Wednesday, May 8, 2013


    Anorexia nervosa is a Greek term for loss of appetite. There are three aspects of anorexia nervosa.
    1.    Self-induced starvation to significant degree.    
    2.  Presence of medical signs of starvation.
   3. Morbid fear of fatness.
Above three features present for three months seal the diagnosis.
There is body image misperception in these youth. To achieve their goal they might reduce their food intake and may or may not indulge in purging behavior.
It is reported in around 3.5% of adolescents mostly occurring in teens with girls being 15 times more affected than boys. In professions such as models and ballet dances, its prevalence is greatest.
Causes of anorexia nervosa
Definite cause is not known to but a disturbance in endogenous opioid production and neurotransmitter imbalance is known to play role. Extra emphasis on thinness in society is also implicated.
Medical complications associated with anorexia nervosa
     1.    Cardiac- loss of heart muscle mass, arrhythmia, bradycardia or sudden death.
     2.    Reproductive- amenorrhea, sterlity.
     3.    Skin- edema
     4.    Blood- decrease in WBC
     5.    Dental- caries
     6.   Skeletal- osteoporosis
     7.     Metabolic- electrolyte abnormalities
    8.  Cachexia- loss of muscle mass and fat. 
    9.  Digestive- bloating, constipation and abdominal pain.
       10.   Neuropsychiatric- Depression, Seizures. 
Course of illness
An untreated illness has waxing and waning course and outcome ranging from complete recovery to death.

Treatment of anorexia nervosa

Patients who are weighing 20% less than the expected weight are recommended hospitalization for around 1 month but who are below 30% require prolonged hospitalization to around 6 months.
During hospitalizations patient is weighed daily. Medical complications are corrected and patient is force fed according to calories calculated. Drugs such as fluoxetine and amitriptyline are beneficial. Cyproheptadine is another useful drug for regaining weight.
Cognitive behavioral therapy may be useful in many cases.
Wishing you a very healthy and long life
Dr Hitesh Sharma
MBBS, MD (Psychiatry)

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