Week 1- eating disorders, OCD, anxiety, phobias Flashcards
What is anorexia nervosa?
Weight loss or in children a lack of weight gain, leading to a body weight of at least 15% below the normal or expected weight for their age and height.
The weight loss is self induced by avoidance of fattening foods.
There is a self perception of being ‘too fat’, with an intrusive dread of fatness
A widespread endocrine disorder that manifests in females as amenorrhoea or in males as loss of sexual interest or potency.
What happens to people who develop anorexia before they reach puberty?
The sequence of pubertal events is delayed or even arrested. (growth ceases, breasts do not develop, primary amenorrhea. In boys- genitals remain juvenile).
If a patients puberty has ceased, but the anorexia is treated, will puberty resume?
Yes to an extent. Menarche tends to be later though.
What is bulimia nervosa?
Recurrent episodes of overeating (at least 2 times per week), in which large amounts of food are consumed within short periods of time.
The patient attempts to counteract the fattening attempts by either self induced purging, self induced vomiting or excessive exercise.
Patient has a self perception of being too fat, with an intrusive dread of fatness.
What are binge eating disorders?
Recurrent episodes of binge eating. Binge eating is characterised by an amount of food consumed that is significantly larger than a normal person would consume in the same amount of time.
A sense of lack of control of over-eating.
The binge eating episodes are associated with three or more of the following..
- eating more rapidly than normal
- eating until feeling uncomfortably full
- eating large amounts of food when they are not physically hungry
- eating alone because they feel embarrassed by the amount they are eating
- feeling disgusted, depressed or guilty after
What other health risks does bulimia nervosa carry?
Damage to dentition- due to constant vomiting the stomach acid erodes away the enamel of their teeth.
Russels sign- callous formation on the knuckles due to them sticking their fingers down their throats repeatedly.
When is anorexia nervosa likely to present?
Typically pubertal in onset. Commonest age is 18.
What psychological issues can be a consequence of eating disorders?
What could these issues be caused by?
Low self esteem
Perfectionist
Black and white thinking
Could be due to childhood abuse.
What social factors can lead someone to anorexia?
Western cultures expectations
Bullying
Academic pressures
What co-morbidities are commonly hand in hand with eating disorders?
Depression
Obsessive Compulsive Disorder
Substance misuse
Diabetes mellitus.
What effect does starvation have on the brain?
Loss of grey and white matter Increased compulsive behaviour Enhanced response to hedonic and nutrostat signals Reduced social skills Focus on food Poor concentration and decision making New learning is stunted.
What is refeeding syndrome?
When you give someone who has been in a starved state nutrition too quickly, it causes an imbalance in potassium, magnesium and phosphate as the body tries to repair itself.
What metabolic complications can eating disorders cause?
Hypothermia- they do not have the body fat to sustain heat Dehydration Electrolyte disturbance Hypoglycaemia Raised LFTs
Severe risk (in terms of BMI) in eating disorders
Less than 13
High risk (in terms of BMI) in eating disorders
14.9-13
Moderate risk (in terms of BMI) in eating disorders
16-15
Low risk (in terms of BMI) in eating disorders
17.5-16
How would you risk assess a patient with eating disorders?
Rate of their weight loss Blood results Circulation Muscle strength Temperature ECG abnormalities
What physical symptoms can anxiety present with?
Sweating, hot flushes or cold chills Trembling or shaking Muscle tensions, aches or pains Numbness or tingling sensations Feeling dizzy, faint or lightheaded Dry mouth Sensation of lump in the throat, difficulty in swallowing or feeling of being choked. Palpitations Difficulty breathing Nausea or abdominal stress.
NOTE ON ANXIETY SYMPTOMS
Lots of noradrenaline is released- sympathetic stimulation hence the shaking, dizziness, dry mouth esc symptoms.
What are common cognitive symptoms of anxiety?
Fear of losing control Feeling tense Difficulty in concentrating Feeling that objects aren't real Depersonalisation- detachment feeling from reality Hypervigilence Racing thoughts Meta-worry (worry about everything) Health anxiety
What are the common behavioural symptoms of anxiety?
Avoidance of certain situations Exaggerated response to minor surprises or being startled Difficulty sleeping because of worry Excessive use of alcohol/drugs Restlessness and inability to relax Persistent irritability Seek reassurance from family/GP
What is the stress response?
Exposure to stress results in instantaneous biological responses. They work to assess the danger and organise an appropriate response.
Which part of the brain is responsible for deciding whether a stimulus is worthy of the stress response?
The amygdala.
Describe the biochemical changes in the stress response
There is an increase in catecholamines and cortisol.
What is cortisol’s role in the stress response? Where does it act?
Cortisol acts to mediate and shut down the stress response. It acts on pituitary, hypothalamus and amygdala.
Describe anxiety disorder?
Anxiety in these people is more extreme than normal. They are anxious in situations that wouldn’t normally cause anxiety.
Describe generalised anxiety disorder
Anxiety that is generalised and persistent. Its not specific to any particular environment or situation.
What are the symptoms of generalised anxiety disorder?
Symptoms are variable however they include complaints of trembling, muscular tensions, sweating, light headedness, palpitations, dizziness and epigastric discomfort.
What criteria do you have to meet to be diagnosed with generalised anxiety disorder?
Needs to be severe enough to be:
- long lasting (most days for atleast 6months)
- not controllable
- causes significant distress/impairment of function
What treatment is given to patients with generalised anxiety disorder?
CBT is first line
SSRIs/SNRI’s
Benzodiazepines- can be used in short term however are addictive and also after a while won’t control the anxiety.
What is panic disorder?
Recurrent attacks of severe anxiety which are unpredictable.
What are the dominant symptoms of panic disorder?
Sudden onset palpitations, chest pain, choking sensations, dizziness and feelings of unreality.
What can commonly present alongside panic disorder?
Agoraphobia.
Describe some biological factors than can cause panic attacks?
Build up of lactate Rebreathing air (CO2)
Treatment of panic disorder?
CBT
SSRI’s, SNRIs, tricyclics
Benzodiazepines for short term use.
Name the three types of phobia?
Agoraphobia
Social phobia
Specific phobia
What is agoraphobia?
Cluster of phobias embracing fears of leaving home, entering shops, crowds, public places or travelling alone on buses, trains or planes.
Agoraphobia can be primary or secondary. Describe each and explain which one is more common.
Primary agoraphobia is when you just have that condition. Secondary agoraphobia is when the agoraphobia comes along with/after another condition such as anxiety and depression.
Secondary is much more common.
Describe specific phobias
A marked and persistent fear that is excessive and unreasonable cued by the presence of or anticipation of a specific stimulus.
Exposure to the stimulus causes an anxiety attack
The person recognises that the fear is excessive or unreasonable.
What treatment can be offered for specific phobias?
Behavioural therapy- exposure to the stimulus in small doses.
Describe social anxiety disorder?
A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny.
The individual fears they will act in an embarrassing or humiliating way.
Typically this occurs in relatively small social settings.
Common social anxiety symptoms
Blushing or shaking
Fear of vomiting
Urgency or fear of micturition/defeacation
Describe the activity in the brain in social phobia
Increased bilateral activation of the amygdala and increased rCBF (regional cerebral blood flow) to the amygdala.
Treatment of social anxiety/phobia?
CBT
SSRI’s/SNRI’s
Benzodiazepines (SHORT TERM ONLY)
What is obsessive compulsive disorder?
Recurrent obsessional thoughts and compulsive acts.
What are obsessional thoughts?
Ideas, images or impulses entering the mind in a stereotyped way.
Recognised as the patients own thoughts.
But unpleasant, resisted and ego-dystonic (doesn’t fit with the sense of self)
What are compulsive acts?
Repeated rituals or stereotyped behaviour
Not enjoyable or functional
Often viewed as neutralising
Recognised as pointless
Resistance against doing these acts may diminish over time.
Criteria for OCD?
Obsessional symptoms or compulsive acts must be present for at least 2 weeks AND be a source of distress and interference with activities.
Common obsessions in OCD
Cleanliness- contamination from dirt, virus’s, bacteria etc.
Fear of harm
Excessive worry about symmetry
Obsessions with the body or physical image
Hoarding possessions
Thoughts of violence or aggression
Treatment of OCD?
CBT
SSRI’s/clopramine
How do benzodiazepines work with anxiety?
The GABA-A receptor is an inhibitory inotropic channel. In the presence of GABA, the ion channel allows chloride into the cell causes membrane hyperpolarisation. This results in an inhibitory post-synaptic potential.
Benzodiazepines enhance the effect of GABA.
Name some issues with benzodiazepines?
Problems occur particularly if used over two weeks Sedation and psychomotor impairment Discontinuation/withdrawal problems Dependency and abuse Alcohol interaction Can worsen co-morbid depression
