Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

Anorexia Nervosa 131

■Decreased potassium levels, particularly associated w/ purging (may

lead to cardiac arrhythmias)

■Hypomagnesemia, hypozincemia, hypophosphatemia, hyperamy-

lasemia

■Metabolic alkalosis, hypochloremia, hypokalemia: vomiting

■Metabolic acidosis secondary to laxative abuse

■ECG: sinus bradycardia

differential diagnosis

■GI disorders

■Brain tumors

■Occult malignancies

■HIV/AIDS

■Superior mesenteric artery syndrome

■Major depression

■Schizophrenia

■Body dysmorphic disorder

■Obsessive-compulsive disorder

■Bulimia nervosa

■Delusional disorder, somatic type

management

What to Do First

■Persuade both pt & family that treatment is necessary

General Measures

■Most pts initially require hospitalization in specialized inpatient unit

to correct weight loss & electrolyte abnormalities

specific therapy

Hospitalized Treatment

■First step: begin weight restoration

■Behavior modification:

➣Systematic reinforcement of weight gain, making access to cer-

tain activities contingent on specified daily amount of weight

gain (eg, 0.2 kg/d)

➣Reward activities tailored to level of success

➣Behavioral contract specifying amount of weight to be gained

■Family therapy: aims to gain independence, social skills training, &

improved communication patterns & more mature defense mecha-

nisms

■Individual psychotherapy