Anorexia Nervosa

By

V K C KIRAN PULLELA
Reg No. 133H1S0610

Under the guidance of ,

Dr. K.Ravishankar M.Pharm,ph.D

Professor, And Principal, Sri Sai Aditya College Of Pharmaceutical Sciences And Research , Surampalem.

Contents

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) 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

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

Risk Factors
Having an anxiety disorder as a child Having a negative selfimage 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)

Symptoms
To be diagnosed with anorexia, a person must:
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:
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 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

Diagnosis
Tests 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

Treatment
Psychological intervention
family psycho education interpersonal therapy family therapy

Treatment
Pharmacological treatment
SSRIs:
Fluoxetine Sertraline Paroxetine Fluvoxamine Citalopram

recent reports : Risperidone, Olanzapine, and Quetiapine may be effective in adolescents

References
http://www.webmd.com/mentalhealth/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