emotional anorexia
Introduction
Introduction Anorexia nervosa, also known as anorexia nervosa, is referred to as anorexia. It is a psychophysiological disorder in which the patient's own intentionally caused weight loss is significantly below the normal physiological standard weight and is strongly maintained.
Cause
Cause
Anorexia nervosa has not yet been clarified, and there are many hypotheses. At present, the more consistent view is that biological, psychological and social factors play a certain role in the pathogenesis of this disease. Among the compatriots, the same patients have 6% to 10%, which is much higher than the expected prevalence of the population. Explain that genetics plays a certain role in the occurrence of this disease. Some thermoregulatory disorders and disorders suggest that thalamic damage is the biological basis of the disease. There are physical obstacles in this disease, and the formation of psychological development is related to the following factors: 1. There are diets in infants and young children; 2. Too much attention to diet; 3. The development of self-identification in the family. Some people think that anorexia is a period of regression. Performance is an avoidance of adolescent mood.
Examine
an examination
Related inspection
White blood cell classification, electroencephalogram, brain CT examination, electrocardiogram
Laboratory: Blood biochemical changes in AN, and BN changes are small.
1. Anemia, leukopenia and bone marrow have different degrees of inhibition. Decreased fibrin, hypokalemia and dyslipidemia. Part of AN IgG, IgM decreased.
2. Vasopressin is elevated in both plasma and cerebrospinal fluid. Plasma zinc and calcium are reduced, and zinc and calcium are produced. Iron power is reduced, but serum iron. Serum Amylase is elevated and BN is more common than AN.
3. Endocrine hormones and functional tests in AN and BN, there are also 1 hot spot:
1 need to confirm the function of the hypothalamic nerve-pituitary axis;
2 In the AN and BN population with amenorrhea, it is necessary to confirm the presence or absence of primary dysfunction of each target gland. About half of the AN is accompanied by secondary amenorrhea and episodic polyphagia. With the rapid decline of body weight, the pituitary exogenous LHRH The reaction was abnormal and the hypothalamus did not respond to the clomiphene test. When the body weight increases, the above reaction is often reversed. The reserve function of the pituitary gland is seen with a small amount of LHRH. In the AN, the hypothalamus is not sufficient for the expression of LHRH.
Auxiliary:
Electrocardiogram
It can be seen that heart rate is slowed down, low voltage, QT is prolonged, ST segment is non-specifically changed, U wave and arrhythmia appear.
2.X line
Osteoporosis and kidney stones can be found.
3. EEG
Some ANs have seizures and present abnormal EEG. EEG is abnormal after eating. Some people think that hunger causes a decrease in specific amino acids in the blood, and these amino acids are the necessary neurotransmitters to maintain brain function. In addition, starvation causes deficiency of trace elements such as zinc, copper, selenium, and magnesium, and functions of enzymes and hormones in the brain. Zinc deficiency is very similar to AN, and it also shows anorexia, thick pronunciation, and depression.
4. Imaging
There were no hypothalamic and pituitary space-occupying lesions in the head CT and MRI. There may be brain atrophy and enlarged ventricles.
1. The diagnostic criteria of AN
(1) Maintaining a body weight higher than the lower limit of the same age, the same height and adolescents, resulting in a body weight lower than 85% of the expected body weight.
(2) Low weight, still afraid of gaining weight and getting fat.
(3) Self-image obstacles, so that judgment errors (skinny, still considered too fat).
(4) Secondary amenorrhea, that is, not coming for three consecutive months.
Some people in China think that women aged 25 years; anorexia, daily intake <150g and weight loss below 80% of standard weight; accompanied by malnutrition, without medical and psychiatric diseases, should have AN, AN can be divided into constraints Type and bulimia removal type.
2.BN diagnostic criteria
(1) Reversible eating, that is, the amount of food consumed in a fixed amount is far more than the amount of food consumed by the same person; the type of eating and the amount of food consumed during the attack; and it is impossible to stop eating by itself.
(2) Repeated use of improper methods to prevent weight gain (such as vomiting, laxatives, diuretics, enema, diet pills and intentional fasting or excessive exercise).
(3) On average, at least 2 episodes of bulimia and improper removal of stomach contents per week, for more than 3 consecutive times.
(4) Self-image obstacles.
(5) In the absence of AN, there is no BN performance.
BN is divided into clear and non-clear. The former applies a method to remove stomach contents; the latter uses hunger or excessive exercise to eliminate the consequences of polyphagia. If the body weight falls below 85% of the expected body weight, it should belong to the bulimia removal type of AN.
Diagnosis
Differential diagnosis
Differential diagnosis of emotional anorexia:
1, summer anorexia: summer anorexia, refers to the child's loss of appetite, appetite does not open, even the normal meals that you usually like to eat do not want to eat, and the child's whole body organs have no abnormal lesions.
2, physiological anorexia: physiological anorexia is the situation when the baby does not eat milk from March to April, the baby's temporary anorexia is called "physiological anorexia period."
3, anorexia nervosa: anorexia nervosa, also known as anorexia nervosa, is a mental eating disorder, characterized by deliberate dieting and weight loss .
