Health Awareness blog

Anorexia nervosa is particularly characteristic of young women. This type of eating disorder has been diagnosed since 17^th century. In 1990, it has been a salutary thought that it is more dangerous to be a fashion model in a ballet school rather than working at a coal miner. This reflects the high level of mortality and morbidity in people having anorexia nervosa in comparison with people with other types of psychiatric condition.

Prevalence in females: males = 20:1 and usually associated with depression and bulimia at later age. Prevalence of bulimia and anorexia is about 5-10% of young women and the risk increase with background history of addictive disorders.

Diagnostic criteria:

• Refusal to maintain body weight at or minimally normal ideal weight for a person by her/his sex, age and height (e.g.: weight loss or failure to make expected weight gain during period of growth, leading to body weight <85% expected)
• Regardless the fact that he/she is underweight, he/she is still having the intense fear of gaining weight or becoming fat.
• There is disturbance in perception of body weight or shape on self evaluation, denial of the seriousness of the current low body weight
• Amenorrhea (no menstruation) in young women that previously has menses (post menarchal)

Signs and symptoms:

• Weight loss of 25% of body weight (or more)
• Onset usually before 17 years old
• Laxative use
• Diuretic use
• Excessive exercising
• Amenorrhea – develop early when <90% ideal body weight (IBW=100lb@60 inch, +5lb for each inch after that)
• Always think self too fat (no matter how thin he/she is)
• Secretive eating
• Lanugo hair maybe found (usually only seen in babies)
• Self appearance is thin and sometimes chacectic

Investigations:

• FBC – to look for evidence of anemia
• BUSE – to look for electrolyte imbalance à hypokalemia (low potassium), hypophosphatemia (low phosphate). In laxative use, the result usually normal anion gap acidosis.
• Serum amylase – usually elevated, sometimes due to pancreatitis but most of the times due to salivary origin (lipase and pancreatic fraction is normal)
• ECG or EKG at some regular interval to detect myocardiopathy or long QT syndrome

Complications:

• Suicide (in 2-5% of cases)
• Depression
• Osteoporosis or bone loss
• Cardiac heart failure ( due to prolonged starvation)
• Addison’s disease need to be ruled out
• 50% of all cases may progress to chronic bulimia
• 9% mortality

Treatment:

• The only effective treatment is behavioral therapy (either inpatient or outpatient)
• Calcium and vitamin D supplement to prevent osteoporosis
• Periactin
• Consider leptin injections for amenorrhea

Reference:

•  
  1. Quick Reference Cards by Medical Protection Society. 2001.
  2. The Little Black Book of primary Care. Daniel K. Onion. 5^th edition. 2006.
  3. Psychology and sociology applied to medicine. Churchill Livingston. Mike Porter et al, 1999.

Bulimia nervosa is a type of eating disorder characterized by self induced vomiting. This type of eating disorder commonly associated with anorexia. The affected persons often use emetine or other medications to help induce vomiting. Females are more common than males with the ratio of 20:1 and high prevalence in young women and college women. Study has done and noted 1/3 of the sufferers have background history of sexual abuse during childhood.

Diagnostic criteria:

• Recurrent episode of binge eating
• Recurrent inappropriate compensatory behavior to prevent weight gain
• Binge eating and inappropriate compensatory behaviors occurring, on average, at least twice weekly for 3 months
• Self evaluation in duly influenced by body shape and weight
• The disturbance does not occur exclusively during episodes of anorexia nervosa

Binge eating is characterized by:

• Eating in a short period of time (e.g.: 2 hours) an amount of food larger than most individuals would eat during a similar period of time and under similar circumstances
• A sense of lack of control over eating(e.g.: amount and type of food)

Pathophysiology:

Diminished cholecystokinin production causes decreased satiety and CNS (central nervous system) serotonin.

Sign and symptoms:

· Onset usually a bit later than anorexia

· Compulsive eating binges usually followed by anxiety and guilt, which then lead to purging

· Callus on back of hand usually can be seen. It developed after frequent emesis induction.

· Dental caries (from gastric fluids on teeth)

· Enlarged salivary glands

· The affected person usually appears thin and normal weight

· Postural blood pressure drops

Investigations:

• FBC – to look for evidence of anemia
• BUSE – to look for electrolyte imbalance à hypokalemia (low potassium), high HCO3 (high bicarbonate). In laxative use, the result usually normal anion gap acidosis.
• Serum amylase – usually elevated, sometimes due to pancreatitis but most of the times due to salivary origin (lipase and pancreatic fraction is normal)
• Urine emetine levels
• Urine qualitative ipecac
• ECG or EKG at some regular interval

Complications:

• Cardiac heart failure (from starvation)
• Ipecac myocardiopathy and myopathy
• Aspiration pneumonia (lung infection)
• Mallory-Weiss tears
• Hypokalemia (low potassium levels)
• Sudden death (due to long QT syndrome)

Treatment:

· Rehydration

· Correct the electrolytes imbalance

· Give calcium and vitamin D supplement to prevent osteoporosis

· Fluoxetine (Prozac) 20mg – 60mg orally 4 times/day

· Psychotherapy (i.e.; cognitive behavioural therapy)

Reference:
1.Quick Reference Cards by Medical Protection Society. 2001.
2.The Little Black Book of primary Care. Daniel K. Onion. 5^th edition.