Anorexia Nervosa

Under the guidance of ,

Dr. K.Ravishankar M.Pharm,ph.DProfessor, And Principal,Sri Sai Aditya College Of Pharmaceutical Sciences And Research , Surampalem.

By V K C KIRAN PULLELA

Reg No. 133H1S0610

Contents• Introduction

• Causes

•Risk Factors

•Symptoms

•Possible Complications

•Diagnosis

• Treatment

•References

Introduction

• Anorexia nervosa is an eating disorder that makes people lose more weight than is considered healthy for their age and height.

• Persons with this disorder may have an intense fear of weight gain, even when they are underweight. They may diet or exercise too much or use other ways to lose weight.

Introduction• Subtypes of Anorexia Nervosa• Two Subtypes• Restricting Subtype

– place severe restriction on the amount and type of food they consume

– Restricting certain types of foods (e.g. carbohydrates, ‘fatty’ foods)– Counting calories– Skipping meals– Obsessive rules and rigid thinking (e.g. only eating food that is one

colour)– Excessive exercise.

Introduction

• Binge Eating/Purging Subtype– In addition to severe food restriction, the person

will also have binge eating/purging behaviour. These behaviours include:• Binge eating – eating a large amount of food

accompanied by a feeling of ‘loss of control’ • Self induced vomiting, deliberately misusing laxatives,

diuretics or enemas to compensate for eating food

Causes• multifactorial with a combination of

biological, psychological, and sociocultural factors.

• disturbances in a number of different neurotransmitters including serotonin, norepinephrine, and dopamine

• Less efficient transport of Ghrelin to the brain

• Gene, transporter, receptor Polymorphisms

• Some infections like Lyme Disease (Caused by Borrelia Spp)

Biophysical Model for Anorexia Nervosa

Risk Factors• Age: Often begins during the pre-teen or teen years or

young adulthood.• Sex: More common in females, but may also be seen in

males.• Hereditary factors.• Being more worried about, or paying more attention to,

weight and shape• Having an anxiety disorder as a child• Having a negative self-image• Having eating problems during infancy or early childhood

Symptoms

• To be diagnosed with anorexia, a person must:– Have an intense fear of gaining weight or becoming fat,

even when he/she is underweight– Refuse to keep weight at what is considered normal for

her age and height (15% or more below the normal weight)

– Have a body image that is very distorted, be very focused on body weight or shape, and refuse to admit the danger of weight loss

– Have not had a period for three or more cycles (in women)

Symptoms

• Behavioral:– Cutting food into small pieces or moving them

around the plate instead of eating– Exercising all the time, even when the weather is

bad, they are hurt, or their schedule is busy– Going to the bathroom right after meals– Refusing to eat around other people– Using diuretics, laxatives, diet pills– Suicidal tendency

Symptoms

• Other Symptoms:– Fatigue– Insomnia– skin that is yellow or blotchy– Lanugo (very fine, soft, and usually unpigmented on the body)– hair thinning or falling out– Constipation– Amenorrhea– Xeroderma– Hypotension

Symptoms

• Other Symptoms:– Hypotension and/or orthostatic hypotension– Bradycardia or tachycardia– Depression– enlargement of the salivary glands (caused by excessive

vomiting)– Swollen joints– Halitosis (Bad Breath) from vomiting or starvation-induced

ketosis.– Abdominal Distension– Rapid mood swings

Possible Complications• leads to death in 10% of cases (estimate)• Osteoporosis (Serious)• Leucocytopenia, which leads to increased risk of infection• Hypokalemia, which may predispose to arrhythmias• dehydration• malnutrition• Seizures due to fluid or sodium loss from repeated diarrhea or

vomiting• Thyroid gland problems• Tooth decay• Increased risk of infertility

DiagnosisTests should be done to help find the cause of weight loss, or see what damage the weight loss has caused. Many of these tests will be repeated over time to monitor the patient. – Albumin– Bone density test to check for thin bones (osteoporosis)– Complete Blood Count– Electrocardiogram (ECG or EKG)– Electrolytes– Kidney and Liver function tests– Total protein– Thyroid function tests– Urinalysis– Tests for any underlying infections which are likely to cause anorexia

Treatment– Medical and nutritional intervention

• Nutritional rehabilitation• Weight restoration• Reversal of the acute medical complications

– Psychological intervention• family psycho education• interpersonal therapy• family therapy

– Pharmacological treatment• SSRIs:

– Fluoxetine– Sertraline– Paroxetine– Fluvoxamine– Citalopram

– there are some recent reports that the atypical neuroleptic medications such as Risperidone, Olanzapine, and Quetiapine may be effective in adolescents with anorexia nervosa

References

– http://www.webmd.com/mental-health/anorexia-nervosa

– http://www.nlm.nih.gov/medlineplus– PubMED Health

http://www.ncbi.nlm.nih.gov/– http://peds.stanford.edu/Rotations/

adolescent_medicine/documents/EDArticle.pdf