Psychiatric Nursing

Anorexia Nervosa

Definition

Anorexia nervosa is an eating disorder characterised by following features:

• most often occur in females than males
• common age of onset in adolescence (13-19 years)
• intense fear of becoming obese
• body image disturbance
• refusal to maintain above a minimum normal body weight for age, sex, height.
• Significant loss of weight - usually more than 25% of the original body weight or BMI below 17.5.
• no medical illness
• absence psychiatric illness
• primary or secondary amenorrhea
• strict dietary restrictions
• poor sexual adjustment and fear of pregnancy(unable to accept the 'female role').

Comorbidity

Depressive symptoms and obsessive compulsive personality traits and about 50% of anorectics have bulimic episodes with binge eating

Differential diagnosis

Medical illness- hypopituitarism, tuberculosis, depressive episodes

Treatment

• Short-term management - to ensure weight gain and correct nutritional deficiencies
• Long-term treatment aimed at maintaining a normal weight achieved through a short-term management

Treatment modalities include

• Behaviour therapy- based on positive reinforcement and sometimes negative reinforcements.
• Individual psychotherapy
• Hospitalization - with adequate nursing care
• Pharmacotherapy with CPZ, FXT, AMT, Clomipramine and Cyproheptadine (8 to 32 mg)
• Group therapy and family therapy

Prognosis

Prognosis is better in

• younger age of onset
• less number of hospitalizations
• no bulimic episodes

Bulimia Nervosa

Definition

Bulimia nervosa is an eating disorder characterised by following clinical features:

• Commonly in early teens and adolescents.
• There is intense fear of becoming obese.
• Recurrent binge eating large quantities of food
• Feeling of lack of control over eating during binges.
• Self-induced purging
• Vomiting, using laxatives, diuretics, fasting or excessive exercise.
• Self-evaluation unduly influenced by body shape and weight.
• Bingeing and purging are not accompanied by anorexia nervosa.

Treatment

• Behavior therapy
  • based on positive and negative reinforcements
• Individual psychotherapy
• Drugs as adjuncts- Imipramine, FXT,
• Group therapy and Family therapy

Binge Eating Disorder

• Sometimes called compulsive overeating.
• This is a common eating disorder.
• Eating an amount of food much larger than most people would eat in a similar period and accompanied by a sense of lack of control or a feeling that one can't stop eating.
• Clinical features include:
• Eating much more rapidly than normal.
• Eating until uncomfortably full.
• Eating large amounts of food when not hungry.
• Eating alone because of embarrassment about how much is eaten.
• Feeling disgusted with oneself, depressed, or guilty about eating.

NURSING PROCESS

NANDA Diagnosis for Eating disorders

• • Anxiety
  • Disturbed body image
  • Powerlessness
  • Imbalanced Nutrition: Less than Body Requirements
  • Imbalanced Nutrition: More than Body Requirements
  • Chronic low self-esteem

Interventions

• • Nutritional Stabilization
  • Strengthening coping skills
  • Promotion of self-esteem and positive self concept.
  • Cognitive Behavioral Interventions
  • Thought stopping techniques
  • Body Image Interventions
  • Family Involvement
  • Group Therapy
  • Exercise
  • Medications