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神经性厌食症

最后审阅: 12 Nov 2024
最后更新: 12 Dec 2023

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 明显低体重
  • 尽管有证据表明体重明显偏低,但是仍担心体重增加或变胖,或者采取妨碍体重增加的行为
  • 混乱的体像
  • 限制能量摄入
  • 暴食和/或催吐
  • 滥用泻药、利尿剂或减重药
  • 闭经
  • 皮下脂肪减少
完整详情

其他诊断因素

  • 全身乏力、虚弱和注意力不集中
  • 过度关注食物
  • 体位性低血压
  • 非特异性的胃肠道症状
  • 心脏症状和征象
  • 头发、皮肤和指甲的变化
  • 依赖性水肿/低垂性水肿
  • 骨质减少或骨质疏松
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危险因素

  • 女性
  • 青少年和青春期
  • 强迫行为和完美主义特质
  • 接触西方媒体
  • 基因影响
  • 中上层社会经济阶层
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诊断性检查

首要检查

  • 全血细胞计数 (FBC)
  • 血清化学
  • 甲状腺功能检测
  • 肝功能检查
  • 尿液分析
完整详情

需考虑的检查

  • 心电图 (ECG)
  • 骨密度测定(双能 X 线骨密度测量仪)
  • 女性中的雌二醇
  • 男性中的睾酮
完整详情

治疗流程

急症处理

身体情况稳定,并适合门诊治疗

医学上不稳定或者门诊治疗失败

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 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

利益声明

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.

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.

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