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[[Category: Eating Disorders]]
 
[[Category: Eating Disorders]]
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Revision as of 21:30, 4 September 2015

Introduction

Anorexia nervosa (AN) was first described in 1689 by Richard Morton, who called it nervous consumption. In 1870's Sir William Gull in England coined the terms anorexia nervosa while Charles Lasegue in France described anorexia hysterique.

Epidemiology

  • Prevalence among US female adolescents is 0.5% and 1-2% among adult females.
  • F:M ratio is 10:1.
  • Mortality in patients with AN is 5-7%, and about 5% per decade of life; Death is most often secondary to medical complications of starvation (50%) or suicide (50%).(2)

Diagnosis

General approach

  • All children and adolescents should be screened for eating disorders; this involves history/questionnaires and tracking of height and weight. (1)
  • Those who screen positive, undergo a diagnostic psychiatric and medical evaluation.
  • Severe acute physical signs and medical complications need to be treated immediately.

Diagnostic criteria

Essential features of DSM-5 diagnosis are:

  • (A)Persistent restriction of energy intake
    • This generally means BMI<17 for adults (however, those with BMI>17 may have mild AN)
    • In children, BMI below the 10th percentile is consistent with AN diagnosis (1)
  • (B) Fear of become fat or persistent behaviors that prevent weight gain
  • (C) Disturbance of body image

The DSM-IV requirement for amenorrhea was removed in DSM-5.

Differential diagnosis

History and physical exam are essential for ruling out medical causes of anorexia (poor appetite) and weight loss. Some examples include: chronic infection, hyperthyroidism, Addison’s disease, IBD, connective tissue disorders, cystic fibrosis, peptic ulcer disease, disease of the esophagus or small intestine, celiac disease, diarrhea, diabetes, and occult malignancies.(1)

Co-morbidities

Common co-morbid conditions include depression, social anxiety, separation anxiety, OCD, GAD, and substance abuse, and avoidant, dependent, obsessive-compulsive, or passive-aggressive personality disorders.

Treatment principles

  • Outpatient treatment first: "Psychiatric hospitalization, day/partial programs, and residential programs for eating disorders should be considered only when outpatient interventions have been unsuccessful or are unavailable." (1)
    • Treatment should involve a multidisciplinary team, uncommon in outpatient setting.
  • Family-based treatment (FBT), a.k.a. Maudsley Family Therapy is effective and superior to comparison individual therapies for AN.
    • Individual therapies such as adolescent-focused therapy (AFT) and CBT are fairly effective.
  • Medications are used only for co-morbid conditions or refractory cases (1)
    • Use of SSRIs for AN had not been studied in adolescents (mostly negative studies in adults)
    • Atypical antipsychotics have not shown clear benefit in small RCTs of risperdone, quetiapine, and olanzapine.

References

1. Lock, J. et.al. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Eating Disorders. J Am Acad Child Adolesc Psychiatry 2015;54(5):412–425

2. Arcelus J, et. al. Mortality rates in patients with anorexia nervosa and other eating disorders. Arch Gen Psychiatry. 2011; 68:724-731

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