Anorexia

 

At the core of anorexia is the relentless desire to lose weight, which patients realize through diet, exercise, and sometimes enemas, laxatives, vomiting. As a result of weight loss were reconstructed metabolic processes, there is amenorrhea, mental changes occur. The patients for weight loss and fatigue do not pay attention. To the doctor they usually lead relatives, concerned about their substantial weight loss. Only some patients have somatic complaints, due to complications (damage to the musculoskeletal system as a result of physical activity, cardiovascular disorders due to starvation and hypokalemia).

Anorexia nervosa is relatively rare, in the U.S. - 15 cases per 100 000 population per year. Because the disease is chronic, the overall prevalence of anorexia nervosa above - 0,1-0,7%. Mainly girls are sick. The peak incidence occurs in teenage age, although onset may be as a child and in adolescence. Painful conviction in its own fullness and desire to lose weight usually are not in anorexia nervosa nature of obsession. Focusing on weight and shape is not contrary to domestic installations, and therefore is not accompanied by anxiety. Only in rare cases, anorexia nervosa is combined with obsessive-compulsive disorder, and then you can identify common for these patients obsessions (fear of pollution, contamination, etc.) and rituals.

Many changes in personality and behavior in anorexia nervosa - a consequence of starvation, they may have any hungry person. This concentration of thoughts on food, slow chewing of food, depression, fatigue, reduced sexual activity, social isolation, deterioration of cognitive function (inability to concentrate, low test scores on intelligence, infringement opinions). Approximately half of patients with anorexia nervosa are binge eating episodes, followed by unloading. This type of behavior is more characteristic of impulsive, less fettered personalities. Some believe that this is not anorexia nervosa and bulimia nervosa, but the consensus here yet.

As shown by the long-term observation, the mortality of anorexia nervosa is about 15% (in contrast to the traditionally accepted 5%). Approximately half the cases the cause of death is suicide - it once again suggests that in anorexia nervosa expressed emotional distress, and that in each case it is necessary to assess suicide risk.
Treatment of anorexia

Emergency aid is reduced primarily to the correction of water-electrolyte disorders. If the concentration of potassium in serum is less than 3 mEq / L, there may be cardiac arrhythmias, including life-threatening. So make sure to cover the shortage of potassium, and if bulimia nervosa potassium enough to give in, then with anorexia - required in /.

Long-term treatment. The first step - convincing the patient and family in need for treatment and details of it. This may require a lot of time and effort, because patients usually underestimate the danger of his condition. Nevertheless, this step is necessary because the involuntary treatment is difficult and often impossible.

Almost always - except for the early stages, when weight loss is negligible, - is shown hospitalization in a specialized hospital. In the hospital first begin to restore weight. Usually used method of compensation: if one day the patient gained weight, for example, 200 grams, then "a reward" him give more freedom (at first allowed for some time to leave the chamber, and then meet with friends, leave the office, etc.) . Since patients entered into the agreement, which determine what remuneration corresponding to a daily weight gain. This agreement is then often discuss and, if necessary, change. It is important to patients themselves to determine for itself incentives. If the weight is not added, then compensation is not enough attractive and should look better. According to one controlled trial, method of remuneration in anorexia nervosa that of the other, although it gives the best results yet in mild cases. Tube feeding - distributed earlier treatment - are rarely used now due to the risk of aspiration pneumonia. After being discharged from hospital should be extended outpatient treatment. His goal - to achieve a healthy weight and maintain it for at least 6 months.

The basis of outpatient treatment - psychotherapy, aimed at psychological support, distraction from relentless thoughts about weight and shape, the resolution of life's difficulties. Teenagers useful family therapy. Most patients with this approach continues to gain weight but often a few months later comes anorexia relapse requiring re-hospitalization. Fully recover less than half the patients, although almost all can work. A rare complication of therapy - obesity