Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Ok. Hi, everyone. Um, thank you for joining us again on a Tuesday evening. So we have lecture here final year me to give us a lecture on eating disorders and substance use disorders. If you have any questions, please pop them into the chat. And, um, yeah, I hand it over. Yeah. So, hi guys. My name is Le, I'm currently a year. Um, so it's about me. I just finished final year, thankfully passed everything. Um, I'm currently on my elective with a mental health charity called Gaming The Mind. This is me volunteering with them at Comic Con in one of their quiet rooms, holding lots of cuddly toys and just having a good time. So that's basically what my elective is and I'm gonna be starting F one and seven this August. Um, and I guess the reason why I'm doing the psych lectures because I'm very interested in psychiatry hoping to pursue that in the future. So I'm glad I can have the opportunity to teach you guys a bit about some topics I'm really interested in. So, about what we're gonna go over today. First of all, just a quick disclaimer. I'm gonna try and cover the things. I feel like you guys definitely need to know or should have a good idea of. Obviously, I can't cover everything you might need to know about these topics or the kind of information that might get you top marks. Um But just generally try to cover the basics and what's useful to know all things that are a bit harder to understand. Um As I said, please feel free to type any questions in the chart. I'm gonna have a few SPS for out as well. So please feel free to answer those in the chat as well in terms of the way I spit it up and what we're gonna cover. So, first of all, I wanna do eating soda. So the main ones I'm gonna focus on are anorexia and bulimia. Um And for substance use, I'm mainly gonna be focusing on alcohol use, opioid use and benzodiazepines. Um Again, this is what I consider to be most high heeled in these topics when they come up in either writtens or in cases. Um And the way you'll see my slides is I've split it into diagnosis, investigations and management for each of these covering most of the other stuff like etiology, history using bedside bloods and imaging where I can because that's super useful for cases. Um And for management, it's just useful to think of it as through a biopsychosocial model, through any psych topics. So where I kind of tried to split it up like that, any gold stars and generally gold standard treatments or first line investigations in any green lightning bolts of the super high yield. Like definitely remember this concept. So to start off, here's a question on eating disorder. So if you just have a quick read of that and then answer in the chat, what do you think the answer is? So that should read out to help as well. A 23 year old university student presents with dizziness, cold intolerance and um, amenorrhea, she follows a restrictive clean eating diet, avoids carbs and fats and exercises for several hours daily. Her BMI is 17.5 and the examination shows a new and dry skin. Her heart rate is 39 and her BP is 88/80 standing. So what would be the most appropriate initial management in this case? That way you can see if you get a few answers. Ok. So if we got a couple more, we've got a split at the moment between A and D. Ok. Cool. We've got a couple more people going for D that is the correct answer. Um So there's notes on underneath the slides when you get the slides, which will kind of explain the different answer options. But the reason why you'd go for an acute inpatient care in this case is that this patient is presented with acute symptoms of anorexia. So the most notably very severe bradycardia So her heart rate is under 40. Um and hypertensive generally like physically unstable. So in this case, she needs immediate medical intervention and monitoring, which has to happen in an acute setting and referring to a dietician wouldn't be enough to treat her in the most immediate sense, which is why you'd go for d rather than a. So starting off about anorexia again and actually just a quick caveat as well. Obviously, the topics I might be discussing today might be a bit sensitive. So if at any point you need to leave, um then please feel free to do so. So anorexia is the most common cause of admissions to child and adolescent psychiatric wards. Um When you're thinking about a history, you wanna think about asking or noticing whether there's a preoccupation with food or calories. Um Are there any, is there any evidence the patient might be starving themselves? So this can be through multiple methods. So via restricted intake of food and water and it's really important to ask about both. Um It could be through purging. So that could be again through lots of different methods. So, emesis or vomiting, diuretics, laxatives, and more recently, uh weight loss, drugs or weight loss injections is also something that needs to be asked about as a possible, a newer methods available more broadly for weight loss nowadays, um or excessive exercise. Um It's really important to ask about the thoughts that are fueling some of those behaviors. So, is there an obsession with weight and shape? Um And is there a determination to lose weight regardless of the impact it's having on their physical health? If they are seeing signs and symptoms of it, it can be diagnosed using D 11 or DSM five criteria and they differ slightly, but I've summarized what the general features are between them, which is a restricted energy intake, an intense fear of weight gain and a distorted body image. And it's just important to note because you might see it in some older years, notes that BMI and amenorrhea aren't used anymore on the DSM five criteria. So a person doesn't need to have a low BMI to be diagnosed with anorexia anymore. In terms of a general way to go through his history is about eating disorders. This could be for anorexia or bleed or any patient where you think there might be disorder eating. It's useful to use the scoff screening tool. Um So this is five questions based on the letters here. So do you make yourself sick because you feel uncomfortable before? Do you worry? You've lost control over how much you eat? Have you recently lost more than one stone in the last three months? Do you believe yourself to be fat when others are saying you're too thin? And a lot of the times, for example, in the patient history, it might be that the patient has been brought in by someone else, for example, by their parent. Um And then would you say that food dominates your life? So this is just a quick screening tool as say, if there's a score of two or more, then this is suggestive of disorder, eating or eating disorder behaviors. And therefore you would prompt you to do more thorough investigations or a referral in terms of investigating anorexia. So I split it up and sort of bedside blood and imaging. The question mark is supposed to be uh x-ray emoji. So if you see that it's supposed to be an X ray emoji um just for bedside blood and imaging. Um So at the bedside, you want to do an examination, you want to take on the examination, you wanna look for any of those red plas that show that they're physically unstable that we mentioned. So, hypertension or bradycardia, you might notice signs of the purging behavior like enlarged sli glands, Russell's sign, which is bruising on the knuckles. That's just a photo there for that. Um And anorexia is also uh possible to see the sort of fine white hair in patients called hair. Um This is a result of sort of chronic malnourishment that that they can get and you need to specify, say if it was Pacer Station that you'd wanna get a weight and height and BMI um if it's under 18.5 that's a signal that they're underweight. So that would be a bit of a red flag. Um You want to pay special attention to their postural BP and their heart rate and their ECG, which would also be important to do because there are risk of arrhythmia. Um You would consider doing urinalysis because presence of ketones can suggest starvation temperature because there's a risk of hyperthermia. And you'd also consider screening for comorbid psychiatric conditions like anxiety or depression with like PHQ nine or GAD seven and to run a really important test, which I used to always forget when I was thinking about investigations for this is the SA test, we set up squat and stand test and this helps identify whether someone's severely malnourished. And then again, there's another criteria for sending someone to hospital to get treated in terms of bloods. You think about doing an F BCU and ES hormone levels and ABG or BBg, you wanna be looking at the white cells since they can be low at U and ES, you got low calcium, magnesium phosphate and potassium for hormone levels, you get um body systems that shut down. So this tends to be the go in there. So you get low sex hormones and then you get other systems sort of on high alert because the body is under starvation mode and these are your stress hormones. So you get low sex hormones and high stress hormones and high cortisol and growth hormone to balance that. Um and then if there's any vomiting or diuresis you might see a metabolic alkalosis on an ABG in these patients. Also. It's important.