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?F???? : ??? ????? ?? ?????????S ???G??S. ??t??? ?????, s????s? ?a? e??t?at??? ??a t?? s?at???? ?a? ??????? eta???? f?s???????? e?e?e???s? t?? ????? s?pe??f???? pe??aat?s??ep?d???? ?et???? e????a? ea?t??. ?F???? : ??? ????? ?? ?????????S ?G?????????S ???G??S.
E N D
1.
??????F???S ?????????S :
????G???S ????????
????G???S ????????
??te?? ?. ?s?ts??a
?a?d?at???-?f???? ?a?d?at????
????da ?f????? ??e?a? (?.?.?.)
??s???e?? ?a?d?? ? & ? ????a???
2. ?F???? : ??? ????? ?? ?????????S ???G??S
??t??? ?????, s????s? ?a? e??t?at??? ??a t?? s?at???? ?a? ??????? eta????
f?s???????? e?e?e???s? t?? ????? s?pe??f???? pe??aat?s??
ep?d???? ?et???? e????a? ea?t??
3. ?F???? : ??? ????? ?? ?????????S ?G?????????S ???G??S
new morbidity
S?pe??f??? ?????? ???d????
4. S?pe??f??? ?????? ???d????
?a?
e????t? p??s?p???t?ta-
p??d?a?es???? pa?????te?
?????????
5. S???S?? ??????F??O? ????????O? S?a?t??? ep?pt?s? p?? s??e??? a????eta?
S?a?t??? ??s???t?ta- ???a???? ?a? ????????????? d?s?e?t?????a p?s???t??
S?a??? ep?p?????
??s???? a?t?et?p?s?, s????? ?p?t??p??
?p?f??a?t??? p?????s?, ????? ???t?t?ta
6. Anorexia nervosa (1) ???t? pe????af? t? 1874 ap? t?? Sir William Gull
O??s?? ???t???a d?????s??: *
?. ????s? d?at???s?? t?? e????st?? ??a t?? ?????a ?a? t? ???? s?at???? ????? ( < 15% t?? f?s?????????)
?. ??t???? f??? ??a t?? pa??sa???a ?a? t?? p??s???? ?????
G. ??ata?a?? t?? e????a? s?at?? (? as?e??? a?s???eta? pa??sa????, pa?? t? ?t? e??a? e???p?a???) ?/?a? ep???? ????s? pa?ad???? t?? ??s?? ?a? t?? a??t?ta? t?? ?at?stas??
?. ????????a (p??t?pa???-25% ? de?te??pa??? : ap??s?a t??????st?? 3 a?ae??e??? d?ad?????? ?????? e??????s?a?)
_____________________________________________________________
* Diagnostic and Statistical Manual of Mental Disorders of the ?merican Psychiatric Association, 4th ed. Washington, DC, APA Press, 1994 (DSM-IV)
8. Anorexia nervosa (2) O??s?? ???t???a d?????s??: *
?pe?d?ast????t?ta, ??t??? s?at??? ?s??s?,d?ata?a??? ?p???
??????? eta????, pe??e??? d?a?t?t??? s?pe??f??? ?a? ?e???s?? t?? t??f??
?p??s?a ?p??e?e??? ???a????? ??s?? p?? ?a e????eta? ??a t?? ap??e?a ?????
____________________________________________________
* Diagnostic and Statistical Manual of Mental Disorders of the ?merican Psychiatric Association,
4th ed. Washington, DC, APA Press, 1994 (DSM-IV)
9. Anorexia nervosa (3) ??a?t?t???? t?p?? :*
?. ?e?????st???? (??ste?a, ap??? ap? t?? t??f?)
?. ?????????
(epe?s?d?a p???fa??a? se s??d?as? e t??
p?????s? e?t?? ?a? t? ???s? ?a?a?t???? ?
d?????t????)
12. ??????????G?? (1) ?p?pt?s? 0.5-1%, 1-5% *(Medscape's General Medicine 6(3) 2004)
????ts?a / a????a: 10 / 1
????? ?????????-????????? ??s?
?e??? f???
????? ??f?t??? ep?ped?, p??? ?a?? s?????? ? a?ad?a??? ep?d?s?
?????a : de?te?? de?aet?a ????
- 13 e?? 20 et?? : 85%,
- ??a??? st?? pa?d??? ?????a : 3%,
- d?????f? ?ap??? ef???s?? t?? ??s??: 14 ?a? 18 et??
13. ??????????G?? (2)
S?a?t??? a???s? ep?pt?s?? t?? ??s?? (1930-1980)*
????s? t?? ep?pt?s?? sta ?at?te?a ????????????????? st??ata
????s? t?? ep?pt?s?? se ???e? f????
????s? t?? ep?pt?s?? se a?apt?ss?e?e? ???e?
______________________________________________
* Lucas AR, Beard CM, O Fallon WM, Kurland LT : Fifty-year trends in the incidence of anorexia nervosa in Rochester, Minn : ? population based study. Am J Psychiatry 148 : 917-922, 1991.
14. ??at??f???? d?ata?a???-a???e??a 6% t?? ef??? e??a? ???? ?????? (pa???????? ????) se s??s? e t? ????, t? f??? ?a? t?? ?????a
? a????? t?? ????ts??? e ???? ?????? ???? ?ta? tet?ap??s??? ap? a?t?? t?? a??????
60% t?? ef??? e ???? ?????? ???? ep?????sa? ?a ??s??? ep?p???? ???? ?a? de? ?ta? e??a??st????? e t?? e????a s?at?? t???
(3.5% t?? s??????)
??G? : ?.?.?.
15. ???????G??
????pa?a???t???
17. Ge?et???? pa????? ? ?e?et???? pa????? e??a? ?s?????
???d???es? se e????t? p??s?p???t?ta e ?????, te?e??a??a ?a? e?????
?t?a e ?t??a ? ade?f? p?? p?s?e? ap? d?at??f??? d?ata?a??, ????? 12 f???? e?a??te?? p??a??t?ta a??pt???? a??????? d?ata?a???, s?????t??? e p????s? e a???t??? ?????e?e?a?? ?st?????.
(Eating Disorders Review. Nov/Dec 2002)
18. ???????e?a ??s?e?t???????? ???????e?e?
(a?ta???s??, ad??a?a ep???s?? ???se??, s??????s?a??? s??se??, ad?af???a)
???????e?e? e ?????e??a
?????at??? s??s? e t? ?t??a
(p?est??? ? s??a?s??at??? ep?ped?)
?d??f?a p?? ???p????? t? e?d?af????
?a??? a?t?e?t??s?
(ap?????? ? ep????t??? s????a ??a t?? ef???s? st? pa?e????)
?e?e??a??a
(pe??????? e ?pe??????? apa?t?se?? ap? t? s??????, t?? a???t??? ? ???? ep?d?s?-pa?ae????ta? ?? s??a?s??at???? a????e?)
19. ??????T?S???? ????G????S 1. ?st????? e?af??? ?p??as?? s?at???? ?????, pa??sa???a?
2. ?e?e??a??? s?pe??f???
3. S???e?e?? a? a??? e anorexia nervosa
4. ??f???f???a sta a????a
5. ?ept? s?????ta (a???t??e? ??????? ???ast????, ???e?t??e?
pa??t??)
6. ?at?????? s??a?s??at??? ast??e?a, ???e??? a?t?pep????s??
7. Se???a???? ?a??p???s?
20. ????????? ????G????S
1. ??es? ???, ??????, ?a????t??, ?at??? :
p??t?p? ?ept?? ?a? a???t???? s?????ta?
2. S?a?? as???e?a ? ???at?? s???e????? p??s?p??
3. ???a?? t?p?? d?a????
4. ????? ap??e?a ????? et? ap? ?p?a as???e?a (???e??? ??s?a, ?ast?e?te??t?? ??p) p?? a???????? s??e???eta? e???s?a
22. S????? ?G????S??S?S ?p??e??d??? d?a?ta + p????aa ???ast????
?p??e?a ?????
????????a
?p??e?a ??e???, a?s??a ??a??p???s??
St???? ??a ??? ?a? e?a??te?? ap??e?a ?????
?eta??? s?pe??f???? : e???, ap????s?, ap???t? af?s??s? st? st???
S?a?t??? ap??e?a ????? - ap?s??as?
?p?p?????
23. F?S??? ?????S? 1. ?p?s??as?, af?d?t?s?
2. ?p??e?a t????? ?efa??? ?a? ef?a???
3. ???a : ????t?ta, ????? ???, ????d? p??s?p??, ???, ?????, t????s? st?????, ?????a??? ???a?
4. ?p??e??a (?e????as?a ????? 36.20 C)
5. ??ad??a?d?a (60 pa??? / ?ept?), ?p?tas? < 80/50 mmHg)
6. ??d?ata ??t? ?????
7. S?e?a ??st????????? a?ep???e?a?
( ????t?ta ???p??, ?p?p?ast??? ?t?a, ?ste?pe??a-?ste?p???s? )
26. ??G?S??????? ???????? (1)
?. ????????G??? :
???? ?a??? ??? (< 10mm/h)
- ?e???pe??a
- T???pe??a
- ??a??a
27. ??G?S??????? ???????? (2) ?. ????????? :
- F?s????????? t??? se p???a st?d?a
??????? t?? ????a? p??sat??
??????? t?? ????ste?????
??????e? t??? t?a?sa??as??
?p?f?sfata??a (???? ?a? d?se??? e???a )
?a???? t??? ?e?da??????
28. ??G?S??????? ???????? (3) G. ???????????G??? :
?a???? (p?e?ef????? t???) ???ad?t??p????
?a???? t??? t?? ?????? t?? f???? (??st???????, a?d???????)
?pe????t????a??a
???tt?s? t?? ???e?e?d???? ?e?t?????a? (?3, ?4)
29. ???F??????G?OS? (1) ?d??pa??? f?e????d?? ??s?? t?? e?t????*
?????st??? ??s??*
?a????e?e? , ?e?p??sata e??ef????
S??d??? ap?s??as?? t?? AIDS
S??d??a d?sap????f?s??
??s??????e?a?t?e??? S?*
T??e?t?????s?
?a?as?t?se?? pept????
______________________________________
* ??s?ata e a?????? ep?pt?s? d?at??f???? d?ata?a??? (comorbidity)
30. ???F??????G?OS? (2) ?at??????
S????f???e?a
?e???se??
??ata?a?? p??s?p???t?ta?
???s? ??s???
31. ?????? ??S?? ????????S (?) ?e?????st???? t?p?? :
1. ?atast??? t?? ?e??? t?? ?st??
(a?a??a, ?e???pe??a, ????pe??a)
2. ???s?a?ep???e?a
(d?ata?a?? t?? ?????? ?a? ??tta????? a??s?a?)
3. ?????e??
(?ta? ap??e?a ????? < 40% t?? f?s???. ????? s?at??)
4. ??????? e?d???s? a?ep???e?a? ?e?da??????
(a??? ep????s? t?? p?????, ??????? d?ata?a???)
5. ?p?f?sfata??a : ?a?d?a?? a?ep???e?a, ?atast??? ??S, a????t??? a?a??a, ?ad?????s?
32. ?????? ??S?? ????????S (?) ????????? t?p?? :
1. ??????s? e?t?? ?a? ???s? ?a?a?t???? : ap??e?a ????? ?p????a??a
2. ?a?a???? a?d?ste????? ap? t??? ?ef????
(de?te??pa??? ?pe?a?d?ste????s??)
3. ?p??at?stas? ????? ?a? ???? ?ata???t?s? ?????
4. ?a????? as?e????, p?????s? e?t?? ?a? ?at????s? ?a?a?t????
(e?? 60 d?se?? ?e??s??? !!!)
S?????S ?????????S ??? ???????? ?? ?O?
33. ?????? ??S?? ????????S (G)
????????? t?p?? :
?. ??????s? e?t??
- ?p????a??a
- ?p??at??a??a, ?p??a??a??a
- ?p?????a???? eta????? a?????s?
- ?at????s? ?pe?a?????a? ???a?d??p??e?a
?. ?at????s? ?a?a?t????
- ?p????a??a
- ?eta????? ????s?
- ?p??a??a??a ( < 15 mEq/Lit se t??a?? de??a ????? )
G. ?at????s? d?????t????
- ?pe?????a???? ????s?
- ?p??at??a??a, ?p??a??a??a ( > 30 mEq/Lit se t??a?? de??a ????? )
34. ???G?OS? (1)
?e ?e?ape?a, 60% t?? pa?d??? ?e?ape???ta? :
??at???s? ?????? ?????
??at??f??? p??????a
?e? ep??????ta? ???? t??f?? ?a???? se ?e??de? ? ??pa??
??at????? ?e?t???????? f?????? ? ??a?t???? s??se??
?????????? ?a????a ?/?a? ???????e?a
35. ???G?OS? (2)
?e???? ?fes? : 20%
?? e?t??s? : 20%
36. ???G?OS? (3) ????? ?e?ape?a, 20% t?? ef??? e ?e????e?? a???e??a ?a p??a??a?
?e ?e?ape?a, t? p?s?st? a?t? e???eta? st? 2-3%
??t?e? ?a??t?? : a?t??t???a, ?a?d?a?? a?????a, ep?p????? epa?as?t?s??, ??e?t????t???? d?ata?a???, ?????e??
37. ?p?a???t???? pa?????te?
???? d?????s?
??d???? f???
????????? t?p??
38. ???????? (1) Stunkard 1959, ?arber 1997
O??s?? ???t???a d?????s??: *
?. ?p?t??p?????ta epe?s?d?a p???fa??a? p?? ?a?a?t??????ta? ap? :
1. ?ata????s? a?t??e?e???? e????? p?s?t?ta? t??f?? se
s???e?????? ????? (p? d?? ??e?)
2. ??s??a ap??e?a? a?t?e?????? ?at? t? epe?s?d??
(? as?e??? de? e????e? t? p?te ?a staat?se? ? t? p?s? ?a f?e?)
?. ?fa???? a?at??????? ?a? ep????d???? a?t????p?st???? ta?t????, p???e????? ?a e?e???e? t? ???? s?at?? (p?????s? e?t??, ???s? ?a?a?t???? ? d?????t????, e?a?t??t??? ?pe?d?ast????t?ta ? s?at??? ?s??s?)
_____________________________________________________________
* Diagnostic and Statistical Manual of Mental Disorders of the ?merican Psychiatric Association, 4th ed. Washington, DC, APA Press, 1994 (DSM-IV)
39. ???????? (2) O??s?? ???t???a d?????s??: *
G. ?f???s? d??(2) epe?s?d??? t?? ed??da ??a t?e??(3) ??e?
?. ? a?t?-a???????s? as??eta? s?ed?? ap???e?st??? st? s??a ?a? t? ???? t?? s?at?? (?pe?????? e?as????s?)
?. ? d?ata?a?? de? pa???s???eta? ap???e?st??? st? p?a?s?? ???se?? anorexia nervosa
????????? t?p?? :
?. ?a?a?t???? (? as?e??? p???a?e? ?et? ? ???s??p??e? ?a?a?t??? ? d?????t???, p???e????? ?a ap?f??e? t? a???s? t?? s?at???? ?????)
?. ?? ?a?a?t???? (? as?e??? de? p???a?e? ?et? ?a? de? ???s??p??e? f??a?a,
?st?s? ?p????eta? se ?pe?????? s?at??? d?ast????t?ta)
____________________________________________________________________
* Diagnostic and Statistical Manual of Mental Disorders of the ?merican Psychiatric Association, 4th ed. Washington, DC, APA Press, 1994
(DSM-IV)
40. ?p?d???????a ?p?pt?s? 1-5%
S?a?t??? a???s? ep?pt?s?? t?? ??s?? ep?d??a st?? ???
????ts?a / a????a : 10/1
????? ?????????-o???????? ??s?
?e??? f???
?????a : ???? ef?e?a ?a? ?ea??? e?????e?
41. ??????T?S???? ????G????S (1) ?st????? e?af??? ?p??as?? s?at???? ?????, pa??sa???a?
?at?????? s??a?s??at??? ast??e?a, ???e??? a?t?pep????s?? ?a? a?t?e??????
?e??????? p?? d??e? ?fas? st?? ef???s? ?a? t? s?st? d?a?t?t??? s?pe??f???
?????at???? ?????e?e?a??? s??se??
?s?e?e?? e anorexia nervosa p?? a???sa? t? ???? t??? p??? ??????a ? ??t? ap? p?es?
42. ??????T?S???? ????G????S (2) ??ata?a?? p??s?p???t?ta? (< 30%)
- a?e???e??t? ?a? a?t??atast??f??? s?pe??f???
- pa?aat???t?ta, a?t?????????? s?pe??f??? (p? ??ept?a??a)
- se???a???? ?pe?d?ast????t?ta e p?????? s??t??f???
- ???s? a?????, ?a???t???
- p????at??? ???????e?a (d?a?????, d?s?e?t???????? s??se??, ???s?
??s???)
43. F?S??? ?????S? S?????? pe??p?????? ef???s?, s?st? ???e???
(?p?????? s???? e?a???se??, e?d??? se pe??pt?se?? d?ata?a??? p??s?p???t?ta?)
S?????? f?s???????? ???? (s?a?t??? e?a??es? ? ???????? t?p?? t?? anorexia nervosa)
Ge???? ? pe??fe???? ??d?a
??a??se?? t?? adaa?t???? ??s?a? t?? d??t??? - ????t??
??????s? t?? pa??t?d??
???? ?a? p????? t?? ?pe??a? ?a? t?? f?????a, t???? t?? da?t????
S?e?a s?a?t???? ?p??a??a??a? (?a?d?a?? d?s?e?t?????a, ??p??e?a, d?ata?a?? t?? ep?p?d?? s??e?d?s??, e??e??)
44. ?ata???pt??? s??a?s??a
??t??t?????t?ta
?a??? a?t?e?t??s?
45. ????????S ?. ??????s? e?t??
- ?p????a??a
- ?p??at??a??a, ?p??a??a??a
- ?p?????a???? eta????? a?????s?
- ?at????s? ?pe?a?????a? ???a?d??p??e?a
?. ?at????s? ?a?a?t????
- ?p????a??a
- ?eta????? ????s?
- ?p??a??a??a ( < 15 mEq/Lit se t??a?? de??a ????? )
G. ?at????s? d?????t????
- ?pe?????a???? ????s?
- ?p??at??a??a, ?p??a??a??a ( > 30 mEq/Lit se t??a?? de??a ????? )
46. ???G?OS?
?fes? : 40-50%
?p?a???t???? pa????? :
d?ata?a?? p??s?p???t?ta?
47.
????e? ?p????? ?a? ?st???? a??pe? se f???????
?a? tape?????? ??e?? st?? ?????
????a ?p???
?a?, e??a? ?a? ? afa??es?
48. ???????O??S? (1)
?. ??at???e???? p??s????s?
?. ????? :
?a?d?at???
?a?d?????at???
??a?t??????
49. ???????O??S? - S?????
1. ?p??at?stas? t?? s?at???? ?e?t??????? ?a? t?? s?at???? ????? se f?s???????? ep?peda
2. ?pa?a?a?????s? f?s????????? d?at??f???? s????e???
50. ???????O??S? (3) 1. ??t?et?p?s? ape???t???? ??a t? ??? d?ata?a???
e?de??e?? e?sa????? st? ??s???e??
2. ???t?a ???a? (3-5 ???e?/ed??da, 6-9 ??e?/???a)
3. ??t?et?p?s? e??te????? as?e??? :
a. ?t???? ?a? ?????e?e?a?? ?????e?ape?a
. Fa?a???e?ape?a
?. ??a?t?t??? pa?a???????s? ?a? ep?t???s? t??
?e????te??? ??e?a? t?? as?e???
51. ????????S ??S?GOG?S S?a?? ?p???e??a (ap??e?a ????? > 25%)
?f?d?t?s?, ??e?t????t???? d?ata?a???
?a?d?a?? d?s?e?t?????a (s?a?t??? ?ad??a?d?a, a?????se?? st? ??G)
?p??e?e?? shock (ta???a?d?a, ????stat??? ?p?tas?)
??e?a ????s? ????? t??f??
??e???e??t? p???fa??a
?pe????se? ????at????? ?atast?se?? (p? a?t??t?????? ?deas??)
??at?????e? pe??a????t???? s?????e? ??a t?? a?t?et?p?s? t?? d?ata?a??? (p? s?a?? ?????e?e?a?? d?s?e?t?????a)
?p?t???a e????s???e?a??? a?t?et?p?s??
52. ????? st???? ap? t?? a??? t?? ?e?ape?a? e??a? t? e????st? ???? p?? e?asfa???e?:
t?? ??e?a ?a? t?? a??pt???
t?? epa?ef???s? e??????s?a?
t?? ?et??? e????a s?at??
t?? ??a??p???s? t??/t?? ef???
53. ?????S???S? ?p??at?stas? t?? s?at???? ????? st? 80% t?? f?s????????? :
?. ????s?a ???? t??f?? (s????te?a)
?????ast????? ?a?et??a?
?a?e?te???? s?t?s?
?. 3 ?e?ata ?a? 2-3 ???? ?e?ata (snacks) : 3000 ?e??de?/ ???a
G. ?p????t? a???s? ????? : 115 - 350 g/???a
?????e?a 10-14 ed??de?
54. S??????? ?????S???S?S ?fa???eta? se as?e?e?? e s?a?? ?p???e??a
(ap??e?a ????? > 30 %) ?ta? epa?as?t?st??? ??????a
?. ?p?a ??f? : ??d?a, a???s? t?a?sa??as??
?. ?a??? ??f? : ?p?f?sfata??a (?a?d?a?? a?ep???e?a,
?atast??? ??S, a????t??? a?a??a, ?ad?????s?)
Se as?e?e?? e s?a?? ?p???e??a :
? epa?as?t?s? ?a p??pe? ?a a????e? stad?a??
(a????? ??????s? 800-1000 ?e??d?? ?e??s??? ?a? stad?a?? a???s? e 100-200 ?e??de? ???e d?? t?e?? ???e?) ?a?
?a ?????e?ta? p??f??a?t??? f?sf????
55. 0.5-1 Kg/ ed??da
??te???? s?t?s? : t?p?p?????? ?s?t?????
t??f? 1kcal/ml
??????s? f?sf?????? se ta?e?a epa?as?t?s?
56. G?a as?e?e?? < 45 ???? :
1400 ?e??de? ?e??s??? ??? ?t?? ?e?t?????se? t? ??te??
(e?te????? ????, 7-10 ???e?)
Se s?a?? ap?s??as? 10-20 kcal/????
57. ?p?p????? epa?as?t?s?? 1. ?p??a??a??a,?p?f?sfata??a, Mg, Ca,
2. ?pat??? ep?????s?,
3. ?a??st???s? ?ast????? ????s??,
d?s??????t?ta,
4. ?s?t??? st?e?,
5. ??d?a epa?as?t?s??
58. ?????????? S??????O???? T??????? ???????S??S?S ?pa?a?t?t? ?e??s?a p??s???? asest???: 1300 mg
??????s? s?e?as?t?? a???a????? asest???
??????s? ??st???????
59. ????T???????- F?????? ? ?????e?ape?a e??a? t? ??e?d? ??a ??a ?a?? ap?t??esa p?? p??e? ?a ??e? d????e?a
?t???? ?????e?ape?a (te?????? ?et???? ? a???t???? e??s??s?? s?pe??f????)
?????e?e?a?? ?????e?ape?a
F??a?a (?????? a?ta????st?? t?? se??t??????) ????? ??s? ?????? st?? a?t?et?p?s? t?? ?????a?
???s??? st? ??????s? ?d?a?te?a se as?e?e?? e d?ata?a?? p??s?p???t?ta?
60. ??t????e?? t?? as?e??? ??a t? t? s????e? st?? ep?t??? pa??as? ??????s? ??a t?? s????e?? d?s????e? a?????s??
Kata???s? ??a ta p????ata p?? p????pt??? ?at? t?? a???t?s? ?????
??t?et?p?s? ????s?? sta a????? st?d?a
?e????t???? st???? ?a? ????t?p???s?
?ailor M, Kreipe R. Recovery from Anorexia Nervosa: Patients perspectives, PAS Meeting 2008
Roschester University
62. ?????S ??????F???S ?????????S ??at??f???? d?ata?a??? p?? de? p?????? ??a ta ???t???a d?????s??
????? ep?pt?s? st?? ?f?e?
?a????e? ??????? d?ata?a??? e t? p???e? s??d???
?e?a??te?e? p??a??t?te? ep?t????? a?t?et?p?s?? sta a????? st?d?a t?? ??s??
63.
The ?ody Betrayed