What Are the Criteria for Hospitalization for Anorexia?

Anorexia nervosa (AN) refers to an eating disorder characterized by an individual deliberately causing and maintaining weight that is significantly lower than normal through dieting and other means, and belongs to the category of "physical disorders related to psychological factors" in the psychiatric field. Its main characteristics are extreme attention to weight and body type, which is characterized by strong fear of weight gain and obesity, blind pursuit of slimness, significant weight loss, malnutrition, metabolic and endocrine disorders, such as amenorrhea in women. Severe patients can develop cachexia due to extreme malnutrition, and endanger their lives. 5% to 15% of patients eventually die of cardiac complications, multiple organ failure, secondary infections, and suicide.

Basic Information

nickname

Anorexia

English name

anorexianervosa

Visiting department

Department of Psychology

Multiple groups

Young women between 13 and 20

Common causes

Multifactorial diseases involving socio-cultural, psychological and biological issues

Contagious

no

Causes of anorexia nervosa

The etiology of AN is complex and it is a multifactorial disease involving sociocultural, psychological, and biological aspects.

In the past, AN was often regarded as a disease closely related to Western European and North American cultures; but in recent years, with the development of globalization, the advertising industry has developed rapidly, eating habits have changed, a large number of fitness industries have emerged, and women's social roles have changed. Increasing evidence shows that many non-Western societies also report on AN. In western countries, there is slim cultural pressure. A large amount of media information and marketing strategies create an atmosphere of dieting and success. Girls in their early socialization process thought that slim women were more attractive than fat women. More successful.

Patients with AN may have certain personality traits before the illness, such as low self-esteem, perfectionism, rigidity, inflexibility, sensitivity, rigor, introvertedness, timidity, retreat, hyperactivity, strong self-esteem, self-centeredness, and out-of-group , Naive, imaginative, unable to stick to one's own opinions, hesitant and so on, the requirements for success or achievement are very high. Clinical data confirm that AN is related to nervousness, frustration in study and life, excessive stress, maladjustment in the new environment, family disharmony, accidents, serious illness or death of family members, and their own unexpected events leading to mental and emotional inhibitory factors related to AN. Some children usually have bad eating habits such as partial eclipse, picky eaters, and delicious snacks. Parents have paid too much attention to their children's diet, repeatedly eaten, and forced to eat. Instead, they reduced the excitement of the child's feeding center and developed AN.

Genetic factors play a role in the pathogenesis of AN, which was confirmed by pedigree studies and twin studies, however, the genetic pattern and genetic locus of AN have not yet been established. The neurobiology of AN has been intensively studied. The neurotransmitters involved are serotonin (5-HT), norepinephrine (NE), and dopamine (DA). There are also many neuroendocrine abnormalities in AN. Many hormones or neuropeptides are related to appetite and satiety, and there are many complex interactions between different hormones or neuropeptides; for most neuroendocrine disorders, they are state-dependent, often after clinical recovery Also returned to normal. In terms of brain imaging, several CT studies have shown that patients with AN have enlarged CSF space (enlargement of the sulcus and ventricle) during long-term starvation, and one study has found weight gain and then recovered; functional imaging studies have found that the frontal and parietal lobes of AN patients Cortical metabolism and perfusion are reduced, and local 5-HT dysfunction is speculated.

Clinical manifestations of anorexia nervosa

Psychological and behavioral disorders

It mainly includes the pursuit of pathological slimming and various cognitive distortion symptoms.

AN patients are not really anorexia, but starve to achieve the so-called "slim", and their appetite has always existed. Patients start dieting or weight loss in order to control weight and maintain a slim body. Common methods include restricting food intake, in order to limit daily calories, usually eat very little; also vomiting or vomiting after eating, excessive physical exercise, abuse of laxatives, diet pills, etc.

Patients with AN suffer from a distortion of their body image and excessive attention to their body shape and weight. Although, like most people, they are even very thin, they still insist that they are very obese. Patients with AN also showed abnormal cognition of their gastrointestinal stimuli and somatosensory, and denied hunger and fatigue. They also lacked a correct understanding of their emotional states such as anger and depression. Denial of illness is another prominent feature of the disease. Patients refuse to seek medical treatment and treatment, and often their families find problems such as weight loss, poor eating, abdominal discomfort, long-term constipation, and amenorrhea and take them to the hospital for treatment.

In addition, AN may be accompanied by depression, emotional instability, social withdrawal, irritability, insomnia, decreased or lack of sexual interest, and obsessive-compulsive symptoms. It can also be manifested as excessive attention to eating in public places, often feeling incompetent, and excessively limiting one's active emotional expression. 10% to 20% of patients with AN admit having bulimia; 30% to 50% of patients have seizures.

2. Physical disorders

Patients with AN are chronically hungry, and suffer from malnutrition due to insufficient energy intake, leading to various dysfunctions in the body. The physical complications caused by malnutrition affect various systems throughout the body. The severity of symptoms is closely related to nutritional status.

Common symptoms are: gastrointestinal symptoms such as chills, constipation, bloating, nausea, vomiting, belching, fatigue, weakness, dizziness, syncope, palpitation, palpitations, shortness of breath, chest pain, dizziness, amenorrhea (no oral contraceptives), Decreased sexual desire, infertility, decreased sleep quality, and wake up early.

Anorexia nervosa diagnosis

1. Significant weight loss of more than 15% compared to the normal average weight, or Quetelet body mass index of 17.5 or lower, or failure to meet the expected body growth standards in prepuberty, and delayed or stopped development.

2. You intentionally cause weight loss, at least one of the following: Avoid "food that causes obesity"; Self-induced vomiting; Self-induced bowel movements; Excessive exercise;

3. There may be pathological fear of obesity: unusually afraid of gaining weight, the patient sets himself an excessively low weight limit, which is much lower than the weight considered moderate or healthy by the doctor before his illness.

4. There may often be extensive endocrine disorders of the hypothalamus-pituitary-gonadal axis. Amenorrhea occurs in women (amenorrhea has lasted for at least 3 consecutive menstrual cycles, but women can experience persistent vaginal bleeding if hormone replacement therapy is used, most commonly with contraceptives), and men show loss of sexual interest or low sexual function.

5. Symptoms have been at least 3 months.

6. There may be intermittent overeating.

7. Exclude weight loss caused by physical diseases (such as brain tumors, intestinal diseases such as Crohn's disease or malabsorption syndrome, etc.).

The normal weight expected value can be reduced by 105 cm in height to obtain the normal average weight in kilograms; or Quetelet body mass index = weight in kilograms / square in height meters.

Differential diagnosis of anorexia nervosa

Physical illness

Many physical diseases, especially chronic wasting diseases, such as tumors or cancers of the brain, can cause significant weight loss. Physical examinations that cause weight loss should be ruled out by relevant tests. Endocrine disorders are common in patients with AN, and primary endocrine diseases should be ruled out by relevant tests.

2. Depression

Depression patients tend to have anorexia, while AN patients have normal appetite and hunger, and AN patients have anorexia only in severe stages; in depression, patients do not have a strong fear of obesity or body image disorders in AN patients; AN Common hyperactivity is planned ritual behavior, a preemptive view of diet and calorie content of food, which is not found in patients with depression.

3. Somatization disorder

Weight loss, vomiting, and peculiar food handling in AN patients can also be seen in patients with somatization disorders. In general, patients with somatization disorder do not lose weight as severely as AN patients, nor do they express the morbid fear of being overweight as common in AN patients. Amenorrhea for more than 3 months is not common in patients with somatization disorder.

4. Schizophrenia

In patients with schizophrenia, food delusions rarely involve calorie content. Patients often show that they are convinced that the food has been poisoned. Patients also rarely have a preconceived notion of obesity and do not have the usual hyperactivity of AN patients.

5. Neurogenic bulimia

Bulimia nervosa is a type of eating disorder that is characterized by recurrent bulimia, compensatory behaviors to prevent weight gain, and excessive attention to body weight and body shape. Patients are normal or slightly overweight, and rarely lose 15% of their weight. . Although patients with AN can also suffer from overeating intermittently, they have a significant weight loss, which is more than 15% lower than the normal average weight, and cause endocrine disorders such as amenorrhea.

Anorexia nervosa treatment

Principles of treatment: Good treatment of AN patients requires close cooperation between multidisciplinary professionals, including nutritionists, physicians, pediatricians, psychiatrists, psychotherapists, social workers, etc. close co-opperation. details as follows:

1. Stimulate and maintain the patient's motivation for treatment.

2. Restore weight and reverse malnutrition

Outpatients, day hospitals and inpatients can restore patient weight. All patients who meet the admission requirements need to be admitted to a general hospital or psychiatric ward. Outpatient treatment should be continued after hospitalization.

3. Combining different treatments with comprehensive treatment and adopting individualized treatment plans

Treat patients with over-evaluation of body shape and weight, their eating habits and general psychosocial functions, including: psychological education, supportive care, nutritional therapy, drug therapy, psychotherapy (including cognitive behavioral therapy, psychodynamic psychology Therapy, family therapy), self-care groups, and support groups.

(1) Supportive therapy The purpose is to save lives and maintain the stability of vital signs. Mainly include correcting water, electrolyte metabolism disorders and acid-base balance disorders, giving enough energy to maintain life, eliminating edema, and lifting the threat to life.

(2) Nutrition The purpose is to restore normal weight. Nutrition therapy, especially dietary intake, should start from a small amount, and increase in a planned and step-by-step manner as physiological functions adapt and recover. In the initial stage, easy-to-digest, non-irritating foods are given. Depending on the condition, liquid, semi-liquid or soft food can also be selected. Ensuring sufficient energy, protein, vitamins and inorganic salts intake will promote the recovery of body function, gradually gain weight and restore its normal weight level.

(3) Drug treatment The requirements for drugs are different in different stages of AN disease. The acute treatment period mainly emphasizes rapid and effective weight gain, and the role of maintenance treatment is to prevent disease recurrence. The current drug treatment methods are mainly through the relief of obsessive-compulsive (such as fluoxetine), improving the mood of depression (various antidepressants), alleviating certain physical symptoms such as delayed gastric emptying (cisapride and metoclopramide) and treatment of The concept of overweight or near delusional beliefs (choose antipsychotics) of one's own weight and body shape can achieve the purpose of eating and gaining weight. In recent years, selective 5-HT reuptake inhibitors (SSRI), such as fluoxetine, have been found to prevent recurrence of AN.

(4) Psychotherapy Supportive psychotherapy has a good effect on chronic adult AN patients with onset of disease over 18 years of age. The specific content includes: establishing a good relationship with patients, gaining the trust and cooperation of patients; patiently and carefully explaining patients with AN , Psychological education, and nutrition counseling, so that patients understand the nature of their disease, recognize the importance of scientific and reasonable diet for physical development and health; encourage their active and active participation in treatment; cultivate patients' self-confidence and sense of independence so that Take personal responsibility in the treatment plan, correct the patient's eating behavior, and ultimately defeat the disease.

Psychodynamic psychotherapy is suitable for AN patients who have a psychological mind, can observe their emotions, can relieve symptoms through understanding, and can establish a working alliance. Understanding the psychodynamic nature of AN patients is the core of psychodynamic psychotherapy and the basis of various psychological treatments for patients. Anorexia behavior of AN patients is actually an external manifestation of subconscious conflicts that patients cannot resolve.

Home treatment is suitable for adolescent AN patients with earlier onset and shorter duration. The view of family therapy believes that the symptoms of AN are not just individual symptoms, but may be a reflection of the pathological problems of the entire family on the individual. The job of family therapy is to trigger the health of the family and turn the problem of eating disorders into Family relationship issues, altered dysfunctional family patterns, and ultimately improved eating disorders.

Cognitive behavioral therapy (CBT) is suitable for older patients. There are reports that CBT is effective in the treatment of AN and has anti-relapse effect in patients during recovery. The treatment goals of CBT are not only to gain weight, to eat regularly, to rebuild motivation and to restore menstruation, but also to test the special lifestyle diet for the development of anorexia symptoms, which can give recommendations for treatment.

Group therapy can be carried out in the outpatient and ward of the hospital. It can allow AN patients to participate with other types of people with eating disorders, obesity and even other problems. Some specific topics can be set up for young people to discuss together.

4. Use mandatory treatment

Only used in very few cases, when the patient's psychotic or physical condition threatens life and the patient refuses to be hospitalized, it must be considered first.

Prognosis of anorexia nervosa

After a series of comprehensive treatment of AN, about 45% of patients have a good prognosis without any sequelae; about 30% of patients have a medium prognosis with many symptoms and body size and weight problems; about 25% of patients have a poor prognosis and it is difficult Reached normal weight with chronic, recurrent episodes, requiring repeated hospitalizations. 5% to 15% of patients died of cardiac complications, multiple organ failure, secondary infections, and suicide. Patients with a short course of disease and a young onset age have a better prognosis.