Anorexia nervosa: Difference between revisions
 
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==Background==
==Background==
*Associated with body image disturbance
*Associated with body image disturbance
*Adolescent girls
*Usually seen in adolescent girls
**3rd most common chronic condition in adolescent girls
**Life long risk
**Life long risk
*Body image is predominate measure of self worth
*Body image is predominate measure of self worth
*Mortality 6-20%
*Mortality 6-20%, highest of any psychiatric disorder


==Clinical Features==
==Clinical Features==
[[File:Anorexia case-1900-Nouvelle icononographie de la Salpetriere.jpg|thumb|Patient with anorexia nervosa.]]
===Diagnostic Criteria===
===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===
===Symptoms===
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*Loss of subcutaneous fat
*Loss of subcutaneous fat
*Breast and vaginal atrophy
*Breast and vaginal atrophy
===Associated conditions===


==Differential Diagnosis==
==Differential Diagnosis==
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*Major depressive disorder
*Major depressive disorder
*[[Schizophrenia]]
*[[Schizophrenia]]
*Substance use disorders
*[[Substance abuse]]
*Social anxiety disorder
*Social [[anxiety]] disorder
*Obsessive-compulsive disorder
*Obsessive-compulsive disorder
*Body dysmorphic disorder
*[[Bulimia nervosa]]
*[[Bulimia nervosa]]
*Avoidant/restrictive food intake disorder


==Evaluation==
==Evaluation==
*Exclude: Inflammatory bowel disease, hyperthyroidism, chronic infection, diabetes mellitus, and Addison’s disease<ref>John F. Bober, Scott E. Moser: Rakel: Textbook of Family Medicine, 8th ed., Saunders, 2011 (Ch)24: p452</ref>
*Exclude: Inflammatory bowel disease, hyperthyroidism, chronic infection, diabetes mellitus, and Addison’s disease<ref>John F. Bober, Scott E. Moser: Rakel: Textbook of Family Medicine, 8th ed., Saunders, 2011 (Ch)24: p452</ref>
*CBC
*CBC
**[[Anemia]], [[leukopenia]] in severe disease
*Chem 10
*Chem 10
**[[Hypoglycemia]], [[hypophosphatemia]] in severe disease
*[[ECG]]
*[[ECG]]


==Management==
==Management==  
*inpatient management
*Treat medical complications<ref>https://pedemmorsels.com/eating-disorders/</ref>
**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 arrest|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
**Extremely low weight (<75% of expected body weight) or rapid weight loss
**Severe electrolyte imbalances
**[[Hypotension]] (<80/50 mmHg)
**[[Hypothermia]] (<96 degrees F)
**Severe [[electrolyte imbalances]]
**Cardiac disturbances
**Cardiac disturbances
**[[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]]
 
==Disposition==


==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

Patient with anorexia nervosa.

Diagnostic Criteria

  1. 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]
  2. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
  3. 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

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

Evaluation

Management

Disposition

Also See

References

  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. ↑ https://pedemmorsels.com/eating-disorders/
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