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Psych (Owen) > Substance abuse and eating disorders > Flashcards

Substance abuse and eating disorders Flashcards

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1
Q

What are the eating disorders

A

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

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2
Q

Diagnostic criteria for bulimia nervosa

A

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

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3
Q

Examples of compensatory methods in bulimia

A

Excessive exercising
Diet pill
Diuretics
Self induced vomiting
Laxatives

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4
Q

Physical signs of bulimia nervosa

A

Erosion of teeth
Russels sign- calluses on knucjles or back of hand
From induced vomiting

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5
Q

Management of bulimia nervosa

A

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

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6
Q

Classifying bulimia nervosa

A

Mild
- over 1 episode a week
Moderate
- over 2 episodes a week
- no other abnormalities
Severe
- electrolyte abnormalities
- daily purges

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7
Q

When would admit someone with eating disorder

A

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

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8
Q

How does alcohol withdrawal present

A

6-12 hours
- tremor
- restless
- sweating
- palpitations

36 hours
- seizures

48-72 hours (delirium tremens)
- coarse tremor
- confusion
- delusions
- auditory and visual hallucinations
- fever

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9
Q

What is mechanism behind alcohol withdrawal

A

Alcohol consumption enhances GABA inhibition and inhibits glutamate receptors
In withdrawal the opposite happens

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10
Q

What is treatment for alcohol withdrawal

A

1st line:
- chlordiazepoxide
- can use carbamezapine
2nd line clomethiazole
Offer advice on local services for addiction

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11
Q

Treatment of delirium tremens

A

1st line: oral lorazepam
If persist- IV lorazepam or haloperidol
Can use chlordiazeperoxide

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12
Q

Management of seizures in alcohol withdrawal

A

Lorazepam or chlordiazeperoxide

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13
Q

What class of drug is chlordiazepoxide

A

Benzo

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14
Q

Management of alcohol withdrawal

A

Fill out clinical institute withdrawal assessment (CIWA)
Used to determine need for seizure prophylaxis or benzos

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15
Q

Low BMI
Bradycardia
Hypotension
Enlarged salivary glands

A

A nervosa

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16
Q

Blood findings of a nervosa

A

Hypokalaemia
Low FSH, LH, oestrogen and testosterone, platelets
Raised Cs and Gs
Cortisol
Cholesterol
GH
Glucose- impaired glucose tolerance

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17
Q

What are lanugo hairs seen in

A

Anorexia- fine downy hair growth in response to loss of body fat

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18
Q

Presentation of opiate withdrawal

A

Everything runs
Neuro- agitation, mydriasis, parasthesia
Psych- depression, craving
Gastro- D&V
Derm- lacrimation, sweating, rhinorrhoea
Goosebumps

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19
Q

Features of opiate withdrawal

A

Occur within 12 hours typically
Not life threatening

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20
Q

How does cocaine withdrawal present

A

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

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21
Q

What is excited delirium

A

A complication of cocaine and other illicit drug intoxication

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22
Q

How does excited delirium present

A

Profuse sweating
Delirium
Hallucinations
Super human strength

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23
Q

What happens to amylase in anorexia

A

High

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24
Q

Management of paracetamol overdose

A

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

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25
Q

What do if present within 2hours of paracetamol OD

A

Activated charcoal

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26
Q

What is used in the assisted withdrawal from alcohol

A

Reducing doses of benzos- chlordizepoxide or diazepam

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27
Q

What is used to prevent relapse of alcoholism

A

Acamprosate
Naltrexone

2nd line- disulfiram

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28
Q

MOA of disulfiram

A

Acetaldehyde inhibitor which promotes feelings of hangover

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29
Q

What presents with poor executive functioning, sexual disnhibition and impulsivity, lack of insight into personality change and forced utilisation

A

Frontal lobe syndrome

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30
Q

What can cause frontal lobe syndrome

A

Head injury
Stroke
Picks disease

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31
Q

Presentation of frontal lobe syndrome

A

Poor executive functioning
Change in social behaviour and personality
Forced utilisation (where use objects correctly but at wrong time)
Re-emergence of primitive reflexes

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32
Q

Difference in administration of methadone versus buprenorphine

A

Methadone a liquid
Buprenorphine a sublingual tablet

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33
Q

Difference between CIWA and AUDIT

A

CIWA used to manage alcohol withdrawal (when to give benzos)
AUDIT used to manage alcohol dependance

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34
Q

Management if come in wanting to sort out alcohol dependance

A

AUDIT- Alcohol use disorders identifcation test
If over 20 refer for specialist management

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35
Q

First line psychotherapy for alcoholism

A

Self help groups

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36
Q

Administration methods of opiods

A

IV
Inhalation

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37
Q

Diagnositc criteria for AN

A

BMI under 17.5
Deliberate weight loss
Body image disotortion
Amenorrhoea in women or low libido in men

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38
Q

How is atypical AN diagnosed

A

AN criteria but without 1 feature

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39
Q

Low weight differentials

A

IBD, addisons, hyperthyroid
Socioeconomic
Confusion
Personality disorders
Depression
OCD

40
Q

When monitoring someone with eating disorder what physical things are worried about

A

Weight
Bone mineral density

41
Q

Management of anorexia nervosa in children

A

1st line- family therapy
2nd ED CBT or adolescent psychotherapy for AN

42
Q

Management of anorexia nervosa in adults

A

Choose from either CBT, MANTRA and selective supportive clinical management
If neither of these work then consider Focal psychodynamic therapy

43
Q

What is refeeding syndrome

A

When refeed after period of starvation get intracellular shift of magnesium, potassium, phosphate

44
Q

When do you get seizures in alcohol withdrawal

A

36 hours

45
Q

Management of binge eating disorder

A

First line- self help guides with supportive sessions
Second line- group-CBT
Third line- individual CBT

46
Q

What is difference in MOA of acamprosate vs naltrexone

A

Acamprosate- reduces cravings for alcohol
Naltrexone- reduces pleasure of drinking alcohol

47
Q

How is alcoholism diagnosed according to ICD-10

A

3 of the following/6
Drinking not problematic without three criteria
Desire- craving
Neglect- do you miss things because of drinking
Pervasive- have there been problems in your life
Withdrawal- what happens when dont drink
Tolerance- has your tolerance increased
Control- have they lost control

48
Q

How assess patient with anorexia nervosa after history

A

Obs
ECG
Squat test
BMI
Bloods- electrolytes, glucose

49
Q

How does cannabis use present

A

Red eyes
Dry mouth
Increased HR
Increased appetite

50
Q

Which /recreational drug is of main concern to psychiatrists nowadays

A

Spice/black mamba- synthetic cannabinoids

51
Q

How can spice used present

A

Psychosis
Confusion
Aggression
Vomiting

52
Q

How to investigate benzo withdrawal

A

Urine drug screen

53
Q

How is benzo withdrawal managed

A

Contact addiction services
Convert to diazepam equivalent dose
Slowly reduce by 10% every 2 weeks
Talking therapies

54
Q

What is difference between harmful use and substance abuse

A

Both involve using a psychoactive substance
Harmful use- pattern of use which has effect on health
Substance abuse- continued use which has effect on physical and mental health plus social responsibilities

55
Q

What questionnaire can be used to quickly screen for alcohol abuse

A

FAST- fast alcohol screening test

56
Q

How do you calculate units

A

(Volume x alcohol by volume)/1000

57
Q

MOA of acamprosate

A

Modulates NMDA to reduce glutamergic transmission

58
Q

MOA of naltrexone

A

Mixed opiod antagonist with high affinity for u-opiod receptor

59
Q

What cant give before thiamine in alcohol withdrawal

A

Glucose

60
Q

Triad for wernickes

A

Opthalmoplegia
Confusion
Opthalmoplegia

61
Q

Management of alcohol withdrawal

A

CIWA- Chlordiazepoxide regime
Add pabrinex

62
Q

How does korsakoffs syndrome

A

Anterograde amnesia
Confabulation
Psychosis
Frontal lobe symptoms- childlike personality

63
Q

What is given to those on opiate susbstitution therapy

A

IM naloxone in case of resp depression

64
Q

How manage OST in acute hospital care

A

Check with GP/drug service the drug and date of last collection

65
Q

How do methadone and buprenorphine compare to heroin

A

Longer half life
Less euphoria and resp depression etc

66
Q

Rating scale for opiate withdrawal

A

Clinical opiate withdrawal scale

67
Q

Difference between withdrawal syndrome and complex withdrawal

A

Complicated involves delirium, seizures or psychosis

68
Q

Person with alcoholism admitted to hospital and becomes quadriplegic with eye movements only possible

A

Central pontine myelinolysis as hyponatraemia common in alcoholism

69
Q

Person with alcoholism admitted to hospital and becomes quadriplegic with eye movements only possible

A

Central pontine myelinolysis as hyponatraemia common in alcoholism

70
Q

What questionnaire for severity of dependance

A

SADQ- severity of alcohol dependance questionnaire

71
Q

Management based on AUDIT and SADQ outcome

A

Over 20 on AUDIT- refer to alcohol services
Over 30 on SADQ- refer for inpatient withdrawal

72
Q

How much of chlordiazepoxide do you give someone withdrawing from alcohol

A

No more than 2 days medication at a tome

73
Q

Principles of managing opiate withdrawal

A

Test for blood borne viruses and offer vaccinations
Detoxification regime- methadone or buprenorphine (will lessen symptoms of withdrawal)
Treat symptomatically
Refer to drugs and alcohol services
- key worker
- talking therapies

74
Q

Which SSRI for BN

A

Fluoxetine

75
Q

What do you assume are units in a pint, glass of wine and a shot

A

Pint- 2
Glass of wine- 1.5
Shot- 1

76
Q

What drugs can cause erectile dysfunction

A

Antihistamines
Parkinsonism
Benzos
TCA
Statins
B blockers

77
Q

What is voyeurism

A

When enjoy watching other people have sex

78
Q

What happens to carotemia in AN

A

Hyper- remember C and Gs go up

79
Q

How manage a staggered paracetamol overdose vs all in one

A

If all pills consumed within 1 hour of eachother then measure levels after 4 hours
If a staggered OD (where over an hour between first and last pill) then give straight away

80
Q

Eating disorder when purges but considerable focus on food and weight loss

A

Anorexia

81
Q

How does body dysmorphic syndrome present

A

When person is consumed with negative and perceived flaws about their body- normally 1 part of body like nose breast size etc

82
Q

How are cocaine induced myocardial infarctions managed

A

Benzodiazepines

83
Q

What murmur can be heard in anorexia

A

Mid systolic murmur with a click due to mitral valve prolapse from loss of cardiac muscle

84
Q

Under what act should you be admitted for anorexia forecful feeding

A

Section 2

85
Q

What happens to WCC in anorexia

A

Down due to malnutrition

86
Q

What is choice of replacement for opiods

A

1st line is methadone
Either can be chose first but methadone first choice, unless has history of OD on methadone

87
Q

What is used for detoxification if people need pharmacological help with opiate withdrawal but want to avoid methadone or buprenorphine

A

Lofexidine

88
Q

If want to quickly withdraw from opiates what do

A

Lofexidine

89
Q

First clinical signs of refeeding

A

Tachycardia
Oedema
Confusion

90
Q

Initial treatment of refeeding

A

Phosphate replacement

91
Q

What are U waves seen in

A

Hypokalaemia

92
Q

How does LSD use present

A

HTN
Tachycardia
Fever
Psychosis

93
Q

What determines whether full dose or titrated boluses naloxone given

A

If apnoeic then give full dose

94
Q

What do excoriation marks after an overdose suggest

A

Opiods as relesaes histamine

95
Q

What drug can be given to help with anorexia nervosa treatment

A

Olanzapine as can reduce obsessions with food as well as increase appetite

96
Q

Person with alcoholism admitted to hospital and becomes quadriplegic with eye movements only possible

A

Central pontine myelinolysis as hyponatraemia common in alcoholism

Psych (Owen) (9 decks)

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