Block 33 Week 2 Flashcards

Question

Moderate depression =

Answer 1

symptoms and impairment between mild and severe

Answer 2

most or all the symptoms (see above) causing marked functional impairment with or without psychotic features

Answer 3

Avoid tricyclics and venlafaxin

Answer 4

* Sertaline * paroxetine * citalopram * fluoxetine

Answer 5

* Block reuptake and enhance the serotonergic neurotransmission * first lines for depression

Answer 6

* Venlafaxine * duloxetine

Answer 7

* block both serotonin and NA reuptake in the synapse

Answer 8

inhibiting the reuptake of dopamine and norepinephrine at the presynaptic cleft.

Answer 9

- amitriptyline - Clomipramine * nortryptiline, proptriptyline * Imipramine * Trimipramine * Desipramine ****end in ine****

Answer 10

* inhibits the reuptake of norepinephrine and serotonin at the presynaptic neuronal membrane

Answer 11

* Moclobemide * Isocarboxazid * Phenelzine

Answer 12

serotonin, NA, dopamine

Answer 13

- vilazodone - trazadone - nefazodone

Answer 14

- inhibition of presynaptic reuptake of serotonin - agonism of post synpatic serotonin receptors

Answer 15

* depressive disorders * premenstrual dysphoric disorder * anxiety * OCD * phobias * PTSD * TCAs - chronic pain

Answer 16

* sexual problems * tooth decay and oral health * diabetes * SIADH * GI bleeding * mania * serotonin syndrome * neuroleptic malignant syndrome

Answer 17

* antimuscarinic effects * serotonin syndrome

Answer 18

* promotes GABA - facilitates GABA release preysnaptically and upregulates GABA-B receptors post synaptically * Mania, bipolar, recurrent depression, aggressive or self harm behaviour

Answer 19

* excessive urination * polydipsia * fine tremor * metallic taste * nausea and diarrhoea

Answer 20

* electric current delivered to the patient's brain which induces a generalized clonic seizure * causes changes in the release of neurotransmittters and hormones

Answer 21

* treatment resistant depression * severe major depression * bipolar depressive and mania * schizophrenia

Answer 22

* nausea * headache * fatigue * confusion * slight memory loss

Answer 23

provide advice on the nature and course of depression, recovery and sources of info including self help materials

Answer 24

* royal college of psychiatrists which provides patient information * MIND * Depression UK * mental health foundation

Answer 25

* provide advice on activities to imptove wellbeing such as * physical activity: walking, jogging, swimming, dance * Maintaining a healthy lifestyle through diet, alcohol intake, and sleep.

Answer 26

* social support for family/ carers supporting the person

Answer 27

* avoid TCAs except lofepramine and venlafaxine (SNRI) due to risk of death from overdose

Answer 28

* SSRIs are the first line * If the person has a chronic physical health condition, sertraline or citalopram may be preferred first-line

Answer 29

NSAIDS interact w SSRIs and SNRIs

Answer 30

- warfarin - heparin - aspirin

Answer 31

* CBT * SSRI * SNRI * TCA * CBT with either an SSRI or TCA

Answer 32

* Elevated mood * Extreme irritability and/or aggression * Increased energy * Restlessness * Pressure of speech * Increase libido and disinhibition * Distractibility, poor concentration

Answer 33

delusions (fixed belief contradictory to reality or rational argument) or hallucinations

Answer 34

features of mania but usually not as severe. there are no psychotic features depression

Answer 35

* characterised by persistently low mood and loss of pleasure/ interest in everyday activities

Answer 36

* Low mood * Loss of interest or pleasure * Significant weight change * Insomnia or hypersomnia (sleep disturbance) * Psychomotor agitation or retardation * Fatigue * Feelings of worthlessness * Diminished concentration * Suicidal thoughts

Answer 37

patients are then allocated a key worker who co-ordinates their treatments

Answer 38

* psychiatrists * MH nurses * social workers * support workers

Answer 39

* can visit the patient's home or them in hospital if they're being discharged * assist with self help strategies * administer medications * provide practical help e.g. with money or housing

Answer 40

support you if you experience psychosis for the first time

Answer 41

* they are MDTs set up to identify and reduce treatment delays at the onset of psychosis and promote recovery by reducing the probability of relapse following a first episode of psychosis

Answer 42

* for those with complex mental health needs e.g. for those with severe long term mental illnesses and those who have been in hospital many times * complex needs such as violent behaviour, drug or alcohol use and mental illness, those detained under the mental health act or serious self harming

Answer 43

* also known as the complex care team or programme of assertive community treatment * AOTs review the care plan every 6 months

Answer 44

poverty and violence

Answer 45

* cultures vary in their conceptualisation of mental health * symptoms they recognize as signs of depression, and their openness towards discussing feelings of depression.

Answer 46

* For instance, some cultures might interpret symptoms of depression in a more somatic or physical way, focusing on complaints like fatigue or pain, while others may focus more on the emotional or cognitive symptoms.

Answer 47

treatment sought by the patient, wirh some cultures relying more on traditional/ alternative medicines

Answer 48

* cultural identity influences the degree to which a person shows physical symptoms of depression * in other words, some cultures are more comfortable reporting depressive symptoms that are physical in nature rather than mental. * For example, research shows that many depressed Chinese people complain of bodily discomfort, feelings of inner pressure, and symptoms of pain, dizziness, and fatigue

Answer 49

* depressed individuals might not readily seek out psychiatric or mental health care for depressive symptoms. * Because the public discourse regarding depression is more prevalent in Western societies, it is more socially acceptable to have depression, and more people are willing to seek help.

Answer 50

- mental illnesses may be denied out of shame of being identified as craxy - Others may find the label "depression" morally unacceptable, shameful, and experientially meaningless

Answer 51

40%, has risen since the pandemic started

Answer 52

* psychosocial needs - social needs like home environment, recent life events, history leading to the thoughts of self harm * psychological and physical needs - MH disorders, miuse of recreational drugs and/or alcohol

Answer 53

* hopelessness * features of depression * features suggestive of suicidal intent - evidence of planninf, changes to will, precautions taken to prevent rescue

Answer 54

* features associated with risk - male sex, physical health problems, low SES, high-risk employment (such as farmers or healthcare professionals)

Answer 55

* prevent access to means of self harm * written and verbal info for the person and their family * ensure all members of MDT are kept informed

Answer 56

* involves the patient talking about their feelings and emotions with a trained therapist * the therapist can help the patient gain a abetter understanding of their feelings and thought processes

Answer 57

coping with a current crisis such as anger, bereavement, interftility etc

Answer 58

* talking therapy that aims to help people with depression take simple, practical steps towards enjoying life again. * The aim is to give you the motivation to make small, positive changes in your life.

Answer 59

problem-solving skills to help them tackle problems that are affecting their mood

Answer 60

improving an individual's ability to cope with stresful life experiences

Answer 61

* The underlying assumption of this approach is that symptoms of psychopathology can often be understood as the negative consequences of ineffective or maladaptive coping.

Answer 62

realistically optimistic view of coping, understand the role of emotions more effectively, and creatively develop an action plan geared to reduce psychological distress

Answer 63

psychoeducation, interactive problem solving exercises and motivational homework assigments

Answer 64

Antipsychotics such as haloperidol, olanzapine, quetiapine, and risperidone

Answer 65

lithium or valproate

Answer 66

the dose should be reduced gradually over at least 4 weeks to minimise the risk of recurrence.

Answer 67

* Use of benzodiazepines (such as lorazepam) may be helpful in the initial stages of treatment for behavioural disturbance or agitation. * Benzodiazepines should not be used for long periods because of the risk of dependence.

Answer 68

* used for the treatment of acute episodes of mania or hypomania in bipolar disorder. * Lithium is also used for the long-term management of bipolar disorder to prevent recurrence of acute episodes.

Answer 69

gold standard

Answer 70

* used for the treatment of manic episodes associated with bipolar disorder if lithium is not tolerated or contra-indicated. * Valproate is also used for the long-term management of bipolar disorder to prevent recurrence of acute episodes

Answer 71

- LT management - to prevent reoccurence of acute episodes in patients unresponsive to lithium therapy.

Answer 72

- Valproate - lamotrigine - carbamazepine

Answer 73

trained to identify and cope with early warning signs of mania and/or depression.

Answer 74

- focuses on the role of interpersonal factors (i.e. interpersonal relationships, role conflicts) - and circadian rhythm stability (i.e. sleep-wake cycle, work-life balance) in the context of bipolar.

Answer 75

- high frequency and intensity sessions to help patients become experts in their own condition. - Aims to improve mood stability, medication adherence and self-management.

Answer 76

- psychoeducation for families with one individual suffering from bipolar. - Looks at risks, communication and problem-solving within the family to prevent relapses.

Answer 77

* offer a psychological intervention * if the person develops moderate or severe bipolar depression offer fluoxetine with olanzapine or quetiapine on its own * if this doesn't work consider lamotrigine on its own

Answer 78

* antipsychotics * lithium - gold standard but requires close monitoring * antieplieptics - prevent depression relapses

Answer 79

* antidepressants restricted due to the risk of inducing mania or rapid cyclinc - SSRI floxetine commonly used

Answer 80

- sleep disorder not directly caused by any underlying medical, psychiatric or environmental factors * It is a standalone condition characterized by difficulties falling asleep, staying asleep, or experiencing non-restorative sleep.

Answer 81

* secondary insomnia is linked to an underlying cause or condition. * It may arise due to various factors such as medical conditions (e.g., chronic pain, respiratory disorders), mental health disorders (e.g., anxiety, depression), substance abuse, or certain medications.

Answer 82

persistent difficulties with sleep initation, maintenance or poor sleep quality without an underlying cause

Answer 83

may have identifiable tiggers or pattens related to specific medical or psychological conditions

Answer 84

CBT-I, improvement with this supports diagnosis of primary insomnia

Answer 85

addressing the underlying cause or condition leads to improved sleep.

Answer 86

* developing a sleep/wake routine - getting up at the same time everyday * 'start the day well routine' e.g. showering and brushing teeth * exercising in the afternoon or early evening * 'end the day well routine' - dinner, taking a bath, changing into sleepware * regular bedtime * relaxation exercise * meditation

Answer 87

* working or studying the hour and a half before bed * thinking abour work the next day * naps * exercising too late in the day * too much caffeine * alcohol in the 4 hours before the routine starts * don't use phones, TVs, computers in the hour before bed * staying in bed if you can't sleep - if you go to bed at your bedtime but can’t fall asleep after 15 minutes, get up and do something relaxing until you begin to feel sleepy

Answer 88

* hypnotics are used if sleep hygiene measures fail, daytime impairment is severe causing significant distress, and insomnia is likely to resolve soon (for example due to a short term stressor) * they can only be used short term if other methods failed and be used as an adjunct to CBT

Answer 89

-preg/ breastfeeding women - older people

Answer 90

* benzodiazepines and z drugs can cause withdrawal symptoms when used long term

Answer 91

injudicious prescribing of hypnotics

Answer 92

3 to 14 days of continous use

Answer 93

rebound insomnia and withdrawal syndrome

Answer 94

bc they're at greatest risk of becoming ataxic and confused leading to falls and injury

Answer 95

- nitrazepam and flurazepam

Answer 96

Zolpidem tartrate and zopiclone are non-benzodiazepine hypnotics - act at the benzodiazepine receptor

Answer 97

- Clomethiazole - bc its freedom from hangover - can't be used routinely though

Answer 98

dyssomnias or parasomnias

Answer 99

- difficulty falling asleep, - difficulty remaining asleep, - abnormal behaviour during sleep

Answer 100

* The sleep itself is largely normal but the client sleeps too little, too much, or at the wrong time. * So, the problem is with the amount (quantity), or with its timing, and sometimes with the quality of sleep.

Answer 101

* Something abnormal occurs during sleep itself, or during the times when the client is falling asleep or waking up (e.g., bad dreams. * The quality, quantity, and timing of the sleep are essentially normal.

Answer 102

—Difficulty initiating or maintaining sleep —Persists for 1 month or longer

Answer 103

—Major Depressive Episode, Manic Episode, or anxiety disorder —Commonly misused substances, as well as some prescription medicines. —Breathing-related problems

Answer 104

—Vigorous daytime exercise, not exercising before sleep —Metronome or ticking clock- slow, 60 beats per minute or slower, beat of human heart —Relaxation exercises, practice regularly but condensed to 5 minutes

Answer 105

- decrease stimulation and inc soothing environments e.g. ear plugs - practice good sleep habits

Answer 106

caffeine - esp minimal in afternoon and evening

Answer 107

* identify and manage causes * advise the person to not drive if they feel sleepy - don't inform DVLA unless a primary sleep disorder is confirmed * advise good sleep hygiene

Answer 108

* only if daytime impairment severe

Answer 109

- short acting benzos like loprazolam - z drugs zopiclone, zolpidem, and zaleplon - 3 to 7 day course

Answer 110

- 2 weeks * Review after 2 weeks and consider referral for cognitive behavioural therapy if symptoms persist

Answer 111

* Refer to psychological services IAPT (Improving Access to Psychological Therapies) for a cognitive or behavioural intervention. * Advise good sleep hygiene and regular exercise in addition to cognitive and behavioural interventions.

Answer 112

generally not recommended for the long-term management of insomnia

Answer 113

modified release melatonin

Answer 114

refer to sleep clinic or specialist

Answer 115

the person sleeps too much, is drowsy at times when they should be alert

Answer 116

—Excessive sleepiness —Persists for 1 month or longer

Answer 117

—Major Depressive Episode, Dysthymic Disorder with atypical features - Use of substances is less likely to produce hyersomnia than insomnia, but it can happen (e.g., sleeping pills overdose)

Answer 118

exercise when becoming sleepy

Answer 119

sleeping at the wrong time

Answer 120

—Sleep intrudes into wakefulness, causing clients to fall asleep almost instantly —Sleep is brief but refreshing —May also have sleep paralysis, sudden loss of strength, and hallucinations as fall asleep or awaken.

Answer 121

Stimulants, sometimes antidepressants with less success.

Answer 122

* Sleep disruption (excessive sleepiness or insomnia) * Due to sleep-related breathing condition (e.g., Obstructive Sleep Apnea Syndrome)

Answer 123

weight loss, sleeping on one’s side, and avoiding hypnotics and alcohol

Answer 124

—Persistent or recurrent pattern of sleep disruption leading to excessive sleepiness or insomnia, due to mismatch between sleep-wake schedule required by a person’s environment and his/her circadian sleep-wake pattern (e.g., shift work, jet lag).

Answer 125

—Darken bedroom and use soundproofing —Limit caffeine and hard to digest food. —Ensure all family members learns shift —To help jet lag, exposure to sun helps

Answer 126

- nighmares - sleep terrors - sleep walking

Answer 127

(1) Repeated awakenings from bad dreams (2) When awakened client becomes oriented and alert —Usually occurs in early morning when REM sleep dominates.

Answer 128

clearly remembered

Answer 129

* (1) Abrupt awakening from sleep, usually beginning with a panicky scream or cry * (2) Intense fear and signs of autonomic arousal * (3) Unresponsive to efforts from other to calm person s

Answer 130

- amnesia for episode - no detailed dream recalled

Answer 131

* usually affects children, isn't a nightmare * usually happens in early evening * probably due to brain wave upset, fever or medications

Answer 132

(1) Rising from bed during sleep and walking about. (2) Usually occurs early in the night. (3) On awakening, the person has amnesia for episode

Answer 133

- 6-12 - may be stress related

Answer 134

* relaxation techniques * Biofeedback training * Hypnosis. * May need to sleep on the ground floor, have outside doors securely locked, and have car keys unavailable

Answer 135

- sleep talking - sleep paralysis - sleep behaviour disorder

Answer 136

- having no memory of it in the morning - REM sleep, pronunciation is clear and understandable; - in deep sleep (delta) apt to be mumbled and unintelligible

Answer 137

- to perform voluntary movement during the transition between waking and sleep. Usually associated with extreme anxiety, and sometimes fear of impending death.

Answer 138

characterized by agitated and violent behavior.

Answer 139

—Evidence must be present that the sleep disturbance is a direct physiological consequence of substance use. - Substance use that produces a sleep disorder severe enough to warrant independent clinical attention

Answer 140

* eating disorder is a MENTAL DISORDER defined by abnormal eating habits that negatively affect a person’s PHYSICAL or MENTAL health

Answer 141

* people maintain a low body weight as a result of wanting to either be thin or due to a fear of being fat - preoccupation with weight

Answer 142

* typical onset during early to mid adolescence * estimated yearly incidence 0.1 in 1000 per year in females

Answer 143

* Female gender * Living in Western society * Family History * Severe life stresses

Answer 144

sexual abuse, dieting behaviour in family, occupational or recreational pressure to be slim, criticism about weight or eating behaviours.

Answer 145

perfectionism, low self-esteem, obsessional traits, anxiety, borderline personality disorder.

Answer 146

* refusal to maintain normal BMI * Weight below 85% predicted (<17.5kg/m2) * Dieting/restricting eating habits * Rapid weight loss * Disproportion about weight or shape. * Denial of problem, resistant to intervention * Social withdrawal; few interests * Enhancing weight loss with excessive exercise, laxatives & self-induced vomiting.

Answer 147

- Fatigue, fainting, dizziness and intolerance of cold.

Answer 148

- GI symptoms such as constipation, dysphagia and abdominal pains

Answer 149

- Delay in secondary sexual characteristics if pre-pubertal - Lanugo hair - fine thin hair all over the body - Primary or secondary amenorrhoea

Answer 150

* height, weight, BMI * core temperature * peripheral circulation and oedema * pulse, BP * test muscle power - sit up test and squat test

Answer 151

* laguno hair * hypotension, bradycardia * peripheral oedema * scanty pubic hair

Answer 152

hands or feet are red/ purple

Answer 153

* ESR & TFTs (screen for other causes of weight loss) * U&E’s- particularly in those who are vomiting, taking laxatives, diuretics or water loading * ECG- may show bradycardia or a prolonged QTc

Answer 154

* raised urea, creatinine or transaminases indicate end organ damage

Answer 155

- first line Anorexia-nervosa-focused family therapy (FT-AN) - CBT or adolescent-focused psychotherapy

Answer 156

- 1st: CBT-ED: 40 sessions over 40 weeks - Maudsley Anorexia Nervosa Treatment for Adults: 20 sessions - Specialist supportive clinical management - Eating-disorder-focused focal psychodynamic therapy

Answer 157

* Managing weight gain and also maintain a healthy weight - aiming for average 0.5kg -1kg gain a week * When in refeeding phase consider daily U&Es and ECGs until electrolytes have stabilised

Answer 158

* Bisphosphonates if diagnoses of osteopenia/osteoporosis

Answer 159

* Advise regular dentist assessment if regularly purging

Answer 160

there is comorbid physical or mental illness

Answer 161

* last resort * should only be done in the context of the Mental Health Act 1983 or Children Act 1989.

Answer 162

* Hypokalaemia, hyponatremia * Hypotension * Hypoglycaemia

Answer 163

mitral valve prolapse, peripheral oedema, sudden death

Answer 164

* Renal calculi * AKI or CKD

Answer 165

* Anxiety and mood disorders * Pseudoatrophy on brain imaging

Answer 166

* characterised by repeated binges followed by compensatory weight loss behaviours

Answer 167

- Self induced vomiting - Fasting/restricting intake - Intensive exercise - Abuse of laxatives, diuretics, thyroxine or amphetamines.

Answer 168

socioeconomic groups

Answer 169

* female:male 10:1 although incidence in men is increasing * common in adolescent and young adulthood

Answer 170

* regular binge eating, loss of control eating during binges * attempts to counteract the binges * BMI > 17.5kg/m2 * Preoccupation with weight, body shape and body image * Preoccupation with food & diet.

Answer 171

* bloating & fullness * lethargy * heartburn & reflux * abdominal pain * sore throat & dental problems

Answer 172

* mood disturbances, anxiety, low self esteem and self harm are common with bulimia * depressive symptoms are more common than anorexia nervosa

Answer 173

* Salivary glands (especially the parotid) may be swollen. * Oedema if there has been laxative or diuretic abuse

Answer 174

* Russell’s sign - calluses develop on the back of the hand due to repeated abrasions against the teeth when inducing vomiting * Erosion of dental enamel.

Answer 175

* usually normal but serum potassium is often low * Renal function and electrolytes should be checked in view of frequent self-induced vomiting

Answer 176

* immediate referral to communit based specialist eating disorder service for assessment and management

Answer 177

* Bulimia-nervosa-focused family therapy first line * CBT-ED (if above not effective or not an option)

Answer 178

* Encouragement to follow an evidence-based bulimia-focused guided self-help programme, with direct encouragement from healthcare professionals * CBT-ED

Answer 179

* If vomiting or taking large quantities of laxatives should have fluid & electrolyte balance assessed weekly. * Regular dental reviews & dental hygiene * Reduce laxatives slowly * Screen for osteoporosis

Answer 180

80% make full recovery without Tx

Answer 181

* Metabolic abnormalities (hypochloraemic, hypokalaemic metabolic alkalosis) following excessive vomiting

Answer 182

* Electrolyte imbalances leading to cardiac arrhythmias, renal impairment, muscular paralysis

Answer 183

* suicide - always screen for mood disturbances and also suicide risk * medical complications - heart failure, fatal arrhythmias, severe dehydration/ malnourishment, multi-organ failure

Answer 184

SCOFF questionnaire

Answer 185

* do you make yourself Sick because you feel uncomfortably full? * do you worry that you have lost Control over how much you eat? * have you lost more than One stone in a 3-month period? * Do you believe yourself to be Fat when others say you’re too thin? * Would you say Food dominates your life? (2+ indicate likely case of anorexia or bulimia)

Answer 186

to look for depressive symptoms

Answer 187

look at distribution of body hair, emaciation, vitamin deficiency, reduced peripheral circulation.

Answer 188

* Characterised by frequent and recurrent binge eating episodes with associated negative social and psychological problems, without episodes of purging

Answer 189

* eating fast in a short space of time, * making themselves uncomfortably full, * eating large amounts when not hungry, * subjective loss of control over how much is eaten. * Binges may be planned in advance involving purchase of special binge foods * Eating alone or secretly due to embarrassment over the amount of food consumed * Dazed mental state during the binge * Feelings of shame, guilt or disgust following a binge.

Answer 190

- Encouraged to follow an evidence-based self-help programme. Healthcare professionals should provide direct encouragement and support. - CBT-BED - Interpersonal psychotherapy, modified dialectical behaviour therapy

Answer 191

monitor weight & offer support.

Answer 192

* Eating disorders, elderly, after severe illness, major surgery & children. * Anyone who has had a period of starvation. * Only occurs AFTER commence refeeding.

Answer 193

4 days - 2 weeks

Answer 194

* Patients develop fluid & electrolyte disorders, specifically hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular & haematologic complications.

Answer 195

peripheral oedema

Answer 196

cardiac arrythmias

Answer 197

confusion, coma, convulsions & cardiac failure.

Answer 198

* biochemical abnormalities and clinical findings * most usual change is decrease in phosphate

Answer 199

* Urea, Cr, Na, K, Ca and Mg should be measured daily for 5 days, on day 10 and then day 14 * electrolyte changes will normally occur 72 hrs into refeeding

Answer 200

* Hydration & nutritional status, daily weight - sharp increase in weight in oedema which is a sign of refeeding syndrome

Answer 201

* Decrease calories until phosphate normalised * Oral phosphate supplements, or IV if not tolerated

Answer 202

deliberate manipulation of insulin levels by T1D to control their rate

Answer 203

* excess exercise with low weight * blood in vomit * inadequate fluid intake in combination with poor eating * rapid weight loss * factors which disrupt ritualised eating habits (journey/ holiday/exam).

Answer 204

* Regular feeding with control of purging is usually sufficient for re-establishment of normal levels. * If potassium replacement is required, because it is usually caused by a loss of gastric secretion, it should be done with oral replacement with a salt and water

Answer 205

* Rebound hypophosphataemia can occur on initial refeeding as it is sequestered by carbohydrate metabolism. * It can be lethal.

Answer 206

milk-based products (>2 pints/day) may be helpful.

Answer 207

* dehydration leads to a medical crisis through circulatory and renal failure * all patients should be assessed fully for dehydration * fluid intake, signs of decompensation (dizziness/ fainting)

Answer 208

should include assessment of skin turgicity, ocular pressure and lying and standing blood pressure.

Answer 209

1. assessed for capacity 2. treated under the appropriate legal criteria.

Answer 210

* understand information relevant to the specific decision; * be able to understand the nature of their illness and understand the implicationsof non-treatment * be able to rationally weigh up the pros and cons of treatment; * thus make an informed decision regarding their management and communicate their decision.

Answer 211

* under the new MCA (2005) people lacking capacity may be treated if it's in their best interest

Answer 212

* needs to be the least restrictive option * is not depriving them of their liberty * there is no advanced refusal or objection by a done or court of protection.

Answer 213

* Treatment of people with severe anorexia nervosa who are not consenting to treatment for their mental disorder will in most cases require use of the MHA as it involves deprivation of liberty and compulsory refeeding.

Answer 214

* For people lacking capacity, emergency medical treatment can be performed under Common Law. * Non-emergency treatment for a physical condition not related to the eatingdisorder may be performed under the MCA 2005.

Answer 215

* treatment for 16-18 year olds who are refusing treatment - parental conset cannot be used as authority to treat

Answer 216

- restricting type - binge eating/ purging type

Answer 217

* during the current episode of anorexia, the person hasn't engaged in binge eating or purging behaviour - self induced vomiting or the misuse of laxatives, diuretics, enemas

Answer 218

* the person has reg engaged in purging behaviour or binge eating

Answer 219

* person has engaged in self induced vomiting, laxatives, diuretics or enemas

Answer 220

* person has used other inappropriate compensatory behaviours like fasting or excessive exercise * but hasn't regularly engaged in self-induced vomiting, laxatives etc

Answer 221

* T wave inversions, ST depression, supraventricular beats and ventricular tachycardia * superior mesenteric artery syndrome

Answer 222

* pubertral delay/ arrest * growth retardation/ short stature * anxiety, depression

Answer 223

* In anorexia, there is an intense fear of gaining weight, even if the person is underweight. The experience of body shape or weight is disturbed and affects self-image excessively. * In bulimia nervosa, recurrent bouts of binge eating alternate with inappropriate compensatory behaviour to prevent weight gain, such as laxatives, vomiting or fasting. * Young people who binge eat consume large amounts of food even if they are not hungry.

Answer 224

* A BMI below the <2nd centile (or percentage median BMI <80%) indicates serious underweight.

Answer 225

- Eyes. Petechiae on the sclerae may be due to vomiting. * Parotid glands. Parotid gland swelling occurs in malnutrition. * Teeth. Dental caries may be caused by increased acid exposure due torepeated vomiting.

Answer 226

* later age of onset * typically higher rates of obesity pre-onset * Often a fixation on body shape or type rather than weight. e.g. ‘to be muscular’ * More likely to see excessive exercise

Answer 227

–Early age of onset –Depression during illness –Disturbed family relationships - Duration of illness (>3 years / more than 1 inpatient admission)

Answer 228

* Individual approach * Focus on patients identifying, tolerating and managing their emotions

Answer 229

* Alliance and mutual understanding of AN * Enhancing independence from parents * Develop strategies to deal with the tasks of adolescence * AFT less effective and takes longer than FBT

Answer 230

1 - Acknowledging state of starvation, focus on refeeding, emphasis on parental control 2 – Continued focus on weight gain, starting to shift responsibility 3 – Weight maintenance, focus on family relationships, develop family strengths 4 – Relapse prevention, endings

Answer 231

* views the problems as relational not individual * externalisation of the ED * non-blaming, unifies the family and shares responsibility * family is best positioned to find their own solutions

Answer 232

* features preceding the onset of EDs which are present in childhood * childhood perfectionism * individuals with both constrained (anorexia) and disinhibited (bulimia) eating share the personality trait of high harm avoidance. * impulsivity & binge eating * compulsivity and anorexia

Answer 233

* genetic predisposition - relatives of those diagnosed with an eating disorder are up to 6x more likely to develop an ED

Answer 234

initating hunger cues ca

Answer 235

sending signals of satiation, telling the organism to stop eating.

Answer 236

inhibitory effect on eating behaviour

Block 33 Week 2 Flashcards

(283 cards)