psychiatric disorders
Anorexia Nervosa
Treatment of Anorexia Nervosa
Nutrition supplementation Psychotherapy (eg, cognitive behavioral therapy) For children and adolescents, family-based treatment Sometimes 2nd-generation antipsychotics Treatment of anorexia nervosa may require life-saving short-term intervention to restore body weight. When weight loss has been severe or rapid or when weight has fallen below about 75% of recommended weight, prompt restoration of weight becomes critical, and hospitalization should be considered. If any doubt exists, patients should be hospitalized. Outpatient treatments may include varying degrees of support and supervision and commonly involve a team of practitioners. Nutritional supplementation is often used with behavioral therapy that has clear weight-restoration goals. Nutritional supplementation begins by providing about 30 to 40 kcal/kg/day; it can produce weight gains of up to 1.5 kg/week during inpatient care and 0.5 kg/week during outpatient care. Oral feedings using solid foods are best; many weight restoration plans also use liquid supplements. Very resistant, undernourished patients occasionally require nasogastric tube feedings. Elemental calcium 1200 to 1500 mg/day andvitamin D600 to 800 IU/day are commonly prescribed for bone loss. Once nutritional, fluid, and electrolyte status has been stabilized, long-term treatment begins. Outpatient psychotherapy is the cornerstone of treatment. Treatments should emphasize behavioral outcomes such as normalized eating and weight. Treatment should continue for a full year after weight is restored. Results are best in adolescents who have had the disorder<6 months. Family therapy, particularly using the Maudsley model (also called family-based treatment), is useful for adolescents. This model has 3 phases: Family members are taught how to refeed the adolescent (eg, through a supervised family meal) and thus restore the adolescent’s weight (in contrast to earlier approaches, this model does not assign blame for the development of the disorder to the family or the adolescent). Control over eating is gradually returned to the adolescent. After the adolescent is able to maintain the restored weight, therapy focuses on engendering a healthy adolescent identity. Treatment of anorexia nervosa is complicated by patients' abhorrence of weight gain and denial of illness. The physician should attempt to provide a calm, concerned, stable relationship while firmly encouraging a reasonable caloric intake. Treatment also involves regular follow-up monitoring and often a team of health care practitioners, including a nutritionist, who may provide specific meal plans or information about the calories needed to restore weight to a normal level. Although psychotherapy is primary, drugs are sometimes helpful.Olanzapineup to 10 mg orally once daily may aid weight gain. 