神经性厌食症15例临床分析

神经性厌食症１５例临床分析杨勇神经性厌食症系心理因素所致的进食障碍。作者于１９９３年３月～１９９６年８月期间在门诊收集符合ＣＣＭＤ—２诊断标准的神经性厌食症女性患者１５例，现就其临床资料报告如下。１临床资料１．１一般资料本组１５例均为女性，年龄１４～...     

神经性厌食症的心理治疗

目的 神经性厌食症的治疗目前仍是一个挑战,单单药物治疗的作用有限,因此成功的治疗往往需要在不同阶段介入心理治疗.本文从神经性厌食症的认知行为治疗、心理教育、人际关系心理治疗、自助技术、家庭治疗和聚焦式心理治疗等方面的研究进展进行综述.     

神经性厌食症的处理

在神经性厌食症 (下称厌食症 )病人中 ,认知行为治疗常较药物治疗更重要 ,因为没有一种药物治疗对厌食本身肯定有效。1　认知行为治疗1 .1　第 1阶段1 .1 .1　改善治疗合作性 :很多病人否认有病 ,一些家属甚至也这样认为。医生应解释厌食、贪食、引吐和导泻的后果 ,使他们意识到疾病的存在 [1]。1.1 .2　恢复进食过程 :严重饥饿病人一开始就恢复正常饮食 ,会引起诸多并发症。故恢复饮食应有一过程 ,住院病人应先予 1 2 0 0～ 1 50 0千卡 /日的食物 ,以后每 4～ 5天增加 50 0千卡能量。门诊病人恢复饮食应更平缓 ,可先予 80 0～ 1 2 0 0千卡 …     

神经性厌食症的治疗进展

神经性厌食症(AN)是一种慢性进食障碍,目前临床治疗尚无特效方法。本文通过引用新近研究结果,从心理治疗、药物治疗和手术治疗三个方面,对AN的治疗方法做一归纳总结,提出目前对AN的研究不足之处并对未来研究前景进行展望。     

神经性厌食症与家庭治疗研究

本文从神经性厌食症的临床意义、流行学、与家庭系统的关系、对家庭的影响及神经性厌食症患者的家庭特征等方面进行总结和讨论。     

综合性心理治疗神经性厌食症1例

目的 对1例22岁神经性厌食症的治疗。方法 行综合性心理治疗,具体方法：①支持性心理治疗,②认知行为疗法,③AN行为矫正治疗观察记录表,④操作性行为疗法⑤暗示疗法⑥家庭治疗。结果 治疗4月余,病人摄食恢复正常,体重由原来的37kg增至47kg,月经已重新来潮,治疗达到预期效果,随访2年症状未再现。结论 对AN的治疗,综合性心理治疗是一种行之有效的治疗模式。     

神经性厌食症临床症状的诊断与治疗

本病由Gull(1872)首先描述:以厌食、消瘦、活动过多、否认有病拒绝就医为主要症状,病因未明。女性患者为男性的10～20倍①。发病年龄大多为15～23岁。国外发病率为4.6‰①。病程迁延,预后大多良好。 临床症状 一、精神症状 (一)厌食 厌食为该症核心症状之一。最初表现为节食,为达到苗条消瘦之目的渐出现食欲减退,进而对任何食物都     

神经性厌食症病因学近期研究

神经性厌食症是一种多见于年轻女性的摄食障碍。本文综述了近期国外文献中有关神经性厌食症的病因学研究进展,包括:体象评价障碍,性心理发展因素,家庭因素,社会文化影响及抑郁症假说。     

青少年神经性厌食症患者的护理

神经性厌食症是一种以进食行为异常为主的精神障碍 ,多见于青少年女性 ,其特征为故意限制饮食或采取过度运动、诱吐、导泻等方法以减轻体重 ,使体重降至明显低于正常的标准。患者常过分担心发胖 ,甚至已经明显消瘦仍自认为太胖 ,即使医生、护士进行解释也无效。1999年至 2 0 0 3年我科共收治神经性厌食患者17例 ,经治疗护理疗效良好。通过对 17例患者的护理观察 ,初步总结出了护理神经性厌食症患者的大体工作模式 ,现总结如下。1　一般资料本组 17例患者均为女性 ,年龄在 13～ 19岁 ,文化程度小学 2例 ,初中 7例 ,高中 8例。发病年龄12 .5～…     

Assessment of ego state in anorexia nervosa and bulimia nervosa.

To clarify the effects of ego states on anorexia nervosa (AN) and bulimia nervosa (BN), the questionnaire of the Tokyo University Egogram (TEG) with critical parent, nurturing parent, adult, free child and adapted child scales was administered to 32 female AN patients aged 14 to 32 years (mean age 20 years) and 49 female BN patients aged 14 to 33 years (mean age 23 years). The scores on the critical parent and adapted child scales for AN were significantly lower than those for BN. A multiple logistic regression analysis including all of the TEG scales, age, duration of illness and education showed that the adapted child scale significantly discriminated between AN and BN. The adaptive ego state is suggested for differentiating between the two disorders.     

Incidence of anorexia nervosa in Denmark.

From 1970 to 1989, 915 people were admitted for the first time to psychiatric institutions in Denmark and had as their main diagnosis an eating disorder, ICD-8 306.50-59. The incidence of these admissions increased from 0.42/100,000 population in 1970 to a maximum of 1.36/100,000 in 1988. During the time of our investigation, the number of discharges of patients with an eating disorder as the main diagnosis was constant from somatic hospitals, whereas discharges from psychiatric institutions increased.     

Drop outs from in-patient treatment of anorexia nervosa

OBJECTIVE: Aim of the study was to identify patient characteristics that distinguish drop outs and completers from in-patient treatment for anorexia nervosa. METHOD: A total of 133 consecutively admitted in-patients with anorexia nervosa (age range 16-50 years; 92.5% women) were analysed using sociodemographic variables as well as measures of psychopathology (SCL-90-R, EDI-2) and interpersonal difficulties (IIP-C). Patients were treated in a multimodal treatment setting, combining cognitive-behavioural and psychodynamic components. RESULTS: Patients, who reported fewer symptoms, were hospitalized before and had a comorbid depression stayed more often in psychotherapy. Patients dropping out of treatment (31.6%) showed a trend to higher levels of maturity fears. Subtype, age, duration of illness, comorbid personality disorders or previous drop outs were not predictive of dropping out. CONCLUSION: Addressing the high ambivalence and maturity fears of anorexic patients should be an essential issue in psychotherapy with this patient group.     

Predictive factors of length of inpatient treatment in anorexia nervosa

Objective  To identify clinical variables influencing the length of stay (LOS) of inpatient treatment for anorexia nervosa (AN). Method  We analyzed structured clinical charts of 300 consecutive hospitalizations for AN in a specialized eating disorder unit. The sample included patients from 12 to 22 years old. Factors related to the patient and events occurring during the stay were investigated as possible predictors of LOS. Results  Mean LOS was 135 days. The best model of linear regression revealed that the following factors were significantly related to LOS: duration of AN at admission, use of tube feeding during the stay, accomplishment of the therapeutic weight contract and presence of a comorbid disorder. Conclusions  The identification of factors influencing duration of stay, both at the outset and during the hospitalization, could help clinicians to optimize and individualize treatments, as well as increase patient and family compliance.     

The stress response in anorexia nervosa

Patients with eating disorders have been found to have problems with Interoceptive Awareness. This study seeks to examine this issue in an experimental paradigm. In the present study, we investigated the hypothesis that, in addition to lowering a body's autonomic stress response, a state of starvation also lowers the psychological stress response. Results indicated that those with anorexia nervosa showed a muted physiology, but they did not show a complete denial of negative emotion. No relation was seen, however, between their affective and physiological responses to a stress task, which contrasted results found for the controls.     

Sexuality of women with anorexia nervosa

The sexual development and life of 30 adult women with anorexia nervosa and of 50 control women was investigated using a structured interview and 3 sexological questionnaires. Heterosexual development was found to be normal in the initial stages, but psychosexual adaptation in adulthood was impaired. Primary or secondary insufficiencies of sexual life were found for 80% of the anorectic patients. Biological and psychosocial factors may participate in this unfavourable state. Discussion of sexual problems should be part of the process of treating women with anorexia nervosa.     

Pellagra: a rare complication of anorexia nervosa

Pellagra is a potentially fatal, nutritional disease with cutaneous, gastrointestinal, and neuropsychiatric manifestations. Because of the diversity of pellagra's signs and symptoms, diagnosis is difficult without an appropriate index of suspicion. A case of pellagra in a 14-year-old girl with anorexia nervosa is presented. Signs and symptoms of pellagra were resolved after niacin therapy and dietary treatment.     

Aldosterone responses to angiotensin II in anorexia nervosa.

Patients with anorexia nervosa (AN) tend to have renin-angiotensin-aldosterone (RAA) abnormalities caused by abnormal behaviors such as strict dieting, fasting, vigorous exercise, self-induced vomiting and abuse of laxatives and/or diuretics. Adrenal responsiveness to angiotensin II (A II) was studied in 13 AN patients before and after therapy and in 6 normal sex- and age-matched controls: adrenal responses to postural change (1 h of walking following 1 h in a supine position) and to exogenous A II injection (A II: 10 ng/kg/min intravenous infusion for 30 min). The 24-h urine sodium concentration was significantly lower in AN patients before therapy than after therapy. Plasma aldosterone secretory response to A II was significantly higher in AN patients before therapy in both postural change and exogenous A II injection tests compared with after therapy response and that of controls. On the other hand, there was no significant difference in adrenal response to postural change or to exogenous A II between AN patients after therapy and controls. In conclusion, increased A II sensitivity caused by chronic sodium deficiency in AN patients normalized over time as the patients recovered.     

The Parental Bonding Instrument in adolescent patients with anorexia nervosa.

The Parental Bonding Instrument (PBI) was administered to 54 adolescent patients with anorexia nervosa. Scores were compared with those of matched groups of normal and of nonanorectic adolescents referred for assessment to an adolescent psychiatric unit. Significant differences between the 3 groups were demonstrated with respect to care and protection dimensions. Overall scores of subjects in the anorectic group resembled those of normals rather than those of referred patients. Anorexia nervosa patients described their fathers and mothers as being more caring and their mothers as being less overprotective than did psychiatrically referred peers. The study raised questions concerning the use of the PBI in adolescents, in particular those with anorexia nervosa, and the role of the family in the aetiogenesis of this condition.     

Fatigue mood as an indicator discriminating between anorexia nervosa and bulimia nervosa

In order to clarify the differences in mood states between anorexia and bulimia nervosa, the Profile of Mood States (POMS) with tension-anxiety, depression, anger-hostility, vigour, fatigue and confusion scales was administered to 32 female patients with anorexia nervosa (age range 14 to 32 years, mean age 20 years), 49 female patients with bulimia nervosa (age range 15 to 33 years, mean age 23 years) and 410‘normal’ female subjects (age range 14 to 35 years, mean age 23 years). The scores on the depression, fatigue and confusion scales for both anorexia and bulimia nervosa and those on the tension-anxiety and anger-hostility scales for bulimia nervosa were significantly higher than those for the control subjects. The score on the fatigue scale for bulimia nervosa was significantly higher than that for anorexia nervosa. Moreover, the result of the multiple logistic regression analysis including all of the POMS scales indicated that the fatigue scale significantly discriminated between the two disorders. Fatigue mood appears to be a principal indicator for differentiating between the two disorders.