Anorexia nervosa

Introduction Anorexia nervosa, also known as anorexia nervosa, is a mental eating disorder characterized by deliberate dieting and weight loss. Anorexia nervosa (AN) refers to an eating disorder in which an individual intentionally causes and maintains a body weight that is significantly lower than the normal standard by means of dieting, and belongs to the category of "physiological disorders related to psychological factors" in the psychiatric field. The term anonexia nervosa was first created in 1874. It is also known as a nervous appetite loss. It is characterized by anorexia with long-term unexplained and significant weight loss. The age of onset is over 10 years old. Female adolescents are more common. If left untreated, it can lead to severe malnutrition and extreme exhaustion, affecting the physical and mental health and development of adolescents.

Cause

The cause of mental disorder, which has not yet been fully identified, is characterized by long-term excessive dieting or refusal to maintain a slim body, resulting in weight loss, nutritional deficiencies, metabolic and endocrine dysfunction, and life-threatening in severe cases. More common in adolescents, the prevalence of women is much higher than that of men. Rehabilitation can be achieved with appropriate treatment. It is clinically differentiated from weight loss caused by physical illness. Because the patient does not lack appetite, not anorexia, but actively refuses to eat, the term anorexia is not consistent. The frequency of the disease varies from place to place, and the incidence rate is higher in Western industrialized countries. The average annual incidence rate in the 1970s was 0.37 to 1.6 per 100,000 people. Longitudinal surveys show that the incidence has increased in the past 20 to 30 years. Most women, males account for only 4 to 6% of the total number of cases. Among girls aged 12 to 18 years in British boarding schools, the prevalence of anorexia nervosa is 0.5%. The first onset age is usually between 10 and 30 years old, and about 80% of cases start between 13 and 20 years old. Surveys in the United States, Britain and other countries have shown that the incidence of this disease is higher in the upper and middle class families with economic prosperity and in the slim-skinned occupations like ballet dancers. There is currently no survey data on epidemics in China.

The cause has not yet been fully clarified. The patient's nervous system and digestive system and endocrine system have no primary changes in the body. Whether there is a molecular level change in the central nervous system and the feeding-related part (hypothalamus), or whether it is completely a psychogenic disorder, is still not certain. At present, it is believed that the onset of anorexia nervosa is the result of a combination of biological susceptibility and social-psychological factors. Biological factors play a role in the pathogenesis of social factors, psychological factors, and social effects. The evidence supporting the biological prime hypothesis is mainly:

* 100% of female patients have menstrual cessation, and about 20% of cases have menstrual cessation and central thermoregulation during the early stage of the disease, and there is a primary dysfunction in the hypothalamus.

* There is circumstantial evidence that the dopamine receptor in the hypothalamus has an inhibitory feedback control defect in this disease, leading to an increase in the activity of the catecholamine neurotransmitters.

* The frequency of anorexia nervosa and Turner's Syndrome (XO Syndrome) and genitourinary malformation are far more frequent than the frequency of opportunity. It is speculated that chromosomal aberrations may increase the susceptibility of anorexia nervosa.

an examination

Related inspection

Gastric filling and emptying function check gastroscope

At present, foreign scholars still follow the six criteria for diagnosis by Feighner in 1972, and believe that the age of onset is about 10 to 30 years old. According to the characteristics of anorexia nervosa cases in China, the diagnosis of juvenile anorexia nervosa should be: 1 age 10 years and older. 2 Due to mental stimulation or learning, work stress is too large and the disease. 3 weight loss of more than 20% or the same age height standard weight loss of more than 15%. 4 with anorexia and weight loss caused by serious diseases and mental illness. 5 to rule out anorexic diseases caused by organic diseases and mental illness. 6 A small number of patients maintain their slimness as a beauty, lest they gain weight and consciously control their diet, preferring to be hungry and thin.

Patients with anorexia nervosa should be hospitalized for further examination. For detailed medical history, secondary anorexia caused by organic disease, liver, kidney, gastrointestinal examination, and saddle body image and/or brain CT examination must be excluded. Attention to pituitary cachexia is essential. Inpatients should also be examined for endocrine gland function, such as pituitary thyroid function, adrenal function, and growth hormone secretion.

Differential diagnosis

Differential diagnosis

Physiological anorexia: Physiological anorexia is a condition in which the baby does not eat milk when the baby is 3 to 4 months old. The temporary anorexia of the baby is called the physiological anorexia period.

Alternate eclipse anorexia: eclipse anorexia is a dietary dysfunction that is extremely harmful to health. It is not enough for patients with this disease to receive medication alone, but also for psychotherapy. Cyclical spontaneous refusal and binge drinking - vomiting (rushing in and out) can have serious physiological effects.

Summer anorexia: Anorexia in summer means that the child's appetite is weak and his appetite does not open. Even the normal meals that he usually likes don't want to eat, and the child's whole body has no abnormal lesions.

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