Anorexia nervosa: Difference between revisions

Revision as of 22:34, 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

Patient with anorexia nervosa.

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
- 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
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)
- 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/

Authors:

[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

[2] John F. Bober, Scott E. Moser: Rakel: Textbook of Family Medicine, 8th ed., Saunders, 2011 (Ch)24: p452

[3] ttps://pedemmorsels.com/eating-disorders/

[1]

[2]

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@@ Line 10: / Line 10: @@
 [[File:Anorexia case-1900-Nouvelle icononographie de la Salpetriere.jpg|thumb|Patient with anorexia nervosa.]]
 ===Diagnostic Criteria===
-*A. 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>
+#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>
-*B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
+#Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
-*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 persistent lack of recognition of the seriousness of the current low body 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===