د . حسين هليل وداعة
- Is the condition which effect any individual eating habit either as result of their
owing doing ( self-inflicting ) or as body reaction to consumption of food .
* eating disorder can range from mild mental anguish to life threating .it can affect
every day exercise .
Anorexia nervosa and bulimia nervosa
* are the most common eaten disorder with significant overlap between two together
AN&BN are estimated 5% - 7% of female in US .
her eaten disorder like :
ot
-
* rumination syndrome .
* compulsive overeating .
* selective eat disorder .
* binge eating disorder .
- cc by low body weight , intense to wish to be thin , in women amenorrhea " most
patient young women who have distorted body image believing themselves to be fat
even really severely underweight .
- most cases of AN begin in late adolescent and few after age of 30 yrs .
Epidemiology :
- the highest rate ------ among school girls and female university student account
about 1% - 2 %
gymnast
nearly all 95% patient are females from high social class in group such as
-
and ballet dancer
خبير الجمباز
د . حسين هليل وداعة
- excessive concerned with shape and weight .
- pursuit of thinness with consequence low body weight .
- diet and avoid carbohydrate .
- self-induced vomiting .
- excessive exercise and purging .
- being eating in some patient .
- amenorrhea .
- consequence of starvation .
* constipation .
* low blood pressure .
* brady-cardia and hypothermia .
- consequence of vomiting and laxatives abuse
* alkalosis and hypokalemia .
- amenorrhea is secondary to weightless
- low BP .
- sensitivity to cold .
- hypothermia .
- hypokalemia lead to epilepsy .
- cardiac arrhythmia lead to death .
د . حسين هليل وداعة
Etiology :
- combination of individual predisposition .
- social factors that encourage dieting .
- school children and female colleges student .
- low self-esteem and pre-occupation with their appearance .
- increase A.N among ballet and actors .
- aggression against predominate mothers .
Course and prognosis :
- A.N run in fluctuation course with period of remission
- 1\5 patient full recovery .
- other patient remaining severity .
- most patient reluctant to see psychiatric
- history of development disorder and presence pattern of control of eating disorder.
-MSE :
* depressive symptoms .
* personality disorder .
physical examination .
-
Distribution of body hair ( lanugo hair ) normal in AN and abnormal in pituitary
failure .
- sign of vitamin deficiency .
- sign of vomiting and purgative effect .
د . حسين هليل وداعة
- making good relation with patient .
- family should be informed about hazard of disease .
- gaining of adequate weight is first priority .
- simple supportive measure .
- admission to hospital if patient weight is dangerous ( less than 5%) and in case of
severe depression .
Hospital treatment :
- ideal body weight in comparism to length is necessary .
- daily diet at least 300 calories \ e meal .
- reassure patient that she can without loss of body weight and avoid vomiting .
- refers to episodes of uncontrolled and excessive eating .some time symtpoms of
BN similar is to AN .
me has two main component :
* BN syndro
1- bulimia 2- behavior intended to prevent weight gain
Usually --------------- * dietary resistance .
* self-induced vomiting .
* excessive exercise .
* abuse of purgative .
* the balance between these type of behavior such as patient usually of normal
weight .
* most patient are female and they have normal menses .
د . حسين هليل وداعة
* patient severely concerned of body weight .
* unlike AN patient with BN accept treat .
* episode predispose by stressful event .
* they extreme lack of control over eating that distinguish BN from AN and
enormous amount of food are consumes .
* at beginning of event eat episode patient feel happy than develop guilt .
- repeat vomiting lead to several potassium depletion us serious . lead to weakness
and arrhythmia and lead to renal damage and UTI
- tetany and epilepsy .
- teeth pitting by repeated vomiting .
- parotid gland enlargement .
* epidemiology *
- prevalence up to 10% of young women .
- more frequent in developed country .
- prognosis most patient persist for many years .
Treatment :
- assessment of B.W
- assessment of depression symptoms ( use TCA )
- most patient treated as out patient .
- cognitive behavior therapy by self-monitoring .
- avoid sudden emotional change
.
د . حسين هليل وداعة
Compulsive overeating ( Bing eating BE) :
- obsessive compulsive overeating is one of most common mental disorder that
related to obsessive compulsive disorder .
- consumed thousands of calories in one sitting . unlike BN food is not vomiting of
the body .
Epidemiology :
- compulsive overeating become obese .
- 2% of adult in USA develop BE .
- most common in young adult .
Etiology :
- high percent of depress among BE .
- BE patient indulge with alcoholism and other .
- impulsive behavior ( such are not thinking before acting out ) .
Clinical picture :
- patient difficult to discuss his problems .
- more health problems .
- difficult in sleeping at night .
- joint , muscle pain , headache .
- suicide thought .
- patient trying to hiding the fact of disease
د . حسين هليل وداعة