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Similar to Anorexia nervosa
Anorexia nervosa
- 1. ANOREXIA NERVOSA Bhavneet kaur B.SCNursing student
- 3. Definition • The termAnorexia Nervosa was first formulated in 1873 by Sir William Gul. The term is greek origin which means : A lack of desire to eat. • It is characterised by self induced weight loss of atleast 15% below the expected weight.
- 4. Eteology 1. Genetic causes-Among female siblings of patient with established anorexia nervosa, 6-10% suffers from the condition compared to the 10-12% found in general population of same age. A disturbance in Hypothalamus functions . 2. Social factors- Influences of mass media and beauty contests.
- 6. Cont.... 3. Individual psychologicalfactors – A disturbance of body image , a struggle for control and a sense of identity are important factors in causation of anorexia nervosa. 4. Causes within the family - Disturbance in family relationship , over protection , family members having an unusal interest in food and physical appearance.
- 7. Fear of fatness Pursuit of thinnes Dieting/ Overeating Weightloss Hormonal /physiological changes Depression and coginitive changes
- 8. Clinical features • Itoccurs much more often in females as compared to the males. The common age of onset is adolscence (13-19 yrs of age). • There is an intense fear of becoming obese. This fear doesnot decrease even if body become very thin and underweight. • There is often a body image disturbance. • There is refusal to maintain body weight .
- 10. Cont...... • Significant weightloss occur usually more than 25% of the original weight. • Amenorrhoea • Lanugo hair • Poor sexual adjustment with conflicts about being a women and fear of pregnancy. • Osteoporosis • Hyponatremia , hypokalemia • cavities
- 11. Cont... • Brain injury •Electrolyte imbalances • Leukopenia
- 12. COMPLICATIONS • Malnutrition ,dehydration , electrolyte imbalances . • Increased susceptibility to infection • Hypoalbuminemia • Life threatening cardiovascular complication
- 13. Diagnostic criteria • Refusalor inability to maintain body weight over a minimum normal weight. • Intense fear of gaining weight despite being underweight. • Disturbance in perception of body shape. • Abscence of three consecutive menstrual cycle. • CBC – Hb , platelet count • Cholesterol level , total protein level , serum sodium and serum potassium . • ECG reading
- 15. TREATMENT MODALITIES a) Shortterm treatment to encourage weight gain and correct nutritional deficiencies. b) Long term treatment aimed at maintaining the near normal weight achieved in short term treatment and preventing relapses.
- 16. Psychological therapies a) Behaviouraltherapy – are based on providing the positive reinforcement ( and at times negative reinforcement ) contingent on weight gain . A too rapid weight gain is not desirable or safe. The weight gain should not exceed 1.5-2 kg in a fortnight . As patient are usually unable to eat a large meal , especially in the initial part of treatment . Occasionally forceful Ryle’s tube feeding may be needed initially in resistent patient.
- 17. Cont..... b) Individual psychotherapy– this involve psychotherapy focused on coginitive behaviour therapy , psychodynamic principles or support measures. c) family therapy is also recommended.
- 18. PHARMACOTHERAPY a) Antipsychotics -chlorpromazine olanzopine Efficacy in improving weight gain . b) Antidepressants – fluoxetine clomipramine cyproheptadine : helps in inducing weight gain , decrease depressive symptoms , increase apetite. dose : 8-32mg/day
- 19. Nursing management Assessment a) Natureand episodes of eating b) Type of disorder( purging or non purging) c) Depressed mood d) Self induced vomiting e) Fasting or excessive excercise , erosion of tooth enamel f) Substance abuse or dependence g) Body mass index , electrolyte status , CBC h) Associated psychiatric disorder
- 20. examples : Nursingdiagnosis • Anxiety related to fear of weight gain evidenced by rituals associated with food preparation and eating. • Disturbed body image rlt to fear of weight gain evidenced by verbalization of being fat while being 30% below ideal weight. • Imbalanced nutrition : more than body requirements evidenced by 40% over IBW and sleep apnea.