Internal Medicine

P1: SBT

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

132 Anorexia Nervosa

Medical Complications

■Fluid retention may occur during initial stages of refeeding

■First 7–10 d: caloric intake should not exceed 2000 calories/d; mon-

itor fluid intake carefully

Pharmacotherapy

■Medication provides little in treatment of anorexia

■Treat comorbid psychiatric conditions, ie, depression

■Appetite stimulants: cyproheptadine (serotonin antagonist that

stimulates appetite) or megestrol (synthetic derivative of proges-

terone) may help

Tube Feeding

■Indications:

➣Dehydration & electrolyte imbalance

➣Intercurrent medical emergency necessitating weight gain

➣Failure to gain weight after adequate treatment trial

➣Negative reinforcement (ie, weight gain above certain threshold

may prevent or discontinue tube-feeding)

■Complications:

➣Aspiration pneumonia

➣Negative transference

follow-up

■Long-term outpatient treatment:

■Usually follows discharge from in-patient unit

■Minimal duration 6 mo if weight stable

■Cognitive-behavioral therapy (CBT):

➣Provide suppor

➣Modify distorted patterns of thinking about weight & shape

➣Dealing w/ ongoing problems of living

■Family therapy recommended for children & adolescents

complications and prognosis

Complications

■Amenorrhea: metabolic adaptation to weight loss & hormonal

changes

■Orthopedic problems due to excessive exercise

■Cardiovascular problems secondary to starvation & potassium defi-

ciency