Download anorexia

2007
ANOREXIA
Facts
 Highest mortality rate of
mental illnesses
 Prevalence of 0.3% in young
women
 Average of onset 15 yrs
Hallmarks of anorexia
• Extreme overvaluation of shape and weight
• Physical capacity to tolerate extreme self
imposed weight loss
• Use of over exercise and over activity to burn
calories
• Purging practices – self induced vomiting,
misuse of laxatives, diuretics, slimming
medication.
• Body checking – mirror gazing
ICD criteria for anorexia
 Body weight 15% < expected BMI < 17.5
 Weight loss self induced – avoid fattening
foods + self induced vomiting, purging, over
activity, use of appetite suppressants,
diuretics
 Body image distortion
 Widespread endocrine disorder involving
hypothalamic- pituitary-gonadal axis
Endocrine disorder
 Women
 Amenorrhoea
 Men
 Loss of sexual interest or potency
 Both
 Growth hormone and cortisol may be raised
 Abnormalities of insulin secretion
 Changes in peripheral metabolism of thyroid
hormones
Causes
 Genetic predisposition
 Found in families with following
traits
 Obsessive
 Perfectionist
 Competitive
 ? Autistic spectrum traits
Causes
 Precipitated as a coping mechanism against
 Developmental challenges
 Transitions
 Family conflict
 Academic pressures
 Onset of puberty and adolescence
 Sexual abuse
 Also found in well functioning families
Diagnosis
 Often suspected by friends, family
school
 Special investigations not needed
 Basic investigations
 Blood tests ecg weighing provide
opportunity for patient to return to
discuss results and probe for
psychological problems
Physical; risk assessment
 There is no safe cut off weight or BMI
 Death unusual where low weight maitained
purely by starvation
 Death more likely if weight fluctuates
grreately rather than being stable even if BMI
< 12
 Risk increased in patients that misuse
substances or purge frequently
Management
 Takes 5-6 years from diagnosis to recovery
 Up to 30% do not recover
 Hospital admission correlated with poor
outcome
 Patients admitted voluntarily do better than
those on compulsory admission
 Brief hospital admission at times of crises
associated with lower mortality
Management
Temporary acceptance of low
weigth
 Acceptance of low weight as long as it is




stable and regularly monitored
Patients/family take responsibility for re
feeding
Psychotherapeutic interventions
Separate dietetic advice
Weight gain is slow but avoids iatrogenic risks
Managment
Early refeeding in hospital
 Early refeeding in hospital
 Exposes patient to iatrogenic complications
such as infections
 Exposed to pro anorexia culture form other
patients
 Weight maintenance not as good as home
treatment
Psychotherapy
 Short term structured treatments such as
CBT do not work
 Long term wide ranging complex treatments
such using psychodynamic understanding,
systemic principles, and techniques borrowed
from motivational enhancement therapy and
dialectical behavioural therapy
Management
 Therapy involving whole family is superior
 Sessions involving family and patient
together give better family psychological
adjustment
 Weight gain greater when family seen
separately from patient
 Dynamically informed therapies both family
and individual produce the best results
Summary
 Anorexia has highest mortality of all




psychiatric disorders
Positive diagnosis of psychologically driven
weight loss
Short term treatments (CBT) don’t help
Focussed family work effective in adolescents
No drugs are effective