Anorexia nerviosa
Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- presencia de factores de riesgo
- peso corporal significativamente bajo
- temor a ganar peso o a ponerse gordo, o comportamientos que interfieren con el aumento de peso a pesar de haber evidencias de que el peso corporal es significativamente bajo
- imagen corporal distorsionada
- restricción calórica
- atracones y/o purgas
- abuso de laxantes, diuréticos o píldoras adelgazantes
- amenorrea
- disminución de grasa subcutánea
Otros factores de diagnóstico
- fatiga general, debilidad y mala concentración
- preocupación significativa con pensamientos sobre la comida
- hipotensión ortostática
- síntomas gastrointestinales inespecíficos
- síntomas y signos cardíacos
- cambios en el pelo, la piel y las uñas
- edema postural
- osteopenia u osteoporosis
Factores de riesgo
- sexo femenino
- adolescencia y pubertad
- rasgos obsesivos y perfeccionistas
- exposición a los medios occidentales
- influencia genética
- clases socioeconómicas media y alta
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- hemograma completo (HC)
- química sérica
- pruebas de función tiroidea
- pruebas de función hepática
- análisis de orina
Pruebas diagnósticas que deben considerarse
- electrocardiograma (ECG)
- densitometría ósea (radioabsorciometría de doble energía)
- estradiol en las mujeres
- testosterona en los hombres
Algoritmo de tratamiento
médicamente estable y apto para el tratamiento ambulatorio
clínicamente inestable o fracaso del manejo ambulatorio
Colaboradores
Autores
Evelyn Attia, MD
Professor of Psychiatry
Columbia University and Weill Cornell Medical College
New York
NY
Divulgaciones
EA is a board member of a not-for-profit religious organisation, a research advisory board member of National Eating Disorders Association (NEDA), a not-for-profit advocacy organisation and a clinical advisor to Equip Health, a for-profit entity that offers telehealth treatment for eating disorders to adolescents.She does not receive payments for the above. She receives research support from the National Institute for Mental Health (NIMH); no conflict. She is involved in no contract research at present, is expecting to begin a contract with COMPASS Pathways to support a multi-site study of psilocybin for anorexia nervosa. She regularly lectures and educates on the subject of eating disorders but does not receive payment for these activities. She receives royalties from UpToDate for written sections. She has stock options from Equip Health.
B. Timothy Walsh, MD
Professor of Psychiatry
Columbia University
New York
NY
Divulgaciones
BTW has received royalties and honoraria for talks, publications and reviews from Guilford Publications, McGraw-Hill, Oxford University Press, UpToDate, Wiley, the University of British Columbia, Guidepoint Global, the University of Alabama, the American Society for Clinical Psychopharmacology, Health Advances, and Dell Medical School.
Agradecimientos
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.
Divulgaciones
PSP and AMI declare that they have no competing interests.
Revisores por pares
Heather Thompson-Brenner, MD
Director
Eating Disorders Program Center for Anxiety and Related Disorders
Psychology Department
Boston University
Boston
MA
Divulgaciones
HTB declares that she has no competing interests.
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