“ The onset of anorexia is situated in the conflict over dependence and autonomy, in the relationship between mother ad daughter.”
Definition
Persistent refusal to eat due to morbid fear of obesity, leading to excessive dieting and marked loss of weight, and later to features of malnutrition. Could alternate with Bulimia nervosa characterized by episode of binge eating with self induced vomiting, misuse of laxatives, enema or diuretics, but still persistent worries about weight gain.
Prognosis
Better if onset is at an early age. Poor in severe cases, those with continued low weight, poor response to treatment and or repeated vomiting 5-20% mortality cited with death due to electrolyte abnormalities, starvation or suicide. Many symptoms resolve with weight again.
Treatment
First rule out – Jaunduice, Fever and Anemia.Inj. Neurobion 2cc IM x on alt days X 5.Syp. Santecini 2 tst x 2 times/ day.Syp. PRACTIN 1tsp x 3 times/ day x ½ hr before meals (Cyproheptidine).Tab. MENDAZOLE 1bd x 3 days (Anthelminthic).Good Food rich in proteins.Proteinex 2 tsp in a glass of milk x bd.Regular Exercises.Change in Climate, especially for convalescent patients.If AnemicCap. Autrin 1 daily x 3 months (Iron)For extreme casesI.V. 25% glucose 4 amps.I.V. Glucose saline 1000ml.Other drugs to tryTab. Liv 52 2 tds x 15 daps (Ayurvedic)Tab. Uniezyme 1 bd x 15.Inj. Decadurabolin 50mg. IM x every week x 3.If there is no response to treatment:Investigate blood. Hb%. S. Bilirubin, Bl. Urea.Urine- for Bile Salts.X-ray chest.Gatroscopy and ultrasound of abdomen in elderly patients.Important that may be missed:Is he taking drugs causing anorexia, biguandies, digitalis, antihypertensives.In Female patient:Is she pregnant? Are there any problems at home with in laws or children?In school going children:Are there any psychological or study related problems at school?In adult males:IS he alcoholic?. Is he eating excess of Tobacco. Mawa, Pan Parag? Could it be malignancy any where? Particularly of Liver/ Stomach.Pulmonary tuberculosis may present with only Anorexia.In old patient with severe anorexia, first think of carcinoma of stomach.
If anorexia is so severe, that patient does not feel like looking at food, think of Infective Hepatieis. The icterius may develop after 1-2 days.
Calls for psycho therapy, structures behavioural therapy and family counseling.Bed rest with supervised meals until patient has gained considerable weight. Weight gain to be gradual at 1-3 pound a week to prevent gastric dilatation.Develop trust of patient and focus on overall improvement of health rather that weight gain.Challenge the fear of uncontrollable weight gain.
Advice to Patient
Provide information on nutrition, metabolic demands, and basic health parameters.Ask the patient to maintain a food dairy listing foods eaten, and associate feelings.The patient should be repeatedly reassured that she would not be allowed to get fat.
Follow Up
Establish regular schedule to monitor weight, deprived feelings, rituals of eating, level of physical activity
Inadequate Response
By nature a chronic problem in the majority of older patients, and calls for good supportive care by physician and nurses.
