The term anorexia nervosa means 'loss of appetite' in Greek. Anorexia nervosa is the most severe eating disorder. It has a prolonged disease course and the highest mortality rate among all psychiatric diseases. It is characterized by restriction of energy intake and subsequent significant weight loss, fear of gaining weight, and distorted body image, which can result in cachexia and related medical consequences. It often takes years for anorexia nervosa patients to recover permanently. A quarter of adult patients go on to develop a persistent form of the disorder, and a third of patients continue to be affected by persistent symptoms in the long term. The long-term results of Anorexia Nervosa before adolescence are more favorable. Due to its severe and protracted course, Anorexia Nervosa is a high emotional and economic burden for patients, caregivers, and society in general. Long-term hunger is seen in anorexia nervosa. The consequences of starvation can have a negative impact on bone density, growth, and brain maturation, especially in children and adolescents. Many patients are affected by comorbid psychological illnesses such as depression, anxiety or obsessive-compulsive disorder, personality disorders, mood and substance abuse eating disorders. In anorexia nervosa, there is a strong ambivalence towards weight gain and recovery due to the nature of the disease. This makes the healing process difficult and slow down. To increase patients' chances of recovery, all individuals dealing with this disease should be well informed about the nature and challenges of treating Anorexia Nervosa.
DSM-V (Diagnostic and Statistical Manual of Mental Disorders-V) diagnostic criteria for Anorexia Nervosa are as follows:
-
What is considered normal for age and height? Refusal to accept being underweight or overweight
-
Extreme fear of gaining weight or becoming fat despite having a body weight below expectations
-
Irregularity in the person's perception of body weight or shape
-
Menstrual cycle irregularity in women, absence of at least three consecutive menstrual cycles
Can be seen in people with anorexia The behaviors and symptoms to be noted are as follows:
-
They constantly worry about concepts such as diet, food, calories and weight.
-
Excessive weight loss. They often state that they feel “fat” or overweight despite being overweight.
-
Individuals often have extensive and detailed knowledge about nutrition, but as a result of Anorexia Nervosa, they lose their knowledge in ways that hinder rather than promote health.
-
These individuals can strictly adhere to incorrect or dangerous nutritional information.
-
Individuals with anorexia who cannot stay hungry in the beginning can eat something. eats it and regrets it. He starts vomiting voluntarily and uses laxatives.
-
He cooks nice meals for others, but does not eat them himself.
-
Especially carbohydrate foods and most foods. He refuses to eat food.
-
He acts as if he is not hungry even though he is hungry, and over time he even begins to enjoy hunger pains.
-
Excessive exercise. and follows a difficult exercise program.
-
He does not want to eat in public, he generally prefers to eat alone.
Every system in our body is affected by eating disorders. In anorexia nervosa, limited energy intake, laxative use, vomiting, etc. things affect the body negatively. The body is forced to slow down all its processes in order to save energy, resulting in serious acute and long-term medical consequences: anemia, heart diseases, kidney diseases, muscle and bone loss, amenorrhea, erosion of tooth enamel, weakness, irritability, growth and Developmental retardation, dry skin, hair loss, easy nail breakage, constipation, hypoglycemia (low blood sugar), hypokalemia (low blood potassium), hypothermia (low body temperature) are observed.
Different eating disorders such as Anorexia Nervosa. Evidence-based guidelines have been developed in various countries around the world to guide treatment. The purposes of these guidelines are as follows:
-
In deciding on adequate care measures (prevention, diagnosis, treatment and after-care), eating disorders are used to help patients and their relatives understand their diagnosis. and supporting all professionals involved in treatment,
-
Improving health care outcomes,
-
Minimizing risks,
-
To avoid unspecified diagnosis and treatment methods.
Suggested screening questions in primary health care interviews are:
-
How many times did you diet last year?
-
Are you happy with your image? Do you consider yourself fat?
-
Does being overweight affect how you think about yourself?
-
Has there been a change in your weight?
-
Have you ever vomited voluntarily to lose weight or after overeating? Have you used laxatives, diuretics or enemas?
Anorexia nervosa treatment
A multidisciplinary approach to the treatment of anorexia nervosa is required. The clinician, dietitian, psychologist or psychiatrist and family members work together.
Inpatient treatment is required for those who fall 20% below the healthy weight. There are debates about the involuntary treatment of patients who do not want treatment and the nature of the treatment to be applied. Approximately 10-15% of cases require involuntary treatment. Individuals with anorexia nervosa can be transferred to partial hospital care when they reach 85% of their healthy weight. Those with chronic and recurrent seizures, comorbid diabetes, clinical disorders (axis 1 in DSM-V), or severe comorbidities of personality disorders and mental retardation (axis 2 in DSM-V) may reach higher weights and require longer hospital stays . Nasogastric feeding is not normally recommended, but may be used at night in some adolescents and children. The short-term goal of the treatment is to ensure that the patient reaches the ideal weight appropriate for his age, height and gender, and to ensure that menstrual periods return to normal at a rate of 50%. Among the second generation antipsychotics in the treatment of anorexia nervosa, olanzapine (the active ingredient in a type of atypical antipsychotic drug group approved by the FDA for use in the treatment of schizophrenia and bipolar disorder. The side effect of this drug is weight gain), quetiapine (Quetiapine, or with its trade name Seroquel), is used to treat schizophrenia, bipolar disorder, and bipolar disorder. ma It is a type of atypical antipsychotic used in major depressive disorder. It has been determined that the most common side effects are weight gain) and risperidone (it is an atypical antipsychotic. Its most common side effects are weight gain and constipation). In a review article reviewing randomized controlled, open-ended studies and case reports, it was stated that second-generation antipsychotics are more effective on the core symptoms of depression, anxiety and eating disorders. Psychotherapy is aimed at changing the core pathological beliefs of the eating disorder and the psychopathological components that contribute to the disease. The essence of psychotherapy is to successfully engage patients, connect with them, motivate patients with self-awareness, enable them to accept a healthy, normal weight, replace overvalued beliefs about the attractiveness of losing weight and fear of fatness, and realize their personal abilities. There is increasing evidence regarding the effectiveness of cognitive-behavioral therapies. Psychodynamically oriented psychotherapies, focal analytical approaches, family and interpersonal therapies are useful.
Nutritional therapy
The main purpose of nutritional therapy is to normalize the eating habits of the individual with anorexia. The aim of the dietitian is to ensure behavioral changes regarding nutrition and to determine the energy and nutrient needs of the individual and to prepare an individual nutrition plan accordingly. The first step is to assess nutritional status. His attitude towards eating and food is determined. His weight, physical activity (exercise) and nutritional history are examined in detail. Then, a nutrition plan is made according to the data obtained and a weight gain target is created. Daily energy intake is gradually increased. As the second step, nutrition education is given. Accurate information is given to the individual about the principles of adequate and balanced nutrition and providing diversity in food selection. The last step is suggestions and support. Communication between the dietitian and the individual is very important in order for the individual to comply with the prepared nutrition plan. The dietitian should reassure the person that he/she will not become obese. Gain confidence that weight gain is not too rapid. Normal nutritional requirements should be explained and the relationship between the diet and the individual's weight gain should be explained to the individual. The importance of regular nutrition in the form of meals should be explained.
In anorexia nervosa, oral nutrition, Nasogastric nutrition or total parenteral nutrition (TPN) is administered depending on the individual's condition. If the individual's chewing and swallowing reflexes are good, oral nutrition is administered. If swallowing and chewing reflexes are not good, that is, if oral intake is insufficient, Nasogastric feeding is performed. If oral or nasogastric nutrition cannot be provided, total parenteral nutrition is administered.
Refeeding syndrome may occur when feeding is started in anorexia nervosa. The reason for this syndrome is that they suddenly consume more calories than they consume because they are on a very low-calorie diet. To minimize refeeding syndrome, avoid overly aggressive refeeding protocols early in the refeeding process. Adequate fluid and micronutrients (thiamine, B group vitamins, sodium, potassium, phosphate, magnesium, etc.) should be given. The patient's daily blood values should be monitored and supplementation should be made in case of missing values.
Read: 0
