In the last post, we saw how:
- There are social and physiologic factors that can give rise to AN
- Using EAT-26 the there were 15% of people who had eating disorders in the study.
- Family therapy and pharmacology is not particularly helpful in AN
Inkscape.org
Depression vector created by pch.vector - www.freepik.com
Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for four consecutive months. This month will be dedicated to Eating Disorders. In the first month, we discussed Depression, and in the subsequent month, anxiety. We just finished with Schizophrenia.
In this post, we are looking at research work done in Nigeria on Eating Disorders. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.
Electrocardiographic changes are seen in typically a flattened T wave or it may be inverted. The ST segment may be reduced and the QR interval may be longer than normal. These ECG changes sometimes are a result of potassium loss from vomiting and this can be the cause of death.
In very few cases of AN, there may be Gastric dilation. A few patients may have superior, mesenteric artery syndrome.
AN may be classified into 2 distinct types which are the restricting type and the purging type. The features of food restriction are seen in 50% of cases of AN. The restriction means that the patient barely consumes any food and at the same time the patient may be very active daily and subject themselves to injury. Food consumption is usually around 300 to 500 calories everyday.
In the purging type, the patient has a high appetite and will alternate the binging with episodes of purging. The patient uses purging to deal with the extra calories taken during the binge eating episodes. The vomiting or purging is self-induced with the use of drugs such as laxatives or diuretics and sometimes with vomiting-inducing drugs.
At times they may be purging many times even though they have had very little to eat.
These two different types of AN are distinct and present typically with depression and reduced interest in sexual activities.
This disorder is common in those who over-exercise and are perfectionists. DSM-5 has separated binge eating disorder from AN as in this condition there is no purging or vomiting to make up for the food taken.
Those who have the binge and purge type of AN are very similar to those who have bulimia. They typically have an overweight family member and have been overweight in their lives too.
Those who have the binge and purging type tend to engage in substance abuse, disorders in control and personality disorders.
Those with the restrictive type of An have OCD traits directed towards food and other things.
People with AN are commonly affected by major depression as comorbidity or on its own or as a dysthymic sub-type of depression is seen in 50% of patients with Anorexia. Patients with the binge and purge type are more like to commit suicide.
The patients with this disorder do not admit to having a disorder and will not follow through with their treatment. The friends and family of this patient are more likely to be more aware of the patient's medical history and behaviour.
The patient is usually very knowledgeable about topics around nutrition and usually has thoughts about food and weight.
The patient needs to be assessed carefully physically and especially through neurology examination. Hypokalemia is usually seen in a patient who is vomiting. The patient should have serum electrolytes done to assess the other electrolyte because they are likely to be dehydrated.
Eating Disorders in Nigeria (Recomendations)
People illustrations by Storyset
For a better representation of the general population, it would be best if a larger population of subjects with more sociocultural variance in the country and this will help find those that are at the highest risk of this condition. There would be a better representation of those who are affected if ED if a diagnostic instrument is used so that therapy could be started immediately.
This research was funded by the Tertiary Educational Fund TETFUND and the Research committee of the University of Lagos to help with the understanding of the pattern and distribution of ED in Nigeria.
Treatment
Regular clinic visits give the best results in this disorder considering it consumes the least amount of money and does not require a change in the patient's actives as hospitalization would require. A good number of patients with this disorder need to be taken through psychotherapy and symptomatic management of the complications of starvation.
So far nobody is sure about the specific methods to be used in outpatient or inpatient management because there is still a lot that needs to be known about this disorder. The reason this disorder is very challenging to manage is probably that the patients do not agree to the diagnosis but even in those who agree to commence treatment the outcome is not very promising.
In the last 2 decades, there has been better documentation on effective treatment methods. These advancements are mostly in outpatient treatment and the psychological pattern of this disorder is better understood and this is probably why the results are better.
Making up your mind about the patient's therapy is usually very hard. The main issue is the plan to manage the patients long term and short-term eating habits and knowing if the patients a safety risk to themselves is also very important.
Some studies have seen some good responses in adolescence to atypical antipsychotics but this is not the mainstay for treatment.
If the condition is detected as it starts there are usually better results in treatment and this is a very important feature of the treatment. The knowledge of the exact time before treatment is very scanty but commencements before 30 months have been seen to give good results in adolescence and adults.
This is also voiced by the First Episode Early Intervention Eating Disorder study.
For children and adolescents to achieve the best results family therapy is best according to empirical evidence. There is no specific therapy method that family therapy follows strictly it follows different methods of therapy.
The main goal is to have the parents be more in control of the disorder where because children will usually have no control over this disorder.
There are psychological theories that surround the family in the development of AN This is why family therapy is seen as the main stay for adolescent and child therapy.
Parents are very important in the therapy for AN but it is particularly very difficult when the patient themselves is not taking control to achieve the necessary changes needed. The parent has to be very devoted to the nutrition of the child. The care of the patient may be very expensive also, especially when they need to be an ascent from work.
Questions
- What did you learn about Eating Diorders?
Conclusion
- A very important feature of AN is the fear of gaining weight
- Part of the limitations of this study was the fact that they used EAT-26 to assess the subjects
- When considering admission there are some features that should be paid close attention to such as temperature, heart rate and blood pressure.
References
- Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
- Page demarcations made with Inkscape.org
- Healthline
- WebMD