醫(yī)學英語課件資料：神經(jīng)性厭食癥

1、Anorexia nervosaFrameworkPsychiatristPart 1 IntroductionDefinitionEpidemiologyCausesPart 2 DiagnosisDiagnostic CriteriaSubtypesAssociated FeaturesDifferential DiagnosisPart 3 TreatmentPrincipleRestoring weightPsychotherapyPart 4 PrognosisOutcomesPrognostic factorsComplicationsFamily supportPreventio

2、nPart 1IntroductionDefinitionEpidemiologyCausesPart 1Anorexia nervosa is an .“eating disorder characterized by a low weight, fear of gaining weight, a strong desire to be thin, and food restriction.”. .“Many people with anorexia see themselves as overweight even though they are underweight.”. .“Some

3、 will exercise excessively, force themselves to vomit, or use laxatives to produce weight loss.”. DefinitionPart 1DefinitionBiologyPsychologySociologyPhysiological disordersPsychological factorsPart 1 DefinitionPart 1DefinitionPart 10.9%4.3% of women and 0.2%0.3% of men in Western countriesOverall i

4、ncident rate remained stable during the decadesAn increase in the high risk-group of 1519-year-old girls EpidemiologyPart 1CausesBiological factorsGeneticsNeuroendocrine dysregulationMicroorganism infectionPsychological factorsChildhood sexual abuseDysfunctional familiesSociological factorsInternali

5、zation of body idealsSocial pressure on professionsBody dissatisfactionDiagnosisPart 2Restriction of energy intake relative to requirements, leading to a significantly low body weight Intense fear of gaining weight, or persistent behavior that interferes with weight gainDistorted experience and sign

6、ificance of body weight and shapeDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)Diagnostic CriteriaPart 2Criterion A: significantly low weight Part 2Usually not alleviated by weight lossYounger individuals may not recognize or acknowledge a fear of weight gain.Criterion

7、B: intense fear of becoming fatPart 2“All I could think about was what a pig I was for eating that pizza, and how Ill never lose the 10 pounds I need to lose to fit into size 2 jeans.”Feeling globally overweight Concerning certain body parts are “too fat”Weight loss: an impressive achievementWeight

8、gain: an unacceptable failure of self-controlCriterion C: distorted experience and significance of body weight and shapePart 2Restricting type (限制型)Weight loss through dieting, fasting, and/or excessive exercise (last 3 months)Binge-eating/purging type (暴食/導(dǎo)瀉型)Engaged in recurrent episodes of binge

9、eating or purging behaviorSubtypesPart 2Binge-eating/purging type Part 2Pursuit of thinnessRestrictive dietingDeprivation & hungerBingePurgingGuilt/shamePhysiological disturbances associated with malnutritionAmenorrhea (閉經(jīng)) Vital sign abnormalities Depressive signs and symptoms when seriously underw

10、eightdepressed moodsocial withdrawalIrritabilityAssociated Features Supporting DiagnosisPart 2Medical conditionse.g. , gastrointestinal disease, hyperthyroidism, occult malignancies, AIDSMajor depressive disorder (重度抑郁)Bulimia nervosa (神經(jīng)性暴食癥)Differential DiagnosisPart 2Part 3TreatmentPart 3Principl

11、eSooner rather than laterThree areasRestore the person to a healthy weightTreat the psychological disorders related to the illnessReduce or eliminate the incentivePart 3Gain weightStart slowly and gradually accelerateModify the disordered dietary patterns Nutrient intake increase the amount and dive

12、rsity in food selection Higher caloric intake than general population energy inefficient Severely malnourishedvitals, electrolytes, cardiac functionsPart 3PsychotherapyChange their opinions and behaviorsCure other psychological problemsdepressed moodPart 3PsychotherapyfoundationHighly value the thin

13、nessMaintain absolute control over their behaviorsResist to therapists attempts Win and maintain the patients trust and participationPart 3Psychotherapyindividual therapyEnhance patients motivation for treatmentacknowledge and explore rather than fight the patients ambivalence about recovery Rewards

14、 on persons gaining weight Relaxation techniquesPart 3Psychotherapyfamily therapyMaudsley model 1. harness the strengths of the family 2. deal with the familys stress Three phases I. Restore weight II. Return the control over eating to the child III. Establish a healthy adolescent identity Part 3Psy

15、chotherapy pharmacological interventionsMedicationsantidepressants, antipsychotics, or mood stabilizersHelp resolve the mood and anxiety symptomsNot effective in helping gain weight or not relapsePart 4PrognosisOutcomesPrognostic factorsComplicationsFamily supportPrevention PrognosisPart 4Complete r

16、ecovery50%Incomplete recovery2030%Mortality20%Serious complicationsSuicide riskDuration For women 7 yearsFor men 3 years OutcomesPart 4DeathIncomplete recoveryFull recoveryPrognostic factorsPart 4Treatment durationDisorder durationOnset ageRelationships with familiesOther psychiatric symptomsFavorab

17、leprognosisPoorprognosisPredict recovery vs. chronicity For adolescents and children with ANGrowth retardation ComplicationsPart 4Height gainSever weight lossChronic malnutritionNormal intakePreserved height potentialNot significant duration and severityDelayed bone ageHypogonadism For adolescents and children with ANPubertal delay ComplicationsPart 4ANSuppression of gonadotrophinsPubertal delayPre-pubertal onsetUsually fully reversible Other Peak bone mass reductionHepatic diseaseKidney diseaseHeart diseaseNeurological disordersImpor