0071643192.pdf

PSYCHOBEHAVIORAL DISORDERS

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EATING DISORDERS

Eating disorders affect 5–10% of adolescent girlsand young women in the

United States, and up to 1% of males.

Anorexia Nervosa

SYMPTOMS/EXAM/DIAGNOSIS

■ Refusal to maintain body weight over a minimum normal weight for age

and height (BMI<17.5)

■ Intense fear of becoming obese even when underweight

■ Misperception of body weight, shape, or size

■ Absence of at least three consecutivemenstrual cycles (primary or secondary

amenorrhea)

■ Chronic findings are emaciated appearance, brittle hair and nails, lanugo,

bradycardia, hypothermia.

TREATMENT

■ Volume repletion and gradual correction of electrolyte imbalances

■ Avoid refeeding syndromesecondary to aggressive refeeding: Rapid elec-

trolyte shifts, hypophosphatemia, hypokalemia, hypomagnesemia cause

severe cardiopulmonary and neurologic sequelae.

■ Admit patients with extreme weight loss, severe metabolic disturbance,

psychiatric disorders, poor familial/social support, complex medical prob-

lems and those who have failed outpatient therapy.

TABLE 16.8. Factitious Disorders (Continued)

DISORDER SYMPTOMS/EXAM/DIAGNOSIS DIFFERENTIAL TREATMENT

Secondary gain may be obvious (eg, patient

is homeless or incarcerated).Patient may

complain of mental illness because this is

more difficult to disprove.

Munchausen Patients view themselves as important people, Same as for Early confrontation,

syndrome usually have extensive knowledge of medical drug-seeking close outpatient

(M>F, ages terminology. There is significant “pseudologica behavior follow-up

20–40 yr.) fantastica”(pathologic lying) about medical

illnesses, which are difficult to diagnose or

disprove (eg, taking warfarin to induce bleeding).

Secondary gain is to subject him or herself

to unnecessary tests to secure the “sick role.”

Munchausen Child has significant history of failure-to-thrive, Same as for drug- This is child abuse. Child

syndrome by with persistent presentation for medical seeking behavior Protective Services (CPS)

proxy (MSBP) treatment. Illness is concocted by perpetrator needs to be notified

(Rare, perpetrator (eg, injection of feces into IV line), and immediately. There is a

is usually the symptoms/signs cease when child is high risk of maternal

biological mother) separated from perpetrator. Secondary suicide associated with

gain is prolonged contact with health confrontation; arrange

care providers at the expense of her child. psychiatric care for mother.