglycaemia
High risk of refeeding syndrome
How does alcohol withdrawal present
6-12 hours
- tremor
- restless
- sweating
- palpitations
36 hours
- seizures
48-72 hours (delirium tremens)
- coarse tremor
- confusion
- delusions
- auditory and visual hallucinations
- fever
What is mechanism behind alcohol withdrawal
Alcohol consumption enhances GABA inhibition and inhibits glutamate receptors
In withdrawal the opposite happens
What is treatment for alcohol withdrawal
1st line:
- chlordiazepoxide
- can use carbamezapine
2nd line clomethiazole
Offer advice on local services for addiction
Treatment of delirium tremens
1st line: oral lorazepam
If persist- IV lorazepam or haloperidol
Can use chlordiazeperoxide
Management of seizures in alcohol withdrawal
Lorazepam or chlordiazeperoxide
What class of drug is chlordiazepoxide
Benzo
Management of alcohol withdrawal
Fill out clinical institute withdrawal assessment (CIWA)
Used to determine need for seizure prophylaxis or benzos
Low BMI
Bradycardia
Hypotension
Enlarged salivary glands
A nervosa
Blood findings of a nervosa
Hypokalaemia
Low FSH, LH, oestrogen and testosterone, platelets
Raised Cs and Gs
Cortisol
Cholesterol
GH
Glucose- impaired glucose tolerance
What are lanugo hairs seen in
Anorexia- fine downy hair growth in response to loss of body fat
Presentation of opiate withdrawal
Everything runs
Neuro- agitation, mydriasis, parasthesia
Psych- depression, craving
Gastro- D&V
Derm- lacrimation, sweating, rhinorrhoea
Goosebumps
Features of opiate withdrawal
Occur within 12 hours typically
Not life threatening
How does cocaine withdrawal present
2 phases
First phase within hours of last use- like a crash
- depression
- exhaustion
- agitation
- irritbaility
Second phase
- increased cravings
- tired
- poor concentration
- insomnia
- slowed activity
What is excited delirium
A complication of cocaine and other illicit drug intoxication
How does excited delirium present
Profuse sweating
Delirium
Hallucinations
Super human strength
What happens to amylase in anorexia
High
Management of paracetamol overdose
If present within 2 hours of ingestion can use activated charcoal
Measure levels after 4 hours of ingestion
Determines if need for IV n-acetylcysteine infusion
What do if present within 2hours of paracetamol OD
Activated charcoal
What is used in the assisted withdrawal from alcohol
Reducing doses of benzos- chlordizepoxide or diazepam
What is used to prevent relapse of alcoholism
Acamprosate
Naltrexone
2nd line- disulfiram
MOA of disulfiram
Acetaldehyde inhibitor which promotes feelings of hangover
What presents with poor executive functioning, sexual disnhibition and impulsivity, lack of insight into personality change and forced utilisation
Frontal lobe syndrome
What can cause frontal lobe syndrome
Head injury
Stroke
Picks disease
Presentation of frontal lobe syndrome
Poor executive functioning
Change in social behaviour and personality
Forced utilisation (where use objects correctly but at wrong time)
Re-emergence of primitive reflexes
Difference in administration of methadone versus buprenorphine
Methadone a liquid
Buprenorphine a sublingual tablet
Difference between CIWA and AUDIT
CIWA used to manage alcohol withdrawal (when to give benzos)
AUDIT used to manage alcohol dependance
Management if come in wanting to sort out alcohol dependance
AUDIT- Alcohol use disorders identifcation test
If over 20 refer for specialist management
First line psychotherapy for alcoholism
Self help groups
Administration methods of opiods
IV
Inhalation
Diagnositc criteria for AN
BMI under 17.5
Deliberate weight loss
Body image disotortion
Amenorrhoea in women or low libido in men
How is atypical AN diagnosed
AN criteria but without 1 feature