神经性厌食症患者进食障碍与家庭功能关系的研究

目的 探讨神经性厌食症(AN)患者进食障碍及其与家庭功能的关系.方法 使用进食障碍调查量表(EDI),家庭功能量表(FAD)对29例AN患者的进食障碍及其家庭功能进行评定,对其身高体重指数(BMI)进行计算,并与大学生样本进行对照研究.结果 AN患者EDI对瘦的追求,贪食,对身体不满意,无效感,完美主义,对他人不信任,...     

米氮平治疗神经性厌食症的疗效对照研究

目的：观察米氮平对神经性厌食症的疗效。方法：42例符合CCMD-3神经性厌食症患者被随机分成2组，分别给予米氮平和5-羟色胺再摄取抑制剂（SSRIs）治疗12周，而后随访12周。比较患者治疗前后的体重变化、汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评分及药物不良反应。结果：共38例患者完成治疗全过程，其中米氮平组20例，SSRIs组18例。在治疗6周时，米氮平组的体重增加大于SSRIs组，差异有显著性（P〈0．01）；治疗12周时，两组体重增加值差异没有显著性。治疗后两组HAMD和HAMA评分均明显减低（P〈0．01），但两组间差异无显著性（P〉0．05）。两组均未出现严重的药物不良反应，主要不良反应SSRIs组为胃肠道不适，米氮平有嗜睡、体重增加等。结论：米氮平能明显提高神经性厌食症患者的食欲和体重，改善焦虑抑郁情绪，依从性好，起效时间早于SSRIs，值得在临床上选用。     

住院神经性厌食患者的3～9年后临床结局

目的:通过追踪随访住院神经性厌食症患者的临床结局,初步分析神经性厌食症患者临床结局的相关因素。方法:选取2000-2006年因进食障碍首次住院治疗,符合国际疾病分类第十版(ICD-10)神经性厌食症诊断标准、无共患重性精神病的病例。先采用自编一般情况调查表从病历中提取数据,然后通过电话联系,使用自编随访调查表进行电话访谈。结局指标包括患者和家属对目前病情的主观评定,患者目前的体质量指数(BMI)、进食情况、月经情况等。结局评定分为主观病情评定和客观病情评定。结果:符合入组标准的患者共114例,成功随访57例,随访时患者平均年龄(21.6±4.3)岁,随访时间距出院时间(6.6±1.3)年。随访到的患者客观评定临床痊愈率为36.8%,主观评定痊愈率56.1%。随访时月经恢复组的患者住院期间BMI增长更多(P=0.026);随访时存在暴食/清除行为的患者组既往住院时即有更高的暴食/清除行为比率和自杀自伤史(均P<0.05);随访时主观痊愈患者组在出院时的BMI更高(P=0.049);客观未痊愈患者组住院期间伴随躯体合并症的比例更高(P=0.008)。结论:住院神经性厌食症患者在出院时体质量指数更接近正常,通过治疗获得较好体质量指数增长可能是利于临床结局的因素,而自伤自杀史、暴食/清除行为史、躯体合并症史可能是不利于临床结局的因素。     

进食障碍患者的异常心理特点

目的:了解进食障碍患者的心理活动特点,分析心理特征与体重指数变化的关系。方法:本研究为临床病例分析。研究对象是2001.1-2004.6年在北京大学第六医院住院或门诊治疗的符合ICD-10诊断标准的进食障碍患者,共连续入组146例。用进食障碍调查表(EDI)评估患者的心理特点。结果:患者中女性140例,男性6例,平均年龄19岁,平均发病年龄16岁。就诊时、病前最高、病中最低和期望的体重指数分别是16.5、21.4、14.9和17.6。就诊时体重指数与EDI的对瘦的追求(r=0.49)、贪食(r=0.43)、对身体不满意(r=0.33)、无效感(r=0.31)、内省(r=0.22)等5项分量表分相关(P<0.01或0.05),期望体重指数与完美主义(r=-0.18)、成熟恐惧(r=-0.19)得分有弱的相关性(P<0.05)。结论:对进食、体重、体形的过度关注是进食障碍患者突出的心理活动特点,但同时也可能存在其他不容忽视的心理问题。     

神经性厌食症患者家庭治疗疗效观察

目的 观察神经性厌食症(AN)患者家庭治疗疗效.方法 将符合神经性厌食症患者30例,给予家庭治疗,并对其疗效进行现察,包括治疗前后身高体重的测量,计算身高体重指数(BMT).结果 AN患者治疗后体重(48.57±9.36)Kg,显著高于治疗前(44.12±9.78)Kg(P＜0.05),治疗后BMI(18.08±2.9...     

北京女大学生瘦身倾向的影响因素

目的：考察北京女大学生瘦身倾向的影响因素。方法：采用进食障碍问卷(EDI)的瘦身倾向分量表、青少年及成人身体自尊量表和BMI体象量表(BMI-SMT)测查了499名北京女大学生。结果：对自身体形的期望偏差、身体自尊状况以及对自身体形的认识偏差对于个体的瘦身倾向状况具有预测作用；体形指数属正常组的个体对自身体形的认识偏差、期望偏差显著高于偏瘦、过瘦组，身体自尊显著低于偏瘦、过瘦组，瘦身倾向显著高于偏瘦、过瘦组。结论：女大学生对自身体形的歪曲认识、不合理的期望及较低的身体自尊是影响瘦身倾向进而引发进食障碍的重要因素。     

某医科大学女生瘦身倾向和不满体形的影响因素

目的:考察某医科大学女生瘦身倾向和不满体形的影响因素.方法:采用进食障碍问卷(EDI)的瘦身倾向分量表和不满体形分量表、BMI体象量表(BMI-SMT)、青少年及成人身体自尊量表(BES)和SCL-90人际关系敏感分量表测查了181名某医科大学大三女生.结果:体重满意感、对自身体形的期望偏差和认识偏差对于个体的瘦身倾向具有预测作用；而体重满意感、对自身体形的期望偏差对于个体的不满体形具有预测作用.体形指数正常组的个体对自身体形的认识偏差、期望偏差显著高于低体重组,身体自尊和体重满意感显著低于低体重组,不满体形、瘦身倾向显著高于低体重组.结论:女大学生对自身体形的歪曲认识、不合理的期望及较低的体重满意感是影响瘦身倾向的重要因素,而对自身不合理的期望及较低的体重满意感是影响不满体形的重要因素.     

EDI-1量表对神经性厌食症患者的初步测试

目的:探讨进食障碍调查量表(EDI-1)用于调查北京市神经性厌食症患者的信度、效度.方法:采用EDI-1对30名神经性厌食症患者和30名正常对照进行调查,用分半信度、同质信度、结构效度和判别效度等指标对EDI-1量表进行评定.结果:EDI-1量表中国版具有较好的内部一致性,除了成熟恐惧分量表的Cronbach's系数为0.50外,其余七个分量表的Cronbach's系数均在0.80以上.除成熟恐惧量表以外的其他分量表分半信度也较好,Pearson相关系数≥0.6.量表的重测信度好,两次测查各分量表的Pearson相关系数为0.76-0.97.八个分量表的累积贡献率为70.65%,结构效度较好.判别效度好,除成熟恐惧量表外,厌食症患者其他七个分量表的分数均明显高于正常对照组,差异有显著性(P<0.05).结论:除成熟恐惧分量表外,EDI-1量表基本适用于北京神经性厌食症患者的评估.     

51例进食障碍患者的临床特征分析

目的 :了解进食障碍患者的临床特征。方法 :对符合CCMD -2 -R神经性厌食症 (AN)和神经性贪食症 (BN)诊断标准的 5 1例住院进食障碍患者的临床特征进行了回顾性分析。结果 :AN和BN患者的怕胖心理、闭经、采取相似的方式减少食物对于身体的影响等临床相相似 (P >0 0 5 )。但是AN患者较BN患者发病年龄早 (t =2 3 2 0 ,P <0 0 5 ) ,体像障碍比较多见 (χ2 =6 110 ,P <0 0 5 ) ;BN患者的抑郁主诉多 (χ2 =8 612 ,P <0 0 0 1) ,病程长 (t=3 2 17,P <0 0 5 ) ,停工、停学时间长 (t=2 2 16,P <0 0 5 ) ,自知力较好。结论 :进食障碍两大综合征可能是一个疾病进程中的两个不同阶段 ,而贪食症的危害更应引起重视     

奥氮平治疗导致的体重增加和血糖、血脂升高与5-HT2A受体基因多态性的关系

目的 :探讨奥氮平治疗患者的体重增加和血糖、血脂改变与 5 -羟色胺 2A受体 (HTR2A)基因多态性T10 2C和 -14 3 8G A的关系。方法 :采用PCR -RFLP技术分析 5 7名奥氮平治疗的精神分裂症患者的HTR2A基因多态性T10 2C和 -14 3 8G A的频率。测定患者治疗前后的体重、血脂和血糖指标 ,并计算体重指数 (BMI)。分析基因型与各指标变化的相关性。结果 :治疗后患者体重平均增加 ( 4 2± 4 2 )kg ,或增加基础体重的 ( 7 5± 7 6) % ,体重变化的范围为 ( -3～ 15 )kg ,平均BMI变化值为 ( 1 5± 1 5 )kg m2 ,空腹血糖平均增加 ( 0 3± 0 7)mmol L ,血清甘油三脂和胆固醇平均增加分别为 ( 0 73± 1 0 5 )mmol L和 ( 0 5 9±0 65 )mmol L。突变型纯合子 -14 3 8A A比野生型纯合子 -14 3 8G G的体重增加更显著。结论 :HTR2A受体与奥氮平导致的体重增加有关 ,基因型 -14 3 8A A可预示服用奥氮平后体重增加。     

Hypothalamic-pituitary-thyroidal dysfunctions in anorexia nervosa

There are clinical similarities between anorexia nervosa and hypothyroidism. Circulating levels of T4 and particularly T3 have been reported to be low in this eating disorder. Previous reports have, however, shown normal basal levels of serum TSH with normal or delayed responses to TRH. To assess thyroid function and the hypothalamic-pituitary axis in 21 women with anorexia nervosa, serum levels of free and total thyroid hormones, binding proteins, and TSH employing an extremely sensitive assay (detection limit = 0.02 microU/ml) were measured. Serum T4, free T4, T3, free T3, TSH, TBG and TBPA concentrations were significantly lower and rT3 levels were significantly higher in anorexia nervosa patients than in normal controls. A delayed TSH response to TRH was noted in 66% of patients, hyporesponsiveness was seen in another 24%, and a normal response in only 10%. In 10 anorexia nervosa patients studied after weight gain, T4, T3, free T3, TSH, TBG and TBPA were significantly increased, and rT3 was significantly decreased. No change in mean free T4 levels with weight gain was noted. Other parameters of hypothalamic dysfunction in anorexia nervosa have been reported and the present data suggest that apparent hypothalamic hypothyroidism occurs perhaps as an adaptation to prolonged starvation.     

Anorexia nervosa: changes in sexuality during weight restoration.

OBJECTIVE: We examined changes in sexual drive during weight restoration in patients with anorexia nervosa. METHODS: Eleven women with anorexia nervosa prospectively completed the Sexual Daydreaming Questionnaire (SDQ) and the Hospital Anxiety and Depression Scale (HADS) at five time points during inpatient treatment involving weight restoration. SDQ and HADS scores were recorded every 4 weeks until 8 weeks after subjects had reached the mean matched population weight (MMPW), which was monitored against body mass index (BMI). Histories were 'taken for purging, self-cutting, childhood sexual abuse, and number of sexual partners. Repeated-measures analysis of variance, regression analyses, and t tests were performed. RESULTS: BMI and sexual daydreaming were closely associated (p < .001). BMI and depression also achieved a statistically significant association (p = .046), with "caseness" for anxiety disorder throughout. Higher levels of sexual drive at MMPW seemed to be associated with purging, self-cutting, and childhood sexual abuse but not at low weight. Levels of sexual drive did not reflect previous sexual behavior. CONCLUSIONS: An increase in sexual drive accompanies weight restoration in patients with anorexia nervosa, which is consistent with psychological and physiological explanations of altered sexuality. Transient depression is also associated with weight gain. Changes in sexuality should be considered in both recovery and treatment failure.     

Osteoporosis in women with anorexia nervosa

Because estrogen deficiency predisposes to osteoporosis, we assessed the skeletal mass of women with anorexia nervosa, using direct photon absorptiometry to measure radial bone density in 18 anorectic women and 28 normal controls. The patients with anorexia had significantly reduced mean bone density as compared with the controls (0.64 +/- 0.06 vs. 0.72 +/- 0.04 g per square centimeter, P less than 0.001). Vertebral compression fractures developed in two patients, and bone biopsy in one of them demonstrated osteoporosis. Bone density in the patients was not related to the estradiol level (r = 0.02). Levels of parathyroid hormone, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D were normal despite low calcium intakes. The patients with anorexia who reported a high physical activity level had a greater bone density than the patients who were less active (P less than 0.001); this difference could not be accounted for by differences in age, relative weight, duration of illness, or serum estradiol levels. The bone density of physically active patients did not differ from that of active or sedentary controls. We conclude that women with anorexia nervosa have a reduced bone mass due to osteoporosis, but that a high level of physical activity may protect their skeletons.     

The childhood and family background of women with clinical eating disorders: a comparison with women with major depression and women without psychiatric disorder

BACKGROUND: Childhood antecedents are often put forward as being of possible aetiological significance for both anorexia nervosa and bulimia nervosa. METHOD: Comparisons were made of groups of women with eating disorders with groups of women with major depression or without current psychiatric disorder, using the Childhood Experience of Care and Abuse interview (CECA). RESULTS: Women with bulimia nervosa (or mixed bulimia and anorexia nervosa) tended to report more troubled childhood experiences than did women from the non-morbid comparison group. In this respect, they resembled those with major depression. In contrast, those with anorexia nervosa resembled the non-morbid women rather than the other psychiatric groups. CONCLUSIONS: Adversity in childhood as measured by the CECA may play a part in the causation of bulimia nervosa but not of anorexia nervosa. It remains possible that more specific or subtle family influences may be relevant.     

QT interval and QT dispersion in eating disorders

BACKGROUND: Eating disorders are thought to be risk factors for cardiac sudden death secondary to arrhythmia. Results in previous studies on QT interval and QT dispersion, markers of fatal arrhythmia, have been inconsistent. METHODS: We prospectively examined 179 female eating disorder patients, being over 18 years old and diagnosed according to the DSM-IV criteria between January 1995 and December 2002, and 52 healthy women. Patients with abnormal plasma electrolytes or taking medications that might influence the electrocardiogram (ECG) were excluded from the study. QT intervals were corrected for heart rate using Bazett's formula and the nomogram method, which is more reliable at extremely low heart rates than Bazett's formula. QT dispersion was measured as the difference between the longest and shortest QT intervals. QT intervals and QT dispersion in each patient group were compared with those in the control group. RESULTS: The 164 eligible patients consisted of 43 patients with anorexia nervosa restricting type, 35 with anorexia nervosa binge eating/purging type, 63 with bulimia nervosa purging type, and 23 with bulimia nervosa non-purging type. There was no significant difference in age between eating disorder patients and controls. QT interval and QT dispersion were significantly longer in all eating disorder subtypes than in the control group. QT interval and QT dispersion were significantly correlated with the rate of body weight loss in bulimia nervosa. CONCLUSIONS: QT interval and QT dispersion were prolonged in both anorexia nervosa and bulimia nervosa. Examination of ECG in eating disorder patients without extremely low body weight also appears to be clinically important.     

Bulimia nervosa: an ominous variant of anorexia nervosa.

Thirty patients were selected for a prospective study according to two criteria: (i) an irresistible urge to overeat (bulimia nervosa), followed by self-induced vomiting or purging; (ii) a morbid fear of becoming fat. The majority of the patients had a previous history of true or cryptic anorexia nervosa. Self-induced vomiting and purging are secondary devices used by the patients to counteract the effects of overeating and prevent a gain in weight. These devices are dangerous for they are habit-forming and lead to potassium loss and other physical complications. In common with true anorexia nervosa, the patients were determined to keep their weight below a self-imposed threshold. Its level was set below the patient's healthy weight, defined as the weight reached before the onset of the eating disorder. In contrast with true anorexia nervosa, the patients tended to be heavier, more active sexually, and more likely to menstruate regularly and remain fertile. Depressive symptoms were often severe and distressing and led to a high risk of suicide. A theoretical model is described to emphasize the interdependence of the various symptoms and the role of self-perpetuating mechanisms in the maintenance of the disorder. The main aims of treatment are (i) to interrupt the vicious circle of overeating and self-induced vomiting (or purging), (ii) to persuade the patients to accept a higher weight. Prognosis appears less favourable than in uncomplicated anorexia nervosa.     

Ego boundary disturbance in juvenile anorexia nervosa

Tested the hypothesis that ego boundary disturbance is present in adolescent females with anorexia nervosa. Twenty anorexics were compared to 20 female depressed controls on Rorschach scales designed to measure theoretically relevant aspects of boundary impairment. Results showed that anorexics scored higher on scales that measure inner-outer and conceptual boundary disturbance and produced significantly more responses that emphasized the solidity of object boundaries. Boundary scores were unrelated to degree of weight loss and global symptom severity, and follow-up testing after normal weight was restored revealed little change from initial levels. These findings are discussed in relation to current theory on the role of developmental ego pathology in the origins and phenomenology of anorexia nervosa.