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Eating disorders. Anorexia nervosa: risk factors. Anorexia Nervosa ARID. A Amenorrhoea for 3 cycles R Refusal to maintain / gain weight > 85% expected I Intense fear gaining weight despite underweight D Disturbed self-image

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Anorexia nervosa arid l.jpg
Anorexia Nervosa ARID

  • A Amenorrhoea for 3 cycles

  • R Refusal to maintain / gain weight > 85% expected

  • I Intense fear gaining weight despite underweight

  • D Disturbed self-image

    Diagnostic criteria for 307.1 Anorexia NervosaA. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% ofthat expected; or failure to make expected weight gain during period of growth,leading to body weight less than 85% of that expected).B. Intense fear of gaining weight or becoming fat, even though underweight.C. Disturbance in the way in which one's body weight or shape is experienced,undue influence of body weight or shape on self-evaluation, or denial of theseriousness of the current low body weight.D. In postmenarcheal females, amenorrhea, i.e., the absence of at least threeconsecutive menstrual cycles. (A woman is considered to have amenorrhea if herperiods occur only following hormone, e.g., estrogen, administration.)

    Restricting // Binge-Eating/Purging Type




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Anorexia nervosa management present.

Give family therapy & dietary advice to all, with CBT also likely to be helpful







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AN pharmacotherapy present.

Antidepressants may be helpful if depressive symptoms present

Antipsychotics may help if over-active. Zn, Li, cyproheptadine warrant further study.




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Bulimia Ox-hunger Nervosa BIAS present.

  • B Binge: recurrent, uncontrollable, 2 per week for 3/12

  • I Inappropriate compensatory behaviour

  • A Anorexia excluded

  • S Self-evaluation influenced by body shape / weight

  • Diagnostic criteria for 307.51 Bulimia NervosaA. Recurrent episodes of binge eating. An episode of binge eating ischaracterized by both of the following:(1) eating, in a discrete period of time (e.g., within any 2-hour period), an amountof food that is definitely larger than most people would eat during a similar period oftime and under similar circumstances(2) a sense of lack of control over eating during the episode (e.g., a feeling thatone cannot stop eating or control what or how much one is eating)B. Recurrent inappropriate compensatory behavior in order to prevent weightgain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or othermedications; fasting; or excessive exercise.C. The binge eating and inappropriate compensatory behaviors both occur, onaverage, at least twice a week for 3 months.D. Self-evaluation is unduly influenced by body shape and weight.E. The disturbance does not occur exclusively during episodes of AnorexiaNervosa.

  • Purging // non-purging type


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Bulimia Nervosa present.


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Bulimia Nervosa - Treatment present.

  • CBT: the only evidence based treatment

  • Self-help CBT

  • Psychoeducation

  • Psychotherapy e.g. IPT

  • Groups/ group therapy

  • ?SSRI

    • No evidence in youngsters

    • Important if comorbid depression


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Prognosis present.

  • About half fully recover

  • One quarter improve

  • One quarter chronic

  • PD, suicide attempts, alcohol abuse, low self-esteem negative prognostic factors

  • No/contradictory evidence for other prognostic factors, including severity


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Anorexia Nervosa: present. Physical Exam findings

Reproductive:

Amenorrhoea/anovulation

Low-birth weight babies

 Spontaneous abortions

Prematurity

Congenital malformations


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Anorexia Nervosa: present. Investigation findings





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Somatization disorder present.

  • All somatoform disorder diagnostic criteria include:

    • Impairment

    • Not general medical in aetiology or symptoms in excess of GMC

    • Not other psychiatric esp. other somatoform (somatization trumps all)

    • Not intentional (vs. malingering or factitious)

Up to 30-50% health care utilization reduction reported in tx studies


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Other somatoform diagnoses present.

  • *Neurasthenia in ICD-10:

    • Either fatigue after mental effort OR body weakness/fatigue after physical exertion

    • + > 2 of: myalgia, dizziness, headaches, insomnia, irritability, dyspepsia, inability to relax

    • Specific Tx:*Some evidence for pivagabine (RCT), Ganoderma lucidum (RCT) and ginko biloba


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Conversion present.


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Conversion present.

Unlikely to respond to long-term intensive psychodynamic psychotherapy*!


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Pain disorder present.

Anatomy

Organ system

Temporal manifestation

Intensity of patient’s complaint

Aetiology

International association for the study of painTaxonomic Guidelines:


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Treatment of pain disorder present.

  • Multi-disciplinary approach is best:

    • Psychiatrist

    • Psychotherapist

    • Physio/OT

    • Social worker




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Somatoform disorders: present. General Principles of Management


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Somatoform disorders: present. Specific Psychological Treatments

Inpatient programs in Canada/Germany: no published data

  • Psychosocial interventions*:

    • Poor methodology in studies

    • <1/4 showed sustained improvements




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Chronic Fatigue Syndrome* present.

  • No identified organic aetiology

  • ? A condition of physical unfitness

  • Moderate period of inactivity leads to physical deconditioning

  • There is reduced exercise tolerance so moderate activity leads to tiredness

  • Further rest leads to further deconditioning

  • Frustration at all this can lead to bursts of activity which are very exhausting

  • …leading to further rest

  • This can be depressing

  • Time away from social activities can lead to an anxiety disorder


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CFS: interventions present.

Follow general somatoform disorder treatment guidelines focussing on gradual functional recovery through a physical rehabilitation program and keeping in mind that patients are often resistant to psychological interventions


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CFS: graded exercise/CBT present.

70% after 12-16 sessions improved vs 25% with relaxation tx

Improvements sustained at 1 and possibly 5 year follow up


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Pseudocyesis present.


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