Psychiatry – Anorexia Nervosa: By Megen Vo M.D. & Sara Buckelew M.D. скачать в хорошем качестве

Psychiatry – Anorexia Nervosa: By Megen Vo M.D. & Sara Buckelew M.D.

medskl.com is a global, free open access medical education (FOAMEd) project covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations for use in the classroom and for physician CME. Psychiatry – Anorexia Nervosa Whiteboard Animation Transcript with Megen Vo, MD & Sara Buckelew, MD https://medskl.com/Module/Index/anore... The DSM-5 diagnostic criteria for Anorexia include: 1. Restriction of energy intake resulting in significantly low body weight, taking into context the individual patient’s age, sex, and previous growth trajectory. There is intentionally no strict cutoff for “significantly low weight”, meaning your clinical judgment is important. Some adult studies use 17kg/m2 or 18.5kg/m2. 2. An intense fear of gaining weight or being fat, or persistent behaviour that interferes with weight gain. 3. A disturbance in the way the patient experiences their own weight or shape, or excessive influence of weight or shape in self-evaluation, or a lack of recognition of the seriousness of their current low weight. Anorexia nervosa can be categorized into either restricting caloric intake, or binging and purging. Purging can refer to vomiting, or using diuretics or laxatives to prevent weight gain. Get a history of the patient’s highest and lowest weights, a diet history, exercise history, and assess for other psychological or psychiatric symptoms such as anxiety, depression, suicidal ideation, and substance use. Physical signs primarily result from malnutrition, which can affect all organ symptoms. When doing a physical exam, pay attention to vital signs, as you may see bradycardia, orthostatic heart rate and blood pressure changes, and/or hypothermia. Plot the patient’s height, weight, and BMI and compare to their historical growth curves to help determine the degree of malnutrition. Other exam signs include: Evaluate mucous membranes for dehydration and teeth for dental erosion from vomiting; Look for bradycardia and arrhythmias; Look for masses or organomegaly; it is very common to have hypoactive bowel sounds and constipation with malnutrition; Lanugo, Russell’s sign, which is callousing of the dorsal hand/fingers from self-induced vomiting, and signs of self-injurious behaviour; GU: Tanner staging; Complete fundoscopic exam, as elevated ICP can cause loss of appetite. Treatment should include medical monitoring, nutrition counselling, and psychological support. In cases of severe malnutrition, inpatient admission for medical stabilization may be necessary. Criteria for admission include weight <75% of expected body weight bradycardia <50bpm, systolic BP <90mmHg, orthostatic hypotension, temperature <96F, acute food refusal, or severe electrolyte abnormalities. Suicidality requires psychiatric hospitalization.