bulimia nervosa in children
Introduction
Introduction to pediatric bulimia Bulimiarvosa is a syndrome characterized by recurrent episodes of overeating and a strong prevalence of weight control, leading to extreme measures to weaken the "fat" effect of the foods eaten. Both neurotic nervosa and bulimia nervosa are bizarre eating diseases. Although the clinical manifestations and prognosis of the two are different, the root causes and the essence of the disease are the same, and they all start from the fear of obesity. Some people treat these two diseases as different manifestations of the same disease. Both diseases are common in young women. As early as 1959, Stunkard reported that there were overeating, followed by vomiting, catharsis, etc. in obese and normal weight groups, and it was called "crazy eating syndrome" and later changed to "buying disorder". In 1979, Russell of the United Kingdom first proposed the term "bulimianervosa", which was gradually accepted by the public. At present, the disease has an independent classification diagnostic standard, but the relationship with anorexianervosa still differs. basic knowledge The proportion of sickness: 1.9% Susceptible people: children Mode of infection: non-infectious Complications: acute gastric dilatation, arrhythmia, amenorrhea
Cause
Pediatric bulimia
(1) Causes of the disease
It is believed that this disease is the result of a combination of biological and psychosocial factors.
(two) pathogenesis
1. Biological factors: Although it has been reported that the same rate of identical twins is 22%, the rate of fraternal twins is 9%; among relatives, the proportion of depression is higher than that of the general population, but The relationship between the disorder and heredity is still unclear. Another study reported that the level of 5-HT metabolite 5-HIAA in the cerebrospinal fluid of this disorder was lower than that of the control, suggesting that the disorder may be caused by insufficient central 5-HT.
2. Psychosocial factors: With the social culture of thinness and beauty, the requirements of some special occupations, women's pursuit of perfection to meet the needs of professional competition, problems in patient personality, such as lack of self-confidence, poor control, etc. Produce a certain effect.
Prevention
Pediatric bulimia prevention
The etiology and pathogenesis of bulimia nervosa are still unclear, but the survey found that patients with bulimia often come from families with abundant diets, often with family, individual childhood, and adolescent obesity history.
Emotion prevention
The incidence of adolescent women in this disease is more, indicating that the personality is unstable during this period, vulnerable to external stimuli, or at home, contradictions between parents, serious illness or death of relatives and friends in the family, or frustration in school accidents. Wait, it is easy to have this disease, so it is crucial to keep the spirit optimistic and open-minded.
2. Work and rest
Reasonable arrangement of study and life, so that mental work and appropriate physical exercise, physical labor combined, appropriate arrangements for recreational activities and rest, can prevent the disorder of hypothalamic function caused by excessive fatigue.
3. Carry out the education of correct human beauty
A small number of cases have stubborn prejudice and morbid psychology for eating and obese body weight, resulting in a strong fear of getting fat and tempering diet, maintaining the so-called "beauty" of body shape, so the education of correct health "beauty" is also indispensable. .
Complication
Pediatric bulimia complication Complications acute gastric dilatation arrhythmia amenorrhea
Acute gastric dilatation, hypokalemia, arrhythmia, renal dysfunction, rare menstruation, and even amenorrhea. The patient's weight loss is not serious, and some are obese. Some patients have a full moon surface with an enlarged parotid gland, scar physique and dental caries. BN patients usually do not lose weight, so amenorrhea is rare, occasionally less menstruation. Often accompanied by diarrhea, bloating, belching and constipation, hypokalemia, muscle weakness and paralysis due to frequent and severe vomiting.
Symptom
Pediatric bulimia symptoms common symptoms appetite abnormal overeating gluttony bulimia
Patients have strong, irresistible desire for food, can not self-made gluttony, eat a lot of food in a short period of time, when the attack, patients often can not control and limit their diet, so there is paroxysmal gluttony, it is reported Bulimia patients can consume a surprising amount of food in a short period of time. In one episode, they can consume 48,116 kilojoules (11,500 kcal) and consume 209,200 kilojoules (50,000 kcal) a day. After eating, Because of fear of obesity, the use of inducement, catharsis, fasting, taking diuretics, thyroxine and other means to eliminate the weight gain caused by binge eating, the patient's weight loss is not obvious, sometimes even higher than normal, but because of long-term overeating, lure Sputum, catharsis, etc., can lead to a series of physical complications.
Examine
Pediatric bulimia check
1. Electrocardiogram examination: visible heart rate slowdown, low voltage, prolonged QT time, non-specific changes in ST segment, U wave and arrhythmia.
2. X-ray examination: Osteoporosis and kidney stones can be found.
3. EEG examination
Some patients with AN are associated with seizures and present with abnormal EEG. EEG abnormalities can return to normal after normal diet. Some people think that because of starvation, the specific amino acids in the blood are reduced, and these amino acids are the necessary neurotransmitters to maintain brain function. In addition, starvation causes trace elements such as zinc, copper, selenium, and magnesium to be insufficient, affecting enzymes and hormones in the brain. The symptoms of zinc deficiency are very similar to those of AN. They are also characterized by anorexia, thick pronunciation, and depression.
4. Imaging examination: There were no hypothalamic and pituitary space-occupying lesions in the head CT and MRI. There may be brain atrophy and enlarged ventricles.
Diagnosis
Diagnosis of pediatric bulimia diarrhea
The diagnosis requires the following conditions:
1. The preemptive concept of persistent eating has an irresistible desire for food; it is difficult to restrain the eclipse of eclipse, and the patient eats a lot of food in a short time.
2. The patient attempts to counteract the "fat" effect of food self-excretion by one or more of the following means; abuse of laxatives; intermittent fasting; use of certain drugs, such as appetite suppressants, thyroxine preparations or diuretics, when diabetics When bulimia occurs, they may ignore their insulin treatment.
3. Psychopathology includes the morbid fear of obesity. The patient has established a strict weight limit for himself. It is much lower than the pre-existing or physician-approved healthy weight standard. There are many (but not always) anorexia nervosa episodes. In the past, the interval between the two ranges from several months to several years.
During the diagnosis process, it is necessary to eliminate the bulimia caused by bulimia, vomiting and other mental disorders caused by physical illness.
