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Treatment of anorexia nervosa
Last reviewed: 20.11.2021
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If anorexia is not treated, the mortality rate is about 10%, although unrecognized disease in mild form rarely leads to death. In the treatment, half of the patients gain all or almost all of the lost weight, they recover endocrine and other functions. Approximately in 1/2 patients a satisfactory result of treatment is noted, there can be relapses. Unsatisfactory treatment of anorexia has the remaining half of patients, exacerbations are observed, mental and somatic complications persist.
Anorexia treatment may sometimes require a short-term vital intervention to restore body weight. All patients need long-term therapy to improve their mental health and prevent relapse.
If anorexia is accompanied by a pronounced or rapid loss of body weight or if the body weight drops below 75% of the ideal, then an urgent recovery of body weight is required, and the question of hospitalization is considered. Meal starts from 30-40 kcal / (kghsut) and should lead to a body weight gain of up to 1.5 kg / week in inpatients and 0.5 kg / week if anorexia is treated as an outpatient. If there is any doubt, the patient must be hospitalized.
Loss of bone mass should be treated with the addition of a microelement of calcium 1200-1500 mg / day, vitamin D 600-800 IU / day and with a severe condition - bisphosphonate.
When the food, water-electrolyte status is stabilized, long-term therapy begins. Treatment of anorexia is complicated by a negative attitude of the patient to a set of body weight, denial of the disease, manipulative behavior. The doctor should try to maintain a calm, stable, sympathetic relationship while explaining the rational consumption of calories. Individual psychotherapy, especially cognitive-behavioral therapy, as well as family therapy for younger patients may be useful. Second-generation antipsychotics (for example, olanzapine 10 mg once a day) can help in weight gain and reduce the painful fear of fullness. Fluoxetine in an initial dose of 20 mg once a day can be useful in preventing relapses after weight gain.
Treatment of anorexia should be carried out under the supervision of psychiatrists in most cases in a psychiatric specialized hospital. Apply general restorative therapy, the purpose of which - the increase in body weight. The main approach to therapy is to restore adequate nutrition. Along with this, specific treatment of anorexia with use of psychopharmacological drugs, psychotherapeutic methods of influence is applied.
Patients should undergo long-term treatment of anorexia in a psychiatrist. Particular attention is given to removing the patient from the state of cachexia (nonspecific stage according to MV Korkina). Mandatory hospitalization in a psychiatric hospital is necessary - supervision of adequate nutrition, isolation from the family. The best effect is observed when carrying out adequate enteral nutrition with elemental mixtures. The next stage is the specific treatment of anorexia with psychotropic drugs, and then psychosocial adaptation.
According to the research, 30-40% of patients do not recover menstrual function after normalizing the body weight to the baseline and maintaining it stable for 5-6 months with the withdrawal of psychotropic drugs. Thus, after recovery of body weight, treatment of anorexia in a gynecologist-endocrinologist is necessary. This group of risk included patients with late establishment of menstruation, a high "weight threshold", the onset of the disease in the pre-fertility period and its prolonged course.