AnorexiaNervosa
神经性厌食症
Anorexianervosaisaneatingdisordercharacterizedbyrefusaltomaintainbodyweightthatiswithintheminimalrangeofnormal.Theaffectedindividualhasadistortedbodyimage,perceivingselfasgloballyoverweightorobsessingaboutshapeandsizeofparticularbodyparts.
神经性厌食症属于进食障碍病，特点是拒绝体胖，尽管它已经是最低限度的正常体重。患者对体形看法偏执，认为自己总体超重或沉迷于身体特定部位的形状和尺寸。
Therearetwosubtypesofanorexianervosa.Oneistherestrictingtype,whereintheindividualseverelyrestrictsfoodintakeandcompulsivelyexercises.Theotheristhebingeeatingandpurgingtypemarkedbyrestricteddietaryintakecoupledwithintermittentepisodesofbingeeating,followedbypurgingthroughself-inducedvomitingoruseofipecac,laxatives,diuretics,orenemas.
神经性厌食症分两种。一是限制型的，患者严格限制食物摄入并强迫自己运动。另一种是狂饮狂泻型的，其特点是在限制饮食的同时又伴有间歇性暴饮，接着又通过自我诱导式呕吐或使用吐根、缓泻剂、利尿剂和灌肠剂等催泻。
Pathophysiology
Avarietyofpsychologicfactorsareassociatedwiththedevelopmentofbehaviorscharacteristicofanorexianervosa.Lowself-esteemoftenplaysasignificantrole.Weightlossisviewedasanachievement,andself-esteembecomesdependentonbodysizeandweight.Thereisalsoarelationshipbetweeneatingdisordersandmooddisorders.Insomecases,majordepressionmayresultfromnutritionaldeprivation.Individualswithanorexianervosamaylackspontaneityinsocialsituationsandmaybeemotionallyrestrained.Theexcessuseofappetitesuppressantsordietpillsisseeninbothtypes.
很多病因素都与一些神经性厌食症特有的行为有关。缺乏自尊常常起着很重要的作用。减肥使其产生一种成就感，自尊依赖于体形和体重。饮食障碍与心境障碍也有关系。有些病人严重抑郁，这通常是营养不足引起的，厌食症患者在社交场合缺乏自发性，在情感上会很拘束。这两类厌食症都会发生过度使用食欲抑制剂或节食丸这种情况。
Familydynamicsmayplayaroleindevelopmentofsymptoms.Parentsmaybecontrollingandoverlyprotective.Eatingbehaviorsmayemergeinanunconsciousattempttogaincontrolovertheenvironment.Alsocontributingtothiseatingdisorderisasocietalidealslimnessthattheadolescentstrivestoemulate.Insomecases,diminishedweightandlossofsecondarysexualcharacteristicsmayberelatedtodifficultyinacceptingmaturationintoadulthood.
家族情况对症状出现也有一定影响。父母对小孩控制过严，保护过度。有意无意地想要控制环境，从而形成了不良饮食习惯。造成饮食障碍的另一个因素是社会对所谓的理想的苗条的追求，青少年努力想要效法这种苗条。在有些病例中，体重减轻，失去第二性征可能也与难以接受成年有关。
ClinicalManifestations
Sudden,unexplainedweightloss
体重突然下降，原因不明
Emaciatedappearance,lossofsubcutaneousfat
瘦弱，在下脂肪丢失
Changesineatinghabits,unusualeatingtimes
饮食习惯改变，饮食时间异常
Excessiveexerciseandphysicalactivity
运动和体力活动过度
Dry,scalyskin
皮肤干燥、脱皮
Lanugoonextremities,back,andface
四肢、背部和脸部长出毳毛
Yellowishdiscolorationofskin
皮肤微黄褪色
Sleepdisturbances
Chronicconstipationordiarrhea,abdominalpain,bloating
长期便秘或腹泻、腹痛、胃气胀
Esophagealerosion医学全在线网站www.med126.com
Depressedmood
Excessivefocusonhighachievement（becomesdistressedwhenperformanceisnotaboveaverage）
过度强调杰出成就，如表现一般就会感到痛苦
Excessivefocusonfood,eating,andbodyappearance
挑剔强调食物、饮食及体形
Erosionoftoothenamelanddentinonlingualsurfaces（lateeffects）
晚期出现牙釉质和牙本质舌面病变
DiagnosticStudies
Electrocardiogram（ECG）
bloodpressure
Serumurea,electrolytes,creatinine
血清尿、电解质、肌酐
Completebloodcount（CBC）,plateletcount
全血计数，血小板
Thyroid-stimulatinghormone（TSH）
促甲状腺激素
Bonedensity
Presenceofhypercarotenemia
血胡萝卜素过多症
TherapeuticManagement
Treatmentisprovidedonanoutpatientbasisunlessseveremedicalproblemsemerge.Aninterdisciplinaryapproachisneededtoensureoptimaloutcomes.Outpatienttreatmentincludesmedicalmonitoring,dietaryplanningtorestorenutritionalstate,andlong-termpsychotherapytoworkthroughunderlyingissues.Psychopharmacologictreatmentmaybeinitiatedtotreatsymptomsofdepression,anxiety,andobsessive-compulsivebehaviors.Hospitalizationisindicatediftheadolescentweighslessthan20%ofidealbodyweightorisunabletoadheretothetreatmentprogramonanoutpatientbasis,orwhenneurologicdeficits,hypokalemia,andcardiacarrhythmiasexist.
如无急诊情况出现，一般行门诊治疗。为确保理想治疗效果，通常进行多科室诊治。门诊治疗包括医学监测、饮食计划以恢复营养、长期进行心理疗法解决潜在问题。抑郁症、焦虑症和强迫性行为可心通过精神药理手段进行治疗。如体重低于理想体重20%或门诊治疗无法保证治疗计划落实，或出现神经缺欠、低钾血及心律失常，这时就需要住院。
Thefollowingmedicationsmaybeused:
Antidepressants--theselectiveserotoninreuptakeinhibitors（SSRI）arealsoused,particularlyifcompulsiveexercisingisacomponentoftheillness（imipramine,desipramine,fluoxetine,sertraline,paroxetine）
抗抑郁药，也可使用选择性5羟色胺再吸收抑制剂，特别是患有强迫运动时，如丙米嗪、地昔帕明、氟西汀、舍曲林、帕罗西丁等。
Estrogenreplacementforamenorrhea
无月经者可补充雌激素。
NursingManagement
Theindividual'sphysicalhealthstatusimproveswithoutsymptomswithsteady,reasonableweightgain（about1lbevery4days）.
患者身体健康状况改善，无症状，体重稳定、合理增加（约每4天1磅）
Theindividualestablishesahealthypatternofnutritionalintake.
患者确立健康的营养摄取方式
Theindividualestablishesincreasedself-esteemandimprovementinpsychologicfunctioning.
患者自尊增强，心理作用改善
NursingDiagnoses
Imbalancednutrition:lessthanbodyrequirementsrelatedtoexerciseinexcessofcaloricintake,refusaltoeat,self-inducedvomitingfollowingeating,orlaxativeabuse
营养失调：低于机体需要量 与运动过多、热量摄入相对不足、拒绝进食、进食后自我诱发呕吐及滥用泻药有关
Disturbedself-conceptrelatedtoinaccurateperceptionofselfasobese
自我概念紊乱 与错误认为自己肥胖有关
Riskfordeficientfluidvolumerelatedtovomitingandexcessiveweightloss
有体液不足的危险 与呕吐及体重丢失过多有关
Disturbedsleeppatternrelatedtofearsandanxietyconcerningweightstatus
睡眠型态紊乱 与害怕或担心体重增加有关
Activityintolerancerelatedtofatiguesecondarytomalnutrition
活动无耐力 与继发于营养不良的疲乏有关
Ineffectiveindividualcopingrelatedtoself-inducedvomiting,denialofhunger,andinsufficientfoodintakesecondarytofeelingsoflossofcontrolandinaccurateperceptionsofbodystates
个人应对无效 与自我诱发性呕吐、否认饥饿、及行为失控感和对自已身体状况认识不足引起的食物摄入不足有关
NursingInterventions
Includefamilyinformingdietarysupplementationplan.
让家人参与制定食物补充计划。
Provideinformationaboutadequatenutritionalintakeandtheimpactinadequateintakehasonenergylevelandpsychologicwell-being.
提供有关足够营养摄入的资讯，使其了解摄入不足对能量与心理健康的影响
Initiatespecificplanofexerciseasreinforcerforpositivebehavioraloutcomes.
制定具体的锻炼计划，强化积极的行为结果
Establishtrustingrelationshipthatpromotesdisclosureoffeelingsandemotions.
建立信任关系，鼓励情感和情结的表达
Organizeeatingofmealswithothers,recordamountoffoodeaten,andmonitoractivityfor2hoursaftereating.
组织与他人共餐，纪录饮食数量，监视饭后2小时内的活动
Promotetheindividual'ssenseofresponsibilityandinvolvementinrecoveryandtreatment.
增强患者责任感，鼓励其参与恢复及治疗活动
Participateoninterdisciplinaryteamthatusesmultiplemodalitiessuchasindividualandgrouppsychotherapy,assertivenesstraining,musicand/orarttherapy,andnutritionaleducation.
参加多种形式科室小组活动，如个人和小组精神 疗法，表达训练、音乐和/或艺术疗法及营养教育等。
Supportinvolvementoffamilymemberswhoarevitaltorecovery.
支持重要家族成员的参与。
PatientTeaching
Recommendpsychotherapyfortreatmentofdistortedbodyimageandself-concept.
建议用精神疗法治疗体像和自我概念的错误认识
Referadolescentandfamilytocommunityresources,thatis,supportgroupsandmentalhealthprofessionals.
安排社区资源，如支援小组和心理健康专家。
Instructparentstopromotethepatient’sactivitiesthatstrengthenthepatient’sself-esteem,facilitatetheresocializationprocessandpromotesocialacceptanceamongpeers.
指导父母鼓励病人参加一些有益的活动，如增强病人自尊、便于重建社交及促进同伴社交接受度的活动。
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