What is Anorexia Nervosa?
Anorexia nervosa is a psycho-physiological disorder in which the patient’s intentionally caused weight falls significantly below normal physiological weight, and he/she tries to maintain this state. More common in adolescents, the age of onset is mostly between the ages of 13 and 25. The ratio of male and female prevalence is about 1:9.5.
Anorexia nervosa is a common eating disorder. Patients often pay too much attention to their body size and weight, fearing that they become fat, they deliberately restrict their diet, and even take emetic drugs and laxatives to remove the intake of food, resulting in severe weight loss. Below normal standards. Even if they are skinny, they still think they are too fat. Severe illness can lead to malnutrition, endocrine and metabolic disorders and even death. It is an eating disorder that is more serious and harmful than bulimia nervosa.
Types of Anorexia Nervosa
There are two types of anorexia nervosa, and both are severe mental illnesses that require treatment.
People with this subtype place severe restrictions on the quantity and kind of food they consume. This may manifest in several ways in which as well as some or all of the following:
- Proscribing bound food teams (e.g., Carbohydrates, fats)
- Investigating calories
- Skipping meals
- Obsessional rules and rigid thinking (e.g., Solely, consume food that’s one color)
These restrictive behaviors around food are often in the midst of excessive exercise.
People with this subtype additionally place the severe restriction on the quantity and the kind of food they consume. Furthermore, to the present, the person can show purging behaviors and should additionally interact in binge consumption. Binge consumption involves consuming an oversized quantity of food and feeling a ‘loss of control’. Purging behavior involves the self-induced ejection, or deliberately misusing laxatives, diuretics or enemas to complete consumption of food.
Causes of Anorexia Nervosa
Many adolescents are faced with growing confusion, specific family problems, and social pressure during adolescence. Some scholars believe that this is related to endocrine disorders.
In fact, almost all adolescents try to diet. Anorexia nervosa has also been triggered. About one-third of people with anorexia are overweight before going on a diet. General dieters stop when they reach an ideal weight. However, patients with anorexia nervosa can still insist that the body weight is far below the standard baseline for age and height. The calories they consume are mainly from low-calorie foods such as fruits, vegetables, and salads.
Symptoms and Signs of Anorexia Nervosa
1. Anorexia Nervosa patients often deny that they are sick and refuse treatment. This performance is puzzling.
- Self-image judges obstacles, resulting in serious mistakes. Although she is skinny, she still feels she is still fat.
3. Energy is not commensurate with the degree of weight loss, although extreme weight loss can still adhere to daily work.
4. Anorexia nervosa patients show loss of appetite, no hunger, or rejection or ignorance of hunger throughout the disease; strict control of their food Ingestion to limit calorie intake as much as possible. In fact, patients with Anorexia Nervosa control the diet from time to time and have already occurred one year before the onset of this disease.
5. The body weight fell within a few months after onset, mostly below the standard body weight of 15%. Patients with anorexia nervosa also participate in overweight exercises that help reduce body weight. Some patients can develop cachexia. If combined with bulimia, weight can also be normal or partial weight.
6. Anorexia Nervosa patients often complain of abdominal pain, abdominal distension, early satiety, slowing gastrointestinal emptying leading to constipation, but also because of laxatives caused by diarrhea
7. Dry skin increased armpit hair, and thick skin folds. Cold water test on Anorexia Nervosa patients, blood vessels are susceptible to hypothermia, showing Renault phenomenon. CT examination revealed that the loss of subcutaneous fat was higher than the loss of thick fat. Therefore, anorexia nervosa is cold, and their body temperature can be reduced to 36°C. The basal metabolic rate was significantly lower than before the disease.
8. Slow breathing, low blood pressure. Left ventricle decreased blood output, mitral regurgitation. Due to severe malnutrition, limb edema often occurs, and half of the patients develop muscle weakness. Peripheral neuropathy has also been reported.
9. Almost 100% of patients with anorexia nervosa have amenorrhea. Most patients have amenorrhea after anorexia and weight loss, but a few occur before anorexia. Loss of sexual function, pubic hair, armpit hair loss, breast, uterine atrophy, vaginal smear estrogen moderate or high.
Diagnostic criteria for Anorexia Nervosa
1) Refused to maintain a lower limit of body weight than healthy children of the same age and same height and adolescents, resulting in a weight lower than 85% of the expected weight.
2) In spite of low body weight, he is still afraid of gaining weight gain.
3) Obstacles to self-assessment have led to the judgment of serious errors (though they are considered skinny and still considered too fat).
4) Secondary amenorrhea, that is, menstruation does not occur on their own for three consecutive months. Some people think that women aged ≤ 25 years old; anorexia, daily intake <150g and weight loss below 80% of standard weight; with severe malnutrition, patients without internal medicine and psychiatric disorders, should consider the possibility of AN diagnosis AN can be divided into constraint type and bulimia elimination type.
- Blood biochemical changes are evident in severe anorexia nervosa patients, and patient changes are minor.
Anemia, leukopenia, and bone marrow have different degrees of inhibition. Reduced fibrin levels, hypokalemia, and dyslipidemia. In some patients with AN, IgG, IgM decreased.
3. Angiotensin levels are elevated in both plasma and cerebrospinal fluid. Zinc and calcium in plasma decreased, and zinc and calcium in hair were normal.
4. Endocrine hormone levels and functional tests There is also one hot topic in patients with AN and bulimia nervosa.
Treatment of Anorexia Nervosa
1. Mental and behavioral treatment
- Treat patients with sincerity, patience, and seriousness, and fully obtain the trust of patients.
- Adjust family relationships and help establish good relationships with others.
Doing subtle psychological work to correct the patient’s wrong understanding of weight and eating and stubborn prejudice.
2. Dietary therapy
It is based on good mental and behavioral therapy. Proper nutritional therapy will quickly produce significant results. Because no medicine is more important than nursing and diet.
(1) Children follow normal weight growth curves, and adults use body mass index as an indicator of treatment. The goal of treatment is to increase body weight by 225 to 1350 g per week.
At the beginning of the treatment, 2134J (510cal calories) of food was added daily based on the weight needed to maintain it. During the period of weight gain, 293 to 418 J (70 to 100 cal) calories per kilogram of body weight are required per day, and 167 to 251 J (40 to 60 cal) calories are required for the weight maintenance period.
(2) The patient’s diet should pay more attention to changing food types. Should be based on carbohydrates, intermittent eating vegetables, and fruits to extend the time to eat, with appropriate fat food delay gastric emptying time. The anorexia nervosa person should take a seat to eat, eat hot food, do not use his fingers to grab food, and do meal records.
3. Medications Therapeutics
Medications Therapeutics for the treatment of Anorexia Nervosa drugs are primarily aimed at the patient’s anxiety about food, improving the function of gastric emptying and restoring the function of the hypothalamic-pituitary-gonadal axis. Depression can often be ameliorated after weight recovery. It should be observed before deciding whether antidepressant medication is needed.
(1) Antipsychotic drugs: chlorpromazine (chlorpromazine): can block the central dopamine receptor Anorexia Nervosa drugs, usually 25 ~ 100mg / time, 2 ~ 3 times / d. The psychological abnormality of Antipsychotic may be the result of the increase of dopamine activity in the central nervous system, and the anxiety of diet after serving is reduced. Imipramine: a tricyclic antidepressant, 25 to 35 mg/time, 3 times daily.
Depression is quite common in patients with AN. Some patients with AN still have depression after returning to a normal diet. After applying imipramine, they can prevent an AD from remaining in a depressed state after eating normally. Lorazepam. Take short-acting benzodiazepines, 0.5 to 1 mg/times or the equivalent of oxazepam 15 mg. This medicine has anti-anxiety and enhances appetite.
(2) To promote gastrointestinal motility drugs: There are two commonly used drugs: 1 dopamine receptor blockers, such as metoclopramide. 2 cholinergic agents, such as clofibrate. After taking to promote gastric emptying, relieve postprandial satiety, stomach discomfort and other symptoms.
(3) Zinc preparation (zinc sulfate): Zinc deficiency is similar to the clinical symptoms of AN. After treatment with zinc sulfate 45 to 90 mg/d for 8 to 16 months, some patients have good menstrual cramps and good results.
(4) Gonadotropin-releasing hormone (LHRH): pump infusion, automatic subcutaneous injection of 12.5 mg every 90 min. After a short-term treatment, her appetite improved, her weight gained, her spirits improved, and her menstrual cramps.