神经性贪食症11例临床分析

目的：了解神经性贪食症（ＢＮ）的临床情况。方法：对１１例神经性贪食症的临床资料进行分析。结果：发现发病前大多有厌食症状或神经性厌食症。结论：认为ＢＮ为持久性神经性厌食症的延续,社会文化因素在发病中起重要作用。应以心理治疗为主。     

认知行为疗法在进食障碍治疗中的应用

对认知行为治疗在进食障碍患者中的应用及认知行为治疗发展的方向进行了综述。     

进食障碍基于家庭的治疗北大核心CSCD

进食障碍(eating disorders,ED)主要指以反常的进食行为和心理紊乱为特征,并伴发显著体重改变和(或)生理功能紊乱的一组慢性难治性精神障碍[1]。其主要包括神经性厌食症(anorexia nervosa,AN)、神经性贪食症(bulimia nervosa,BN)和暴食障碍(binge eating disorders,BED)[2]。进食障碍好发于青少年和年轻女性[1-2],其中AN的发病年龄在13~20岁,发病的高峰年龄在13~14岁和17~18岁;BN的发病年龄在12~35岁,平均为18岁。该病呈现高病死率、高共病率、高疾病负担[3],且有证据显示我国近年来进食障碍患者数量有增多的趋势[4],因此寻求循证有效的进食障碍治疗方法是当务之急。     

五羟色胺与进食障碍

本文对中枢五羟色胺(5-HT)与进食障碍关系的研究进展作一综述。     

认知疗法治疗神经性贪食症1例

1病例.患者女性,17岁,半年前目睹其姨去世前,无法进食而饿死,心里很难过.自此,每餐多吃一点,意以替姨进食;并因恋爱而烦恼,进食量明显增加,每日达10次以上,每次2.5～5kg.吃不下则自己采取引吐-进食-引吐-再进食.由于呕吐频繁,导致严重营养不良,体质量(体重)由70 kg减轻至40kg.闭经3个月,明显消瘦,不能上学.入院检查:体质量35 kg,消瘦.精神检查:意识清,有体象障碍,认为自己的身体并不瘦,对肥胖恐惧.认为自己的胃有问题,大量进食就愉快,不进食就烦.诊断为神经性贪食症.     

重型脑外伤引起的神经性贪食症（附7例临床分析）

报道７例重型颅脑外伤后神经性贪食症患者，主要为脑外伤恢复期出现贪食、暴食，体重增加，情绪抑郁，自发诱吐等。颅脑外伤急性期的格拉斯哥昏迷计分５～９分，平均７分。ＣＴ检查：额颞部脑损伤为主，５例合并颅内血肿。脑电图轻度异常２例。７例患者经药物及综合心理治疗后痊愈或好转。并结合国内外有关文献对本病的诊断、临床特征、病因、治疗、预后及与抑郁症的关系等问题进行了讨论。     

喂食及进食障碍的核心特征与治疗

喂食及进食障碍的代表疾病主要包括神经性厌食、神经性贪食、暴食障碍等,该组障碍的共同特征是进食或与进食相关行为的持续性紊乱。神经性厌食的核心特征是持续限制能量摄取,强烈害怕体重增加,对自我体重的感知紊乱。神经性贪食的核心特征是反复发作的暴食,因为对体重的不恰当认知而出现的反复性不健康的代偿行为。暴食障碍的核心特征是短期内大量进食,难以控制。喂食及进食障碍的治疗目标是帮助患者恢复正常的体重,通过认知行为疗法(CBT)、家庭治疗或团体治疗帮助个体调整对体型、体重和美的认知,也可给予抗抑郁药物、小剂量抗精神分裂药物或心境稳定剂进行对症治疗。     

神经性贪食症综合治疗1例

1病例 患者女性,22岁,未婚,大专文化.烦心时以暴食排忧,反复发作,不能自控5年余,由母亲陪伴来咨询治疗.     

Intensive psychiatric care of patients with psychogenic eating disorders]

The authors summarize their therapeutic results in anorexia nervosa achieved at the unit of specialized care for eating disorders at the Psychiatric Clinic of the First Medical Faculty, Charles University, Prague. They find that applications for hospitalization of these patients have a rising trend and that in recent years in the unit mainly patients with severe forms of these diseases are admitted. During the past 7 years in the unit a total of 147 patients were hospitalized. By comprehensive regime treatment 84% of the patients with bulimia nervosa. As to basic symptoms, in bulimia nervosa the results were achieved in vomiting and bulimic attacks and in anorexia nervosa as regards appetite, hunger and general attitude to food. Finally the authors summarize the advantages of the unit specialized care for psychogenic eating disorders.     

阴性精神症状自身免疫性脑炎患者的临床分析

目的 研究阴性精神症状自身免疫性脑炎(AE)患者的临床特征,提高对疾病的认识,以优化其治疗。方法 收集2018年1月至2021年12月武汉大学人民医院神经内科收治的40例确诊为AE的患者,其中4例无精神行为异常。精神行为异常表现为胡言乱语、幻觉、容易激惹、攻击行为和性格改变等。将有精神行为异常的36例患者分为阴性精神症状组（N组,9例）和非阴性精神症状组（P组,27例）。比较2组患者的临床表现、实验室检查、影像学特征、治疗及预后等指标。结果 40例患者中抗NMDAR脑炎最多见,为32例(80%);抗LGI1脑炎4例(10%);抗GABABR脑炎2例(5%);抗CASPR2脑炎1例(2.5%);抗NMDAR脑炎合并抗MOG脑炎抗体阳性1例(2.5%)。40例AE患者的常见临床表现有精神行为异常36例(90%)、癫痫发作20例(50%)、运动功能障碍4例(10%)、认知障碍7例(17.5%)、言语障碍6例(15%)、意识障碍8例(20%)等。40例AE患者均接受了一线免疫治疗,单用激素冲击治疗23例(57.5%),激素冲击联合静脉注射免疫球蛋白(IVIg)治疗15例(37.5%),激素+IVIg+血浆置换联合治疗2例(5%)。N组较少出现前驱头痛(P<0.05)。N组与P组在白细胞及中性粒细胞计数方面差异存在统计学意义(P<0.05)。N组9例患者预后均为良好;P组22例患者(81.5%)预后良好,5例预后不佳。结论 自身免疫性脑炎可表现出复杂多样的精神症状,应在诊断的早期进行阴性精神症状筛查,并尽早制定个体化治疗方案,以期改善预后。 [国际神经病学神经外科学杂志, 2022, 49(6): 1-6]     

DSM-III-R personality disorders in patients with eating disorders

The authors conducted a systematic examination of DSM-III-R personality disorders among 35 patients with eating disorders. Fifty-seven percent of the patients met the criteria for at least one axis II diagnosis; borderline, self-defeating, and avoidant were the most frequently assigned personality disorders. Forty percent of the patients were given two or more diagnoses, and 17% of the patients met criteria for five to seven diagnoses. No differences were found between patients with anorexia nervosa, anorexia and bulimia nervosa, and bulimia nervosa in the distribution of diagnoses or the frequency with which individual criteria (traits) were assigned.     

Dependency and eating disorders in female psychiatric inpatients

Research indicates that oral dependent and eating-disordered individuals have similar personality traits, attitudes, and behaviors, suggesting that dependency may be a factor in the dynamics of anorexia and bulimia. To investigate this issue, we compared the proportions of dependent and food-related percepts in the Rorschach protocols of matched samples of eating-disordered (N = 16), obese (N = 18), and non-eating-disordered, normal-weight female psychiatric inpatients (N = 17). Eating-disordered patients reported significantly more dependent Rorschach imagery than did obese or normal-weight control patients, but no difference in the proportion of food-related imagery was found among the three groups. These results support the hypothesis that unresolved dependency issues underlie anorexia and bulimia.     

Body dissatisfaction and suicidal ideation among psychiatric inpatients with eating disorders

The current study the relationship between eating disorders (EDs) and suicidal ideation and suicide attempt in adult inpatients. In particular, the present study investigated one potential mechanism, body dissatisfaction (BD), which may contribute to increased risk for suicide in adult ED patients. A sample of 432 psychiatric inpatients ranging from 18 to 65 years of age participated in the current study. Findings indicated that patients who have higher levels of BD also had higher levels of passive and active suicidal ideation and previous suicide attempts. Higher levels of BD were also related to increased suicidal ideation after controlling for depression and emotion dysregulation. Although additional risk factors for suicide should be investigated in adults with EDs, this study provides evidence regarding the relationship between BD and risk for suicide ideation and attempt.     

Sexual abuse in patients with eating disorders

The incidence of sexual abuse in eating disorder patients appears significant. Fifty percent of both our anorectic and bulimic patients reported a history of sexual abuse while only 28% of a non-anorexic, non-bulimic control population reported similar problems (p less than 0.01). Several patterns of behavior seemed related to previous sexual assault. In one, the eating disorder was used to change the body image of the patient and therefore to provide a defense to future abuse. Other behaviors which occurred more specifically in bulimic women dealt with a projection of repressed anger toward male authority figures. Forty six percent of the bulimic women seen in our study exhibited some promiscuous behavior, using sex either as a gauge of their own self worth or as a means of punishing men. It is essential that sexual issues be addressed early in the treatment of patients with eating disorders. Disclosure is often difficult particularly in outpatient situations where the patient lives at home with her family. It usually does not occur in such cases until the later stages of therapy, or until the patient is hospitalized. Rape is the exception since our data suggests that it is usually revealed early in the course of treatment (p less than 0.001). Once disclosure occurs, a dramatic change is usually seen in the patient and treatment becomes more effective. As the patient deals with the issues of sexual abuse, they no longer need to deny their sexuality or punish themselves or others. Issues of guilt, depression, repressed anger, low self-esteem, social isolation and inadequacy are important and need to be addressed during the course of therapy with sexually abused patients.