Term
| Things to watch for that signify an athlete has an eating disorder |
|
Definition
restriciton of energy intake - focused on calories
excessive exercise >1-2 h a day, exercising outside of practice
vegetarian diet
food choice restriction
dieting
preoccupation with food
environmental and social factors |
|
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Term
|
Definition
disordered eating
amenorrhea
osteoporosis |
|
|
Term
| how does undernutrition/over-exercise effect the female reproductive cycle |
|
Definition
may inhibit hyopthalamic-pituitary-gonadal axis and suppress hypothalamic secretion of GnRH in a dose-response fashion through a leptin-controlled pathway due to lack of adipose
results in disruption of pulsatile secretion of LH by pituitary - causes amenorrhea and subsequent ovarian suppression |
|
|
Term
3 hypotheses on why female athletes become amenorrheic:
1. body fat hypothesis - female reproductive system is disrupted when body fat declines below __%
2. exercise stress hypothesis - female reproductive system is disrupted by an increase in ___ levels when athletes forced to exercise - found not to be true
3. energy availability hypothesis - low energy availability disrupts disrupts ___ and exercise stress does not |
|
Definition
1. 10%
2. cortisol
3. LH pulsatility |
|
|
Term
1. absence of a menstrual cycle > 3 mos
2. menstrual cycles occurring >35 days
3. menstrual cycles occurring every ~28 days |
|
Definition
1. amenorrhea
2. oligomenorrhea
3. eumenorrhea |
|
|
Term
| health and performance effects of female athlete triad |
|
Definition
psych: low self esteem, depression, anxiety
medical: cardiovascular problems (echo/EKG changes), endocrine (low BG), reproductive (amenorrhea), skeletal (DEXA), GI (ulcers, IBS, reflux), renal (endstage, metabolic wasting, BUN/Cr rises), CNS system (syncope)
6 fold increase in mortality compared to general population |
|
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Term
| things on PE to look for in pts suspected for FAT |
|
Definition
signs, sx of eating disorders:
ht, wt, vitals, BMI
bradycardia
postural hypotension
cold hands and feet
hpercarotonemia
lanugo
parotid gland enlargement
get EKG
labs; electrolytes, chem, CBC, sed rate, TSH, urinalysis, pregnancy, FSH/LH -- LABS ARE THE LAST TO CHANGE |
|
|
Term
3 phases of starvation:
1. ___ stores depleted. ___ levels maintained by breakdown of proteins and fats.
2. can last for weeks. ___ is primary energy source. ___ also used for energy, so you can check these levels in urine.
3. fat reserves are depleted so switch to ___ as main energy source. ___ depletion occurs. Cell function degenerates. |
|
Definition
1. glycogen depleted, blood glucose maintained
2. fats, ketones
3. proteins, muslce |
|
|
Term
| gold standards for body fat composition test |
|
Definition
underwater weighing or air displacement in bod pod
measures visceral and subcu fat |
|
|
Term
|
Definition
team approach - MD, RD< mental health practitioner, ATC, exercise physiologicst, coach, parents
modify diet and exercise
ensure adequate bone building nutrients in diet - Ca (1k-1300 mg/day), Vit D (400-800/day), Vit K (60-90/day), protein (1.2-1.6 g/kg/day), calories needs vary - 30-45 cal/kg/day |
|
|
Term
Top 10 sports nutrition tips:
1. athletes high calorie needs. XC runners ___-___ cal/day
2. keep an eye on weight. most athletes gain muscle when coming to college.
3. Carbs should comprise __% of an athletes plate. |
|
Definition
|
|
Term
| 5 most common comorbidities with eating disorders |
|
Definition
major depressive disorder/dysthymia
sexual abuse
OCD
substance abuse
bipolar |
|
|
Term
| risk factors for eating disorders |
|
Definition
low self esteem
family dysfunction
family hx of eating disorder
chronic dieting
hx of physical or sexual abuse
peer, family, and cultural pressures to be thin
traumatic life experience
participation in certain types of athletics/occupations |
|
|
Term
refusal to maintain normal body weight or 85% of normal body weight
intense fear of gaining weight
body image disturbance
amenorrhea |
|
Definition
|
|
Term
2 types of anorexia:
1. absence of regular binge eating or purging. just not eating.
2. regular binge eating and purging |
|
Definition
1. restricting
2. binge-purge |
|
|
Term
recurrent episodes of binge eating characterized by;
1. eating within a discrete period of time an amount of food that is considerably larger than most people would eat
2. a sense of lack of control over eating during the binge
recurrent inappropriate compensatory behaviors focused on preventing weight gain - laxatives, excessive exercise, vomiting
binge eating and compensatory behaviora at least twice a week for 3 mos
self evaluation heavily influenced by body shape and weight
dose not occur exclusively during episodes of anorexia |
|
Definition
|
|
Term
| recurrent epidsodes of binge eating w/o regular use of compensatory behaviors |
|
Definition
|
|
Term
Formal assessment of eating disorders:
1. Ideal body weight (standard of 5 lbs. per inch over 5 ft.)
2. BMI range of <__ is considered significantly underweight and possible indication of anorexia
3, Structured interviews, questionnaires, etc. can be enlisted in the process of diagnosing (ex. Eating Disorders Examination & Interview for the Diagnosis of Eating Disorders) |
|
Definition
|
|
Term
| physical and emotional consequences of anorexia and bulimia |
|
Definition
anorexia: hair loss, lanugo, depression, concentraiton probs, weakness, fatigue, cold intolerance, constipation, diarrhea, amenorrhea
bulimia: oral deterioration, constipation, ulcers, dizziness, irregular menstruation, cardiac arrhythmia, brusied knuckles from gagging
|
|
|
Term
| level 1 care for eating disorders - outpt tx |
|
Definition
for BMI >17.5
stable
no suicidal intent
some motivation to recover
no problematic comorbid condition
able to control compulsive exercising
able to reduce purging w/o structure
good social support |
|
|
Term
| level 2 care for eating disorders - intensive out pt |
|
Definition
bmi around 17
medically stable
absense of suicidal intent
fair motivation to recover. not defiant
no problematic comorbidities
unable to gain wt w/o structure
unable to control purging w/o structure
seeks and suess support
limited social support |
|
|
Term
| level 3 care for eating disorders - inpt tx |
|
Definition
bmi <16
medically unstable
poor motivation or commitment
problematic comorbidity
requires supervision at all meals
requires supervision to prevent purging/exercising
severe fam conflict/little social support |
|
|
Term
| multiaxial assessment of psych disorders |
|
Definition
axis 1 - clinical disorders
axis II - personality disorders and MR
axis III - general med condiitons
axis IV - psychosocial and env problems
axis V - global assessment of functioning |
|
|
Term
which axis of psych disorders?
Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Delirium, Dementia, and Amnestic and Other Cognitive Disorders
Mental Disorders Due to a General Medical Condition
Substance-Related Disorders
Schizophrenia and Other Psychotic Disorders
Mood Disorders
Anxiety Disorders including PTSD
Somatoform Disorders
Factitious Disorders
Dissociative Disorders – multiple personalities
Sexual and Gender Identity Disorders
Erectile dysfunction and other disorders in which a medical cause cannot be found
Eating Disorders
Sleep Disorders
Could be anxiety, hyperarousal
Impulse Control Disorders Not Elsewhere Classified
Explosive disorder, kleptomania, pyromania, gambling
Adjustment Disorders |
|
Definition
|
|
Term
what disorder?
The person has been exposed to a traumatic event in which both of the following were present:
The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
The person’s response involved intense fear, helplessness, or horror.
B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
(2) recurrent distressing dreams of the event.
(3) acting or feeling as if the traumatic event were recurring
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness as indicated by three or more of the following:
Efforts to avoid thoughts, feelings, or conversations associated with the trauma
Efforts to avoid activities, places, or people that arouse recollections of the trauma
Inability to recall an important aspect of the trauma
Markedly diminished interest or participation in significant activities
Feeling of detachment or estrangement from others
Restricted range of affect
Sense of foreshortened future
D. Persistent symptoms of increased arousal as indicated by two or more of the following:
Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hypervigilance
Exaggerated startle response
E. Duration of the disturbance is more than one month
F. The disturbance causes clinically signigicant distress or impairment in social, occupational or other important areas of functioning
- pts with sx that don’t seem to affect theirs or others’ lives don’t count as a “disorder” |
|
Definition
|
|
Term
which axis of psych disorders?
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Antisocial Personality Disorder
Borderline Personality Disorder
May mask as an axis I disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Avoidant Personality Disorder
Dependant Personality Disorder
These people are often in abusive relationships
Obsessive-Compulsive Personality Disorder
Personality Disorder Not Otherwise Specified
Enduring, maladaptive personality traits. Pattern is stable and of long term duration. Onset can be traced back to at least early adulthood if not earlier. Won’t go away but can be controlled.
Starts in childhood, but usually don’t dx a person with this until late teens
Pts whose sx aren’t caused by anxiety or depression fall in this axis |
|
Definition
| II - personality disorders |
|
|
Term
ex of what kind of disorder?
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts as indicated by four or more of the following:
(1) suspects without sufficient basis, that others are exploiting, harming, or deceiving him or her
(2) is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
(3) Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
(4) Reads hidden demeaning or threatening meanings into benign remarks or events
(5) Persistently bears grudges
(6) Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
(7) Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner |
|
Definition
| personality disorder - axis II |
|
|
Term
Significantly subaverage intellectual functioning: an IQ of approximately 70 or below on an individually administered IQ test.
Concurrent deficits or impairments in present adaptive functioning in at least two of the following areas: communication, self-care, home living, social/ interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health and safety.
The onset is before 18 years. |
|
Definition
|
|
Term
Mild Mental Retardation - IQ level _-_
Moderate Mental Retardation – IQ level __-__
Severe Mental Retardation – IQ level __-__
Profound Mental Retardation – IQ level below __-__ |
|
Definition
mild: 50-70
mod: 35-55
severe: 20-40
profound: <20 |
|
|
Term
which psych axis?
Problems with primary support group
Doesn’t know dad. Mom has multiple boyfriends.
Problems related to the social environment
Bullied at school
Educational problems
Occupational problems
Housing problems
Living in trailer w/o running water
Economic problems
Problems with access to health care services
Problems related to interaction with the legal system/crime |
|
Definition
|
|
Term
Axis V: GAF
100 – Superior functioning
90 – Absent of minimal symptoms
80 – If symptoms are present they are transient and expectable reactions to psychosocial stressors
70 – Some mild symptoms
60 – Moderate symptoms
Flat affect, circumstantial speech, occasional panic attacks. Moderate difficulty in school/social functioning
If pt only has problem in ONE of these areas, they will be higher. If they have problem in all, they’ll be lower.
50 – Serious sympotms
40 – Some impairment in reality testing or communication or major impairment in several areas
30 – Behavior is considerably influenced by delusions or hallucinations or serious impairment in communication or judgment or inability to function in almost all areas
20 – Some danger in hurting self or others or occasionally fails to maintain personal hygiene or gross impairment in communication
10 – Persistent danger of severely hurting self or others or persistent inability to maintain minimal personal hygiene or serious suicidal act with clear expectation of death |
|
Definition
|
|
Term
Personality testing:
4 objective tests
4 projection tests |
|
Definition
objective: MMPI, millon clinical multi-axial inventory, 16PF, children's personality questionnaire
projective; rorschach inkblot, incomplete sentences blank, house-tree-person, kinetic family drawing |
|
|
Term
| components of mental status exam |
|
Definition
appearance
attire
gait
eye contact
speech
Ox3
memory
fund of knowledge - basic facts
thought content
thought process
mood
affect
judgement
insight
prior med tx
informaiton from caseworkers, teachers, employer
info from fam/friends |
|
|
Term
| sx requiring immediate action |
|
Definition
suicidal ideation with gestures or a plan
hopelessness
homicidal ideal with a place, severe aggression, or killing animals
significant paranoia
incoherence, cognitive disorganization
hallucinations
delusions
severe substance abuse |
|
|
Term
alcoholism:
__ leading cause of lifestyle related death |
|
Definition
|
|
Term
what kind of drinkers:
1. predictable, guilt free, oce every 6 mos once a month, during the holidays, etc, can leave half a drink w/o difficulty, 1-2 drinks seldom more
2. no negative consequences, 10% of kcals from ETOH, may have had bad experiences, not consistent, no rituations, drinks quickly, typically daily drinker
3. negative consequences. hangovers, spend money, lose some control, no predictability, ritual drinking, often feel guilty/embarassed, can stop
4. continue to drink despite adverse consequences, defined by periods of abstinence, 3 types: continuous, binge, periodic, relapse is quick after abstinence |
|
Definition
1. social
2. moderate drinkers
3. problem drinkers
4. alcoholic |
|
|
Term
binge drinking:
1. __ or more for men
2. __ or more for women
"moderation":
1. no more than __ drink/day for men
2. no more than __ for women |
|
Definition
|
|
Term
| signs of alcohol poisoning |
|
Definition
semiconscious, unconscious
slow respirations <8/min or >8 sec between breahts
cold, clammy, pale, blue skin
strong odor of alcohol |
|
|
Term
| what substances are considered mood altering? |
|
Definition
alcohol
food
illicit drugs
tobacco
OTC/Rx drugs |
|
|
Term
| chemical dependency is __, __, and ___ and is manifest by ___, ___, and ___ |
|
Definition
chronic progressive incurable
loss of control, tolerance, consequences |
|
|
Term
|
Definition
compulsion/craving
continued use despite consequences
control lost |
|
|
Term
|
Definition
microsomal ethanol oxidizing system - uses energy but inefficiently - reduces body's ability to detox drugs - occurs after pt has drank heavily for a long period of time
causes pt to lose weight despite the fact that they are drinking a lot
causes them to be sweaty and smell like vinegar |
|
|
Term
associated with large binges of alcohol intake, low food intake over a long period of time
acute thiamine deficieincy, confusion, psychosis, nystagmus, ataxia, drowsiness, coma, amnesia, disorientation, confabulation, weak gait |
|
Definition
| wernicke-korsakoff syndrome |
|
|
Term
| lab changes with alcoholism |
|
Definition
GGT >35
CDT >20
increased iron
high trigs
hyperuracemia |
|
|
Term
| ___ is the chemical component of addiction |
|
Definition
|
|
Term
| diet and drugs to recommend for alcohol recovery |
|
Definition
high CHO, nutrient dense
thimain - 100 mg
folate - 1 mg
multivitamin
mg
disulfuram
naltrexone
acamprosate |
|
|
Term
| 7 A's of alcohol recovery |
|
Definition
| abstinence, antabuse, AA, aftercare, acceptance, avoidance, action |
|
|
Term
what drug?
an anorectic
typical users: eat fewer complete meals, high fat, high etoh, high coffee
activates TIQ's in brain |
|
Definition
|
|
Term
what drug?
numerous methods of use
euphoria decreased fatigue
paranoid, aggressie behaviors
dental caries
brain damage
long term effects undetermined |
|
Definition
|
|
Term
what drug?
causes pts to take in 40% more than normal diet
wt gain
active ingredient stored in fat
health risks: cancer, brain degeneration
high estrogen - gynecomastia
possibly birth defects |
|
Definition
|
|
Term
what drug?
cheap
desire to eat taken away
thought of as thin, with acne
constipation
poor GI absoprtion
gastic distress
affect BG - create intense sweet cravings |
|
Definition
|
|
Term
smokers:
__% increase in LDL
high trigs and LPL
high body fat
but weigh less |
|
Definition
|
|
Term
drinking and smoking decrease life by __ years
stop drinking, increase life by __ years
stop drinking and smoking, increase life by ___ years |
|
Definition
|
|
Term
most common type of psych disorder in all human cultures
defect in genes that regulate specific chemical messengers in brain - dopamine and serotonin
response to INTERNAL CONFLICT, not external stimuli |
|
Definition
|
|
Term
| tx for acute panic attack? |
|
Definition
| ativan 0.25 mg or zyprexa |
|
|
Term
depression tx
Major Depressive Disorder is a syndrome of a persistent sad mood lasting 2 weeks or longer. The feelings of sadness are accompanied by
poor concentration
sleep disorder
lethargy
appetite loss
loss of feeling pleasure
loss of mood reactivity
2-3x more common in people w/ first degree relatives
serotonin deficiency, increased cortisol
effects of antidepresasnt in 7-14 days |
|
Definition
listen
welbutrin
ativan
melatonin for sleep
lexapro: 10 mg once daily - weight gain
effexor - 75 mg once daily - need to be tapered off
pristiq 20 mg
prozac 20 mg
zoloft 20 mg
ECT |
|
|
Term
___ refers to a group of severe, disabling psychiatric disorders marked by withdrawal from reality, illogical thinking possible delusions and hallucinations
They have trouble distinguishing reality from fantasy. Their speech and behavior may frighten or mystify those around them
5 subtypes:
Catatonic
Paranoid
Disorganized
Residual
Undifferentiated
excess of dopamine
Speech abnormalities
Clang associations—words that rhyme or sound alike, rain, train, main, sane
Echololia- words repeated.
Loose associations, flight of ideas
Word salads
Neologisms- words only the patient understands.
Thought Distortions
Delusions
Hallucinations
Magical thinking |
|
Definition
|
|
Term
Depressed mood for most of the day, for more days than not for at least 2 years (In children and adolescents mood can be irritable and duration must be at least 1 year.
B. Presence of two or more of the following:
1) Poor appetite or overeating
2) Insomnia or hypersomnia
3) Low energy or fatigue
4) Low self-esteem
5) Poor concentration or difficulty making decisions
6) Feelings of hopelessness |
|
Definition
|
|
Term
|
Definition
1. SSRI - citalopram, escitalopram (lexapro), paroxetine (paxil), sertraline (zoloft)
2. SNRI: venlafaxine (effexor), duloxetine (cymbalta)
3. SARI: trazodone
4. TCA: amitriptyline (elavil), desipramine (norpramin), doxepin (sinequan), nortiptyline (pamelor),
5. atypical: bupropion (wellbutrin)
6. MAI: isocarboxazid, phenelzine
ect
transcranial magnetic stimulation
vagus nerve stimulation
brain stimulation |
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|
