Anorexia Nervosa Treatment Medication Diagnosis, causes: Anorexia nervosa refers to an eating disorder characterized by individuals who intentionally cause and maintain body weight significantly lower than normal standards by means of dieting, etc. , belonging to the category of “physiological disorders related to psychological factors” in the psychiatric field. Its main feature is the extreme attention to weight and body shape, which is characterized by a strong fear of weight gain and weight gain. Anorexia Nervosa Treatment Medication Diagnosis, causes. The blind pursuit of slim, significant weight loss, often malnutrition, metabolism and endocrine disorders, such as women with amenorrhea. Severe patients may suffer from cachexia and body failure due to extreme malnutrition, which is life-threatening. 5% to 15% of patients eventually die from cardiac complications, multiple organ failure, secondary infection, and suicide. Anorexia Nervosa Treatment Medication Diagnosis, causes.
The age of onset and gender characteristics of AN are similar at home and abroad. Mainly seen in young women between the ages of 13 and 20, the two peaks of the disease are 13 to 14 years old and 17 to 18 or 20 years old. After 30 years of age, the incidence is rare, and perimenopausal women are even awkward; Men are only 5% to 10%, and the ratio of male to female is 1:10. In Europe and America, the lifetime prevalence of female AN is 0.5% to 3.7%; the annual incidence of AN is 3.70‰ to 4.06‰. AN is more common in the high social class than in the lower social class, developed countries are higher than in developing countries, and cities are higher than in rural areas.
Table of Content:
1: Anorexia Nervosa Cause
2: Clinical Manifestations of Anorexia Nervosa
3: Anorexia Nervosa Diagnosis
4: Anorexia Nervosa Differential Diagnosis
5: Anorexia Nervosa Treatment Medication
1: Anorexia Nervosa Cause:
The etiology of AN is complex and is a multifactorial disease involving many aspects such as social culture, psychology, and biology. In the past, AN was often considered to be a disease closely related to Western European and North American culture; but in recent years, with the development of globalization, the rapid development of the advertising industry, changes in eating habits, the emergence of a large number of fitness industries and the transformation of women’s social roles, There is growing evidence that many non-Western societies also have AN reports. In Western countries, there is a “slender” cultural pressure. A large amount of media information and marketing strategies create an atmosphere of dieting and success. Girls in their early socialization process think that slim women are more attractive than fat women. More successful.
AN patients may have certain personality traits before illness, such as low self-esteem, perfectionism, stereotyped stubbornness, conservative inflexibility, sensitivity, rigorousness, introversion, timid retreat, hyperactivity, self-respect, self-centeredness, disharmony, childish, illusory, unable to insist on their own opinions, hesitating, etc., the requirements for success or achievement are very high. Clinical data confirmed that interpersonal relationships were tense, learning and life suffered setbacks, excessive stress, a maladaptive adaptation of the new environment, family disharmony, family members with accidents, serious illness or death, and their own accidents caused mental stress inhibition factors related to AN. Some children usually have poor eating habits such as partial eclipse, picky eaters, and good snacks. Parents pay too much attention to their children’s diet, repeatedly licking and forcing food. Instead, they reduce the excitability of the child’s feeding center and develop into AN.
Genetic factors play a role in the pathogenesis of AN, which is confirmed by family studies and twin studies. However, the genetic pattern and genetic loci of AN have not been established. The neurobiology of AN has been further studied. The neurotransmitters involved are serotonin (5-HT), norepinephrine (NE), dopamine (DA), etc. There are also many neuroendocrine abnormalities in AN. Many hormones or neuropeptides are associated with appetite and satiety, and there are many complex interactions between different hormones or neuropeptides; for most neuroendocrine disorders, they are state-related, often after clinical recovery. It also returned to normal. In brain imaging, a number of CT studies have shown that patients with AN have enlarged CSF gaps during long-term starvation (brain sulcus and ventricle enlargement), and one study found that weight gain is restored; functional imaging studies found that patients had frontal and parietal lobe Cortical metabolism and perfusion are reduced, and local 5-HT dysfunction is presumed.
2: Clinical Manifestations of Anorexia Nervosa
Psychological and behavioral disorders
It mainly includes the pursuit of pathological slimness and a variety of cognitive distortion symptoms. Patients are not really anorexia, but hungry to achieve the so-called “slim”, and their appetite has always existed. The patient begins to diet or lose weight in order to control weight and maintain a slim body shape. Common methods are limited to eating, to limit daily calories, usually, eat very little; there are vomiting or vomiting after eating, excessive physical exercise, abuse of laxatives, diet pills and so on.
Patients with AN have a misrepresentation of their body image, over-focusing on their size and weight, and despite being as thin as most people, they still insist that they are very obese. Patients also have abnormalities in their own gastrointestinal stimuli and physical sensations, denying hunger, denying fatigue, and lacking a correct understanding of their emotional states such as anger and depression. Denying the condition is another significant feature of the disease. Patients refuse to seek medical treatment and treatment. They are often taken to the hospital by family members who find that they are thin, have little food, abdominal discomfort, long-term constipation, amenorrhea, and other problems.
In addition, AN may be associated with depressed mood, mood swings, social withdrawal, irritability, insomnia, loss of interest or lack of, obsessive-compulsive disorder -like. It can also be expressed as excessive attention to eating in public, often feeling incompetent, and excessively restricting the active emotional expression of oneself. 10% to 20% of patients admitted to stealing behavior; 30% to 50% of patients have paroxysmal bulimia.
The long-term hunger state of patients, lack of energy intake and malnutrition, leading to various dysfunctions in the body, the physical complications caused by malnutrition affect the various systems of the body. The severity of the symptoms is closely related to the nutritional status.
Common symptoms are: chills, constipation , bloating, nausea, vomiting, belching and other gastrointestinal symptoms, fatigue, weakness, dizziness , syncope, palpitation, palpitations, shortness of breath, chest pain, dizziness, menopause (not oral contraceptives), Reduced libido, infertility, decreased sleep quality, and early awakening.
3: Anorexia Nervosa Diagnosis:
- Significant weight loss is more than 15% less than normal average weight, or Queteletbody mass index is 17.5 or lower, or the desired body growth criteria cannot be achieved in prepubertal, with developmental delay or cessation.
- Deliberately cause weight loss, at least one of the following: 1 avoiding “food that causes weight gain”; 2 self-induced vomiting; 3 self-induced bowel movements; 4 excessive exercise; 5 taking anorexia or diuretics.
- Often pathologically obsessed with fat: unusually afraid of getting fat, the patient sets a too low weight limit for himself, which is far lower than the weight that the pre-treatment doctor thinks is moderate or healthy.
- There may be extensive endocrine disorders of the hypothalamic-pituitary-gonadal axis. Women present with amenorrhea(menopause has at least 3 consecutive menstrual cycles, but women with persistent vaginal bleeding with hormone replacement therapy, the most common use of contraceptives), males with loss of sexual interest or sexual dysfunction.
- Symptoms have been at least 3 months.
- There may be intermittent overeating.
- Exclude weight loss due to physical illness (such as brain tumors, intestinal diseases such as Crohn’s disease or malabsorption syndrome, etc.
The normal weight expectation can be reduced by 105 in height and the normal average body weight in kilograms; or the Quetelet body mass index = weight kilograms per square meter of height. ‘Anorexia Nervosa Treatment Medication Diagnosis, causes’
3: Anorexia Nervosa Differential Diagnosis:
1: Physical illness:
Many physical illnesses, especially chronic wasting diseases, such as tumors or cancers in the brain, can cause significant weight loss, and physical examinations that cause weight loss should be excluded through relevant tests. Endocrine disorders are common in patients with AN, and primary endocrine diseases should be excluded by relevant tests.
Depressed patients often have the characteristics of loss of appetite, while AN patients have normal appetite and hunger, only in the severe stage AN patients have loss of appetite; in depression, patients do not have strong obesity fear or body image disorder in AN patients; Common overactive activities are planned ritual behaviors, preoccupation with recipes and food calorie content, which are not present in depressed patients. Read This also: how to know depression symptoms | Solve seasonal depression
3: Somatization disorders:
Body weight fluctuations, vomiting, and peculiar food handling in patients can also be seen in patients with somatization disorders. In general, weight loss in patients with somatization disorders is not as severe as in patients with AN, nor does it express morbid fear of overweight as is common in patients. Amenorrhea is less common in patients with somatization for more than 3 months.
In patients with schizophrenia, delusions about food rarely involve calorie content, and patients often have a belief that food is poisoned; patients rarely have a preconceived notion of obesity, and there is no overactive activity common in AN patients.
5: Neurogenic bulimia:
Neurogenic bulimia is an eating disorder with recurrent episodes of overeating, accompanied by compensatory behaviors to prevent weight gain and excessive attention to body weight and body shape. Patients have normal or slightly overweight, with little weight loss of 15%. Although patients with AN can also be overeating by intermittent episodes, they have a significant weight loss, which is more than 15% less than normal average weight and leads to endocrine disorders such as amenorrhea.
5: Anorexia Nervosa Treatment Medication:
Principles of treatment: Good treatment of patients with AN requires close collaboration between multidisciplinary professionals, including nutritionists, physicians, pediatricians, psychiatrists, psychotherapists, social workers, etc., as well as between patients and families. close co-operation. details as follows:
- Inspire and maintain the patient’s treatment motivation.
- Restore weight and reverse malnutrition
Outpatient, day hospital and hospitalization can all restore the patient’s weight. All patients who meet the admission criteria need to be admitted to a general hospital or psychiatric ward and should continue to be treated after hospitalization.
Combine different treatments with comprehensive treatment and adopt an individualized treatment plan:
Treatment of patients’ excessive assessment of body shape and body weight, their eating habits and general psychosocial functions, including psychological education, supportive care, nutritional therapy, drug therapy, psychotherapy (including cognitive behavioral therapy, psychodynamic psychology) Treatment, family therapy ), self-care group and support group.
1: supportive care
Aims to save lives, to maintain stable vital signs. It mainly includes correcting water and electrolyte metabolism disorders and acid-base balance disorders, giving enough energy to sustain life, eliminating edema and lifting the threat to life.
The purpose is to restore normal body weight. Nutritional therapy, especially dietary intake, should start from a small amount, with a planned and step-by-step increase with the adaptation and recovery of physiological functions. In the initial stage, digestible and non-irritating foods are given, and depending on the condition, fluid, semi-liquid or soft food can also be used. Ensuring the intake of sufficient energy, protein, vitamins, and inorganic salts, the body’s function is restored, the body weight is gradually increased, and its normal body weight is restored.
3: Drug treatment
Different requirements for drugs at different stages of AN disease, the acute treatment period mainly emphasizes rapid and effective weight gain, while the role of maintenance treatment is to prevent disease recurrence. Current medical treatments mainly rely on relieving compulsion (such as fluoxetine), improving depression (various antidepressants), alleviating certain physical symptoms such as delayed gastric emptying (cisapride and metoclopramide) and treatment The concept of overweight and near-imaginary beliefs (using antipsychotics) of their own body weight and body shape achieve the purpose of eating and gaining weight. In recent years, selective 5-HT reuptake inhibitors (SSRI), such as fluoxetine, have been found to prevent recurrence of AN.
4: Psychotherapy Supportive
psychotherapy has a good effect on chronic adult AN patients who are over 18 years old. The specific contents include: establishing a good relationship with patients, obtaining the trust and cooperation of patients; patiently and meticulously explaining the patients with AN , psychological education and nutrition counseling, to enable patients to understand the nature of their disease, to recognize the importance of scientific and rational diet for physical development and health; to encourage active and active participation in treatment; to cultivate patients’ self-confidence and self-reliance Take personal responsibility in the treatment plan, correct the patient’s eating behavior, and ultimately overcome the disease.
Psychodynamic psychotherapy is suitable for patients who have a psychological mind, are able to observe their own emotions, can be relieved by comprehension, and can establish a work alliance. The psychodynamic understanding of AN patients is the core of psychodynamic psychotherapy, and it is the basis for various psychological treatments for patients. The anorexia behavior of AN patients is actually an external manifestation of subconscious conflicts that patients cannot solve.
Family therapy is suitable for adolescent AN patients with earlier onset and shorter onset. The idea of family therapy is that the symptoms of AN are not just the symptoms of the individual, but maybe the reflection of the pathological problems of the whole family in their individual. The work of family therapy is to stimulate the health of the family and translate the problem of eating disorders of the patient into Family relationship problems, changing the family model of loss of function, and ultimately improving the symptoms of eating disorders.
Cognitive Behavioral Therapy (CBT) is suitable for some older patients. It has been reported that CBT is effective in the treatment of AN and has an anti-recurrence effect on patients in the recovery period. The goal of CBT treatment is not only to increase weight, regular diet, rebuild motivation and restore menstruation, but also to test the special lifestyle of the development of anorexia symptoms, which can give advice on treatment.
Group therapy can be carried out in hospital outpatients and wards. Patients can participate in other types of eating disorders, obesity, and even other problematic teenagers. Some specific topics can be set up for teens to discuss.
5: Adopt mandatory treatment
For very few cases only, when the patient’s psychotic or physical condition threatens life and the patient refuses to be hospitalized, it must be considered first.
After a series of comprehensive treatments, about 45% of patients have a good prognosis without any sequelae; about 30% of patients have a moderate prognosis. “Anorexia Nervosa Treatment Medication Diagnosis causes” there are still many symptoms and body types, weight problems; about 25% of patients have a poor prognosis, it is difficult Achieving normal weight, chronic, recurrent, requiring repeated hospitalization. 5% to 15% of patients eventually die from cardiac complications, multiple organ failure, secondary infection, and suicide. Patients with a short course of a disease and younger onset have a better prognosis.