Anorexia nervosa is a kind of eating disorder caused and maintained by itself, which is manifested by anorexia, weight loss and even anorexia caused by dieting, and often causes malnutrition, metabolic and endocrine disorders and physical dysfunction. The most basic symptoms of anorexia nervosa are anorexia, extreme lack of appetite and emaciation. This symptom is mainly related to psychological factors, not caused by organic diseases of digestive system. The onset age of this disease is 10-30 years old, mostly 15-23 years old. Female patients are about10-20 times higher than men. Due to the change of social atmosphere and lifestyle, the incidence of anorexia nervosa has greatly increased or decreased. Acute mental trauma or persistent depression may lead to this disease under certain conditions.

Recently, the number of girls with anorexia nervosa caused by blind weight loss and excessive dieting in Shanghai has gradually increased. The data of the Municipal Children's Mental Health Center also shows that the incidence of the disease has tripled compared with the same period last year.

Its main clinical manifestations are: at first, there was the psychology and behavior of deliberately dieting for fear of obesity, and then there was uncontrolled eating and rapid weight loss. The emaciated elephant cachexia still refuses to increase its food intake, and even feels too fat when it is infinitely thin and fatal. Refuse to keep the weight at the lowest level corresponding to their age and height, so that some patients are skinny and unable to get out of bed, some people starve to death, some use exercise, vomiting, venting and other means to lose weight, sometimes overeating, vomiting after meals, and lose more than 25% weight. Due to hypoglycemia, nausea, dizziness, fatigue and sometimes syncope often occur. Extreme malnutrition such as dry skin, pale skin, poor elasticity, thin subcutaneous fat and skin edema caused by hypoproteinemia. Accompanied by severe endocrine dysfunction, female amenorrhea, male libido loss or impotence. If it happens before puberty, puberty development slows down or even stagnates, breast dysplasia, male secondary sexual characteristics are undeveloped, and genitals are childish. This kind of patients often have emotional instability, anxiety, insomnia, obsessive-compulsive ideas, and some will also lead to secondary depression and morbid psychology. In severe cases, they may have suicidal thoughts and behaviors. It should not be ignored that many girls generally lack knowledge of anorexia nervosa, and girls who blindly pursue slimming and deliberately diet suffer from anorexia nervosa and dystrophic muscular atrophy to varying degrees.

Diagnostic criteria of anorexia nervosa: (1) The standard weight of the same age and height is less than 15%, and the original weight is reduced by 25%; (2) Pursuing slimness, intentionally controlling diet and being willing to starve; (3) Women who have been in menopause for more than 3 months; (4) Slow heartbeat, vomiting, etc. (5) No other physical diseases or schizophrenia; (6) onset age 10 ~ 30 years old.

The treatment of anorexia nervosa mainly includes the following aspects:

(1) Psychotherapy: First of all, we should get the cooperation of patients, understand their inducing factors, give cognitive therapy, behavioral therapy and treat fatigue at home? [6] How dare you send me an email? How to get to Wenping? ┪??5?? Fat? ≡≡≡ 888 Hey, what's up? ⒌⒌⒌⒌⒌⒌⒌⒌⒌⒌⒌⒌⒌⒌⒌⒌⒌⒌⒌⒌⒌. Tomu？ Trouble source? ∪ Play? Flood season > m [5]? ⒄ What's the matter with you? Hey? Hey? ∪⒂⒂∽?atmosphere？ Has this man been sentenced to death?

(2) Physical support therapy: according to the characteristics of less food intake, provide a high-calorie diet, and give intravenous infusion or high intravenous nutrition therapy to patients who vomit or refuse to eat. Take multivitamins, and hormone therapy can be given for endocrine changes.

(3) Stimulate appetite: Under the observation of a doctor, inject 2 ~ 6 units of insulin into the muscle half an hour before meals until the weight returns.

(4) Psychotherapy: antidepressants, lithium antipsychotics, antiepileptic drugs and anti-anxiety drugs can all be used for the treatment of this disease. Commonly used are sulpiride 200 ~ 400mg/ day, cyproheptadine 12 ~ 32mg/ day, amitriptyline 150mg/ day, which has better effect on people who overeat and vomit.

(5) Change of ideas. Slim is popular now, and thinness is beauty, which is a trend. The recognition of being fat, thin, strong and thin changes with the guidance of public opinion. It is widespread in some countries and regions in history or now to regard fat as beauty and firmness as beauty. In my opinion, girls are in the period of physical development, so don't blindly lose weight and diet. No matter what the trend is, health is always beautiful. Being strong and plump is more conducive to enhancing resistance and fertility, and it is also sexier, so you can enjoy a good sex life in the future.

A junior high school girl, after overhearing her classmates say that she is fat, only eats a small amount of snacks and fruits every day. When eating, she either said she had eaten, or quietly dug it out and spit it out. Three months later, her weight dropped from 95 kg to 60 kg, her appetite disappeared and her mood was obviously low. However, girls still don't feel thin and insist on controlling their weight. After her mother found out, she took her to the hospital for treatment and was diagnosed as anorexia nervosa. There is also a female student who weighs 100 kilograms. She felt overweight, so she went on a blind diet to lose weight, almost to the point of not eating. In less than two months, the weight dropped to 65 kg, but it was accompanied by malnutrition edema and anorexia nervosa. This is obviously overkill. If you really want a healthy body, you should not start with dieting, but strengthen exercise, get rid of the bad habit of eating snacks, adjust your diet structure, eat more fruits and vegetables with low sugar, low fat and high protein. The singer Carpenter died of anorexia nervosa because of dieting, which is a great loss for the world literary and art circles. Do you want to follow in her footsteps? Anorexia nervosa is more common in adolescent girls and young women. It is characterized by anorexia, obvious weight loss and amenorrhea. The cause of anorexia nervosa is still unknown. Related factors can be divided into the following aspects. 1. Socio-psychological factors In adolescence, girls become more and more plump with the development of secondary sexual characteristics. In this regard, it is easy to have a sense of fear and shyness, and there is a desire to maintain or restore the body shape to be "slim" before development. Adolescence is the period with the highest incidence of anorexia nervosa. Social concept affects the standard of being fat, thin, beautiful and ugly. In a civilized and developed society, there is a misunderstanding that thinness is beauty. This is why the social civilization and living standard have been continuously improved for more than 20 years, but the prevalence rate of anorexia nervosa characterized by emaciation is obviously increasing gradually, especially in some occupations, such as ballet dancers and fashion models, which is 3-4 times that of the general population (the same age). In addition, anorexia nervosa mostly comes from families with high social status or rich economy; The prevalence rate of urban population is higher than that of rural population; In cities, the prevalence rate of female students in private schools is higher than that in ordinary schools. 2. Individual susceptibility. Such patients tend to be competitive, pursue perfection, like to pursue praise, self-centered, neurotic; On the other hand, they are often immature, unstable, suspicious, sensitive, over-dependent on their families and shy. Some studies have found that the occurrence of this disease may be related to some genetic qualities. 3. Patients with hypothalamic dysfunction anorexia nervosa have obvious hypothalamic dysfunction, such as menstrual disorder or amenorrhea; The level of thyroxine in blood is low; Abnormal appetite and appetite, low mood or irritability. The clinical manifestations of anorexia nervosa are usually occult, with gradual anorexia and weight loss, 1/4- 1/2 or above, and amenorrhea. Different degrees of emaciation, serious when skinny. However, physical strength is still abundant, and amenorrhea without pubic hair loss is the characteristic of this disease, which can be distinguished from pituitary dysfunction (Simon's disease), but fatigue, burnout and depression may occur in the later stage. Patients don't necessarily have anorexia at first, but just create various reasons to refuse to eat. Some patients have a good appetite, but after eating a few bites, they feel full and uncomfortable and stop eating, or they don't want to eat when they see food. If you eat forcibly, it will often induce nausea and vomiting; Some patients even try their best to induce vomiting. In addition to anorexia, patients may also have other neurosis symptoms, such as hysteria, epigastric fullness and discomfort, unexplained fatigue, lack of interest in sexual desire, insomnia and so on. Patients diagnosed with anorexia nervosa need to go to the gastrointestinal specialist clinic for a comprehensive examination. If the gastrointestinal examination is negative, there is a history and manifestations of severe mental trauma, emaciation and physical strength are acceptable, and there is no comprehensive endocrine gland dysfunction, the diagnosis of anorexia nervosa can be made. Treatment of anorexia nervosa 1. Supplementing nutrition and correcting malnutrition can endanger life. In the case of severe malnutrition, the mortality rate of anorexia nervosa patients can be as high as 10%. Therefore, emergency treatment is necessary. If the patient refuses treatment, he should be hospitalized by persuasion and coercion to save the patient's life. At this time, the treatment is to correct the water-electrolyte balance, supplement blood potassium, sodium and chlorine, and monitor. When plasma protein is low, hydrolyze protein, plasma, etc. It's all intravenous. Iron, folic acid and vitamins should be supplemented for anemia. Because the patient does not eat for a long time, the gastrointestinal function is extremely weak, so eating should be gradually increased from soft food and a small amount of meals, and there is no rush to achieve success; Appropriate digestive AIDS: gastric enzyme mixture, multi-enzyme tablets, lactase, etc. Or acupuncture treatment, can also be used to promote the recovery of appetite and digestive function. The patient's weight should be increased by1-1.5 kg/week. 2. Psychotherapy Psychotherapy should find an experienced specialist psychologist. Psychotherapy includes relieving patients' psychological pressure, having an objective understanding of the environment and themselves, finding an angle to adapt to society and the ability to handle and cope with various life events. In addition, the concept of healthy body, the significance of standard weight, and the objective evaluation of one's physical condition. Understand the knowledge of food and nutrition. For patients with family tension, family members can be invited to do family psychotherapy when necessary. Behavior correction is another kind of psychotherapy, which mainly promotes the patient's weight recovery. It can be used to limit the patient's range and amount of activity, and gradually give him freedom of movement with the increase of weight. This method is generally used in hospitals with extremely low patient weight. 3. Antidepressants are often used in the treatment of psychotropic drugs. Etiology thinks that the disease may be related to depression, so clomipramine, amitriptyline and dodopin are used. Diazepam is also often used to regulate patients' anxiety. These two kinds of drugs have positive effects on improving patients' depression. The earliest drugs used to treat anorexia were hibernating spirit (chlorpromazine) and perphenazine. A small dose is used to treat patients who are extremely afraid of obesity and cannot objectively evaluate their body shape (physical disorder), and has also achieved certain results in the treatment. The prognosis study of anorexia nervosa shows that 70-75% patients recover after about 5 years. The prognosis of patients with a course of more than 5 years is poor; The mortality rate of patients with a course of 4-8 years is 5-8%, including deaths caused by malnutrition, infection and suicide. What is the cause of anorexia nervosa? 200114:14: 6 The etiology of this disease is still unknown in Peking University Institute of Mental Health. Most experts believe that the occurrence of this disease is the result of many factors. Perhaps one factor is too strong to cause the disease, or it may be caused by the interaction of several factors. Related factors can be divided into the following aspects. (1) socio-psychological factors l) fear of sexual development in adolescence: 13 years old is the fastest stage of sexual physiology and psychological development. For girls with immature sexual psychology, they lack sufficient psychological preparation for their secondary sexual development and increasingly plump figure, and are prone to fear, anxiety and shyness, and have a strong desire to maintain or restore their figure to the "slim" before development. In Britain, a survey of female students shows that 60-70% of female middle school students want to lose weight, and 75% of female college students want to lose weight, which is much higher than that of primary school students and people after 30 years old. And this stage is precisely the peak age of onset. 2) Social and cultural factors: There is no doubt that social pressure will seriously affect individuals' thoughts and behaviors. The ideal image is influenced by social and cultural factors. In less developed times (poverty), fullness and obesity are envied as symbols of wealth; In modern society, slim figure is regarded as a sign of ability, elegance and attraction, which makes people prefer low weight. In the past 30 years, the prevalence of anorexia nervosa has obviously increased gradually, especially in some occupations, such as ballet dancers and fashion models, which is 3-4 times that of the general population (the same age), indicating that the occurrence of this disease has a certain relationship with social and cultural factors. 3) Other sociological factors: In most surveys on the prevalence of anorexia nervosa, it is found that most patients come from families with high social status or rich economy; The prevalence rate of urban population is higher than that of rural population; In cities, the prevalence rate of female students in private schools is higher than that in ordinary schools. And these characteristics are consistent with the research reports of Britain, America and Japan. (2) The individual's susceptibility quality is 1) Personality characteristics: these patients often have the characteristics of being competitive, being perfect in doing things, being fond of pursuing praise, being self-centered and being neurotic; On the other hand, they are often immature, unstable, suspicious, sensitive, over-dependent on their families and shy. In addition, recent studies have noticed that the IQ of such patients is generally high. 2) Genetic factors: In some family history surveys, it is found that the prevalence of anorexia nervosa is several times higher than that of other people, especially in siblings and parents. This shows that although it is not a genetic disease, the occurrence of this disease may be related to some genetic qualities. In addition, the number of patients with manic-depressive psychosis and neurosis in the family is also higher than that in the general population. These data also support the theory that genetic quality plays a role in the pathogenesis. 3) Specific susceptibility: Some researchers believe that excessive weight loss plays an important role in the onset and illness. When the weight drops to a certain extent, it stimulates the specific pathological mechanism of anorexia nervosa hidden in the body, which makes the patient in such a state: losing the ability of self-control, lacking the correct analysis and judgment of his own thinking and behavior, immersed in pathological experience, so a person drops from normal weight to disease state. However, this theory has not received enough evidence. (3) Hypothalamic dysfunction: Hypothalamus is located under the cerebral cortex and is the central position responsible for emotional regulation, diet control and endocrine regulation. It is one of the most important parts of the brain. Patients with anorexia nervosa have obvious hypothalamic dysfunction, such as menstrual disorder or amenorrhea; The level of thyroxine in blood is low; Abnormal appetite and appetite, low mood or irritability. The results of many years' research on these extensive hypothalamic functional abnormalities show that there may be abnormalities in some aspects of regulating hypothalamic functional activities, such as norepinephrine can excite the feeding center, promote the intake of carbohydrates (food) and participate in the secretion of gonadotropins (menstrual cramps). Some studies have found that the level of norepinephrine in cerebrospinal fluid of patients with this disease is low; Another example is that serotonin can excite the satiety center and stop eating. Some studies have also found that serotonin in patients' cerebrospinal fluid has changed. But so far, there is no consistent positive conclusion in this field. How is anorexia nervosa? 2001March 20 14: 14:8 Anorexia nervosa, also known as anorexia, is a psychological and physiological obstacle for patients to intentionally drop their own weight below the normal physiological standard weight and try to maintain this state. The disease mainly occurs in teenagers, mostly in the period of 13-25 years old, and mainly affects women, with a male-female ratio of about 1: 9.5. The prevalence rate of the disease is different around the world, with the highest report in western countries such as Europe and America. The prevalence rates of different ages and different populations are also different. For example, it is reported in Britain that the prevalence rate of high school girls is 1/250 and 15-35 years old is 1%. In recent years, the incidence of the disease in China has shown an obvious upward trend, especially in areas with rapid economic and cultural development, mainly in cities, and the number of patients has increased significantly. For example, the number of patients treated before 10 was about 1-2%. About 5-6% in recent years. Most of these patients are in a serious state, the shortest course of disease is half a year, and the longest is more than five years. It can be seen that a large number of patients still do not come to see a doctor. The main symptoms of anorexia nervosa are endless weight loss, fear of weight gain, and discoloration when smelling "fat". Although the disease is called anorexia, it is not that such patients have no appetite, or more accurately, they are afraid to eat, rather than "unable to eat". In the late stage of the disease, due to lack of food for a long time, loss of appetite may occur. Patients mainly carry out various activities around losing weight, such as deliberately dieting, strictly controlling the amount of staple food, fat and protein, and increasing daily activities, which are far below the appropriate weight standard of patients, and often present emaciation, extreme emaciation and severe malnutrition. On the contrary, patients will feel gratified or feel safe. Most patients still think that they or a part of them are still "fat", so they are uneasy and insist on "losing weight" activities. This state is medically called the patient has body image disorder. Even if he is thin, the patient still feels that his eyes are fat. Many studies have found that patients' estimates of their abdomen, chest, buttocks and legs are actually larger than the actual ones 10-65438. The main hazards of anorexia nervosa are: due to severe malnutrition, decreased body function, severe anemia, cachexia, slow heart rate and easy infection, which is life-threatening. When it is lower than 65% of the standard weight, the mortality rate of patients is as high as 10- 15%. Because teenagers are in the physiological development period, this disease seriously affects their physical and mental development, affects their sexual maturity, thus affecting the future sexual psychology of patients, and also brings about a decline in social adaptability. So pay attention to early treatment. Advanced control of the dietary center We already know that the center of mammals is the hypothalamus. Leptin is a peptide hormone secreted by adipose tissue. When the body's energy storage is sufficient, leptin will act on nerve cells in the hypothalamus and control the body's eating behavior. However, we also know that the body's control over diet is undoubtedly controlled by the advanced center. For example, it is often said that she will eat a lot when she is unhappy, while boys say that she will not eat when she is unhappy. How to study this complex advanced control? Defalco, etc. The modified virus was used to trace the afferent nerve of mouse hypothalamus and many interesting results were found. The researchers modified the pseudorabies virus to be controlled by Cre recombinase, and the virus can only replicate in the presence of Cre. Then they added GFP to the virus vector, which is characterized by tracking the afferent nerves of neurons through synaptic connections. Therefore, Cre was first fused with the specific expression gene of nervous system, so that the virus was replicated in neurons of hypothalamus, and GFP was expressed in neurons. After a few days, GFP will be found in the afferent neurons of this neuron. In this way, the researchers analyzed the distribution of high-level control neurons of neurons expressing leptin receptor and NPY (nerve Y)Y in hypothalamus. They found that the afferent neurons of neurons expressing leptin receptor are more widely distributed than those expressing NPY neurons, and found several unreported areas, such as the input to hypothalamus through retrisplenial cortex and Lent. Of course, this method still needs to analyze the tertiary structure of brain images, but this wonderful method has enabled us to study other complex neural circuits more conveniently.