Anorexia nervosa
小结
定义
病史和体格检查
关键诊断因素
- significantly low body weight
- fear of gaining weight or becoming fat, or behaviors that interfere with weight gain despite evidence of significantly low body weight
- disturbed body image
- calorie restriction
- binge-eating and/or purging
- misuse of laxatives, diuretics, or diet pills
- amenorrhea
- decreased subcutaneous fat
其他诊断因素
- general fatigue, muscle weakness, and poor concentration
- significant preoccupation with thoughts of food
- orthostatic hypotension
- nonspecific gastrointestinal symptoms
- cardiac symptoms and signs
- changes to hair, skin, and nails
- dependent edema
- osteopenia or osteoporosis
危险因素
- female sex
- adolescence and puberty
- obsessive and perfectionist traits
- exposure to Western media
- genetic influence
- middle and upper socioeconomic classes
- athlete
- appearance-related teasing
- childhood maltreatment
- celiac disease
- type 1 diabetes mellitus
诊断性检查
首要检查
- clinical diagnosis
- CBC
- serum chemistry
- thyroid function tests
- liver function tests
- blood glucose
- urinalysis
- Sit Up-Stand-Squat (SUSS) test
需考虑的检查
- Sick, Control, One, Fat, and Food (SCOFF) questionnaire
- ECG
- bone densitometry (dual-energy x-ray absorptiometry)
- estradiol in females
- testosterone in males
- urine or serum pregnancy test
治疗流程
medically stable and suitable for outpatient treatment
medically unstable or outpatient failure
撰稿人
作者
Evelyn Attia, MD
Professor of Psychiatry
Columbia University and Weill Cornell Medical College
New York
NY
利益声明
EA receives royalties from UpToDate and Oxford University Press for authorship and has served as a clinical advisor to Equip Health, Inc.
B. Timothy Walsh, MD
Professor of Psychiatry
Columbia University
New York
NY
利益声明
BTW has received royalties and honoraria for writing, editing, speaking, or consulting from Guilford Publications, McGraw-Hill, Oxford University Press, UpToDate, Wiley, the University of British Columbia, Silverhill Hospital, the University of Alabama, the American Society for Clinical Psychopharmacology, Health Advances, and Dell Medical School.
鸣谢
Professor Evelyn Attia and Professor B. Timothy Walsh would like to gratefully acknowledge Dr Pauline S. Powers and Dr Abby M. Irwin, previous contributors to this topic.
利益声明
PSP and AMI declare that they have no competing interests.
同行评议者
Heather Thompson-Brenner, MD
Director
Eating Disorders Program Center for Anxiety and Related Disorders
Psychology Department
Boston University
Boston
MA
利益声明
HTB declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
National Institute for Health and Care Excellence. Eating disorders: recognition and treatment. Dec 2020 [internet publication].全文
American Psychiatric Association. Practice guideline for the treatment of patients with eating disorders. Feb 2023 [internet publication].全文
Royal College of Psychiatrists. Medical emergencies in eating disorders (MEED): guidance on recognition and management. Oct 2023 [internet publication].全文
Hornberger LL, Lane MA, Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics. 2021 Jan;147(1):e2020040279.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Bulimia nervosa
- Avoidant-restrictive food intake disorder (ARFID)
- Depression
更多 鉴别诊断指南
- Determining treatment goal weights for children and adolescents with anorexia nervosa
- World Federation of Societies of Biological Psychiatry (WFSBP) guidelines update 2023 on the pharmacological treatment of eating disorders
更多 指南患者教育信息
Anorexia
Anorexia: questions to ask your doctor
更多 患者教育信息医学计算器
Body Mass Index (BMI) percentiles for boys (2 to 20 years)
Body Mass Index (BMI) percentiles for girls (2 to 20 years)
更多 医学计算器
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