Anorexia nervosa: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
[[File:Anorexia case-1900-Nouvelle icononographie de la Salpetriere.jpg|thumb|Patient with anorexia nervosa.]] | |||
===Diagnostic Criteria=== | ===Diagnostic Criteria=== | ||
#Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. <ref>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref> | |||
#Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. | |||
#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 persistent lack of recognition of the seriousness of the current low body weight. | |||
===Symptoms=== | ===Symptoms=== | ||
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***Osteoporosis due to HPA dysfunction | ***Osteoporosis due to HPA dysfunction | ||
***Risk of fracture with minimal or no trauma | ***Risk of fracture with minimal or no trauma | ||
*Must avoid use of [[bupropion]] as it may lead to seizures in patients with eating disorders | |||
==Disposition== | ==Disposition== | ||
*Inpatient management for: | *Inpatient management for: | ||
**Extremely low weight (<75% of expected body weight) or rapid weight loss | **Extremely low weight (<75% of expected body weight) or rapid weight loss | ||
**Hypotension (< 80/50) | **[[Hypotension]] (<80/50 mmHg) | ||
**Hypothermia (< 96 degrees F) | **[[Hypothermia]] (<96 degrees F) | ||
**Severe electrolyte imbalances | **Severe [[electrolyte imbalances]] | ||
**Cardiac disturbances | **Cardiac disturbances | ||
**Bradycardia < 50 | **[[Bradycardia]] <50 | ||
**Acute medical disorders | **Acute medical disorders | ||
**Severe or intractable purging | **Severe or intractable purging | ||
**Psychosis or a high risk of suicide | **Psychosis or a high risk of [[suicide]] | ||
==Also See== | ==Also See== | ||
Latest revision as of 22:35, 1 February 2023
Background
- Associated with body image disturbance
- Usually seen in adolescent girls
- 3rd most common chronic condition in adolescent girls
- Life long risk
- Body image is predominate measure of self worth
- Mortality 6-20%, highest of any psychiatric disorder
Clinical Features
Diagnostic Criteria
- Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. [1]
- Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
- 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 persistent lack of recognition of the seriousness of the current low body weight.
Symptoms
- Constipation
- Abdominal pain
- Fatigue
- Weakness
- Amenorrhea
- Depression
- Hair loss
Signs
- Fine facial and body hair (lanugo)
- Brittle hair and nails
- Dry, scaly skin
- Loss of subcutaneous fat
- Breast and vaginal atrophy
Associated conditions
Differential Diagnosis
- Gastrointestinal disease
- Hyperthyroidism
- Occult malignancies
- AIDS
- Major depressive disorder
- Schizophrenia
- Substance abuse
- Social anxiety disorder
- Obsessive-compulsive disorder
- Bulimia nervosa
Evaluation
- Exclude: Inflammatory bowel disease, hyperthyroidism, chronic infection, diabetes mellitus, and Addison’s disease[2]
- CBC
- Anemia, leukopenia in severe disease
- Chem 10
- Hypoglycemia, hypophosphatemia in severe disease
- ECG
Management
- Treat medical complications[3]
- Cardiovascular
- Bradycardia due to increased vagal tone
- Other serious dysrhythmias
- Decreased cardiac muscle from malnutrition --> cardiac dysfunction, mitral valve prolapse
- Caution with rate of IVF (risk of pulmonary edema)
- Fluid/Electrolytes
- Serious electrolyte abnormalities can occur
- Hypophosphatemia can impair cardiac and diaphragmatic muscle contractions--> respiratory/cardiac arrest
- Hypomagnesemia, hypokalemia and alterations with refeeding can cause arrhythmia
- Refeeding syndrome risk
- Even 1L of d5 NS could harm patient subsisting on <400kcal daily
- Serious electrolyte abnormalities can occur
- Gastrointestinal
- Delayed gastric/colonic emptying--> gastroparesis, distension, GERD, constipation, SMA syndrome
- MSK
- Osteoporosis due to HPA dysfunction
- Risk of fracture with minimal or no trauma
- Cardiovascular
- Must avoid use of bupropion as it may lead to seizures in patients with eating disorders
Disposition
- Inpatient management for:
- Extremely low weight (<75% of expected body weight) or rapid weight loss
- Hypotension (<80/50 mmHg)
- Hypothermia (<96 degrees F)
- Severe electrolyte imbalances
- Cardiac disturbances
- Bradycardia <50
- Acute medical disorders
- Severe or intractable purging
- Psychosis or a high risk of suicide
Also See
References
- ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- ↑ John F. Bober, Scott E. Moser: Rakel: Textbook of Family Medicine, 8th ed., Saunders, 2011 (Ch)24: p452
- ↑ https://pedemmorsels.com/eating-disorders/