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Anorexia Trastornos de Conducta Alimentaria TCA Pediatra Parte 2

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TCA Trastornos de la Conducta Alimentaria
Los trastornos de la conducta alimentaria, constituidos principalmente por la anorexia y la bulimia, son enfermedades caracterizadas por un patrón irregular de alimentación asociado a sentimientos, pensamientos y acciones irracionales en cuanto al peso y la forma corporal. Esto genera sintomatología física secundaria a la desnutrición, a patrones dietéticos desordenados y a otras vulnerabilidades a nivel personal. Estas enfermedades tienen alta prevalencia en la adolescencia. Uno de los aspectos que representa un reto al tratar un adolescente con un trastorno de la conducta alimentaria es el de los deseos del adolescente enfermo, ya que en muchas oportunidades éste se encuentra en conflicto con el equipo tratante y su familia

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  • Thankfully this community blesses you with the right information and tools to get through the inevitable tough times and the joy of having people who are in the same situation and helping you as you go. I'm forever thankful for having the irreplaceable support to fight for what is best for me with all force and knowledge and much love! Shaye and other girls did it, I'm doing it and do can anyone struggling from this, no matter how deep and dark it seems! One step at a time, TOGETHER! ■■■ http://t.cn/A6Pq6ilz
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Anorexia Trastornos de Conducta Alimentaria TCA Pediatra Parte 2

  1. 1. Trastornos de la conducta alimentaria Parte 2 Alejandra Saldarriaga Ángel Residente pediatría primer año Universidad de Antioquía
  2. 3. PAPEL DEL PEDIATRA <ul><li>Prevenir </li></ul><ul><li>Dx temprano </li></ul><ul><li>Evitar progresión </li></ul><ul><li>Tto complicaciones físicas </li></ul><ul><li>Cribado anual - ¿? Simples, P, T, IMC </li></ul><ul><li>Alto índice de sospecha </li></ul><ul><li>Buscar comorbilidades </li></ul><ul><li>Remitir oportunamente </li></ul>
  3. 4. Cuestionario SCOFF <ul><li>¿Te preocupa perder el control sobre lo que comes? </li></ul><ul><li>¿Has perdido recientemente > 6.3kg en un periodo de 3 meses? </li></ul><ul><li>¿Te sientes gordo(a) pero otros dicen que eres muy delgado(a)? </li></ul><ul><li>¿Sientes que la comida domina tu vida? </li></ul><ul><li>¿Te enfermas a ti mismo porque te sientes inconfortablemente lleno? </li></ul>
  4. 5. EVALUACIÓN COMPLETA <ul><li>Sí hay sospecha…. </li></ul><ul><li>Dx? </li></ul><ul><li>Evaluar estado médico y nutricional </li></ul><ul><li>Gravedad? </li></ul><ul><li>Evaluación psicosocial inicial </li></ul>
  5. 6. INDAGAR… <ul><li>Ideas y cambios en peso </li></ul><ul><li>Ejercicio </li></ul><ul><li>Hábitos Alimentarios </li></ul><ul><li>Conductas purgativas </li></ul><ul><li>Patrón de eliminación </li></ul><ul><li>Historia Familiar </li></ul><ul><li>Antecedentes personales </li></ul><ul><li>Síntomas </li></ul><ul><li>S. enfermedades orgánicas </li></ul><ul><li>Ttos previos y su rta </li></ul>
  6. 7. Examen Físico <ul><li>Bradicardia- Arritmias </li></ul><ul><li>Cambios ortostáticos </li></ul><ul><li>Soplos </li></ul><ul><li>Hipotermia </li></ul><ul><li>Caquexia </li></ul><ul><li>Cambios en piel y cabello </li></ul><ul><li>Retraso dllo puberal </li></ul><ul><li>Signo de Russell </li></ul>
  7. 8. Diagnósticos diferenciales
  8. 9. Laboratorios <ul><li>HLG </li></ul><ul><li>Electrolitos + Ca y Mg </li></ul><ul><li>Glucemia </li></ul><ul><li>Fx Hepática </li></ul><ul><li>Uroanalisis </li></ul><ul><li>TSH </li></ul><ul><li>EKG </li></ul><ul><li>Estudios Amenorrea </li></ul><ul><li>Densitometría </li></ul><ul><li>Otros </li></ul>
  9. 10. Complicaciones
  10. 11. Complicaciones por la restricción calórica <ul><li>Talla baja- retardo puberal </li></ul><ul><li>EKG ↑ QT, arritmias, ↓ Voltaje, Inversión T, Depresión ST </li></ul><ul><li>Prolapso Valvula mitral, derrame pericardico </li></ul><ul><li>Hipoglucemia </li></ul><ul><li>Inestabilidad térmica </li></ul><ul><li>Alteración fx hepática </li></ul><ul><li>Sx eutiroideo enfermo </li></ul><ul><li>↓ volumen cerebral </li></ul>
  11. 12. <ul><li>Vómitos -> Alcalosis metabolica hipocloremica, Esofagitis, RGE, Erosiones dentales, Mallory-Weiss (raro), Neuomonía x aspiración (raro) </li></ul><ul><li>Laxantes -> Acidosis metabolica hipercloremica, hipocalcemia, hiperuricemia, retención de liquidos (al retirarlos) </li></ul>
  12. 13. Complicaciones de la realimentación <ul><li>Diaforesis </li></ul><ul><li>Poliuria y Nicturia </li></ul><ul><li>Edema </li></ul><ul><li>Síndrome de realimentación </li></ul>
  13. 14. TRATAMIENTO <ul><li>Multidisciplinario </li></ul><ul><li>Evitar la estigmatización </li></ul><ul><li>Paso a paso </li></ul><ul><li>Informar </li></ul>
  14. 15. Recuperación nutricional <ul><li>Ambulatoria </li></ul><ul><li>Consentida </li></ul><ul><li>Oral </li></ul><ul><li>Gradual -> aporte de 2000-3000 Kcal/d ganancia 0.25-1 Kg/sem </li></ul><ul><li>Individualizado </li></ul><ul><li>Porciones pequeñas, frecuentes y con alta densidad energética </li></ul><ul><li>Suplementos Vit y minerales </li></ul>
  15. 16. Manejo de las complicaciones <ul><li>Paulatino – recuperación nutricional </li></ul><ul><li>DHT -> Rehidratación oral -> IV solo si NTA o alt electroliticas graves SS 0.9% </li></ul><ul><li>Suplemento de K (2mmol/kg/día C/8h) y P </li></ul><ul><li>Suspender purgas </li></ul><ul><li>↓ gradual de laxantes </li></ul><ul><li>Higiene dental </li></ul>
  16. 17. Tratamiento hospitalario
  17. 19. Tratamiento farmacológico <ul><li>Anorexia: </li></ul><ul><li>No existen aprobados x la FDA </li></ul><ul><li>Manejo comorbilidades </li></ul><ul><li>Antidepresivos tricíclicos </li></ul><ul><li>ISRS </li></ul><ul><li>Antipsicóticos atípicos </li></ul><ul><li>Bulimia: </li></ul><ul><li>+ evidencia pero estudios en adultos </li></ul><ul><li>Fluoxetina único aprobado x FDA </li></ul><ul><li>Venlafaxina </li></ul><ul><li>Antidepresivos tricíclicos </li></ul><ul><li>Topiramato (EA) </li></ul><ul><li>También estudiados en trastornos de atarcones </li></ul>¡NO ES PRIMERA LÍNEA!
  18. 20. Psicoterapia <ul><li>↓ riesgos, promover ganancia peso y alimentación saludable, ↓ síntomas asociados y facilitar recuperación </li></ul><ul><li>Familia </li></ul><ul><li>TCC </li></ul><ul><li>TIP, Psicoterapia de apoyo </li></ul><ul><li>CAT y TDC + especializadas </li></ul><ul><li>Anorexia Min 6 m (12 si se requirió hospitalización) </li></ul><ul><li>Bulimia TCC 16-20 sesiones en 5m, TIP 8-12m </li></ul>
  19. 21. Poblaciones especiales <ul><li>DM </li></ul><ul><li>Riesgo bulimia 3 veces y otros Tx 2 veces </li></ul><ul><li>Omisión intencional o subdosificación de Insulina -> mal control glucemico, > riesgo complicaciones </li></ul><ul><li>Tto + difícil </li></ul><ul><li>Embarazo </li></ul><ul><li>Raro en anorexia – pero descartarlo sí amenorrea </li></ul><ul><li>Bulimia – Síntomas mejoran con el embarazo </li></ul><ul><li>> riesgo complicaciones perinatales (Aborto, ↓ P y T) </li></ul><ul><li>Problemas en la alimentación de sus hijos, + preocupadas x P y figura en ellos. </li></ul>
  20. 22. Pronóstico: <ul><li>A < edad mejor </li></ul><ul><li>Lento (hasta 79 meses) </li></ul><ul><li>Recaidas </li></ul><ul><li>Mejor si: < duración síntomas, buena relación con los padres </li></ul><ul><li>Peor si: Purgas, ↓ significativa de peso, cronicidad , desordenes psiquiátricos, pobre ganancia peso, pobre ajuste social luego del tto </li></ul><ul><li>Mortalidad 0-21% - complicaciones médicas y suicidio. </li></ul><ul><li>A < peso > mortalidad </li></ul>
  21. 23. BIBLIOGRAFÍA <ul><li>1. National collaborating centre for mental health, Royal College of Psychiatrists’ Research Unit, National Institute for Clinical Excellence. Eating Disorders Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. London: The British Psychological Society and The Royal College of Psychiatrists; 2004. </li></ul><ul><li>2. Rosen DS. Identification and management of eating disorders in children and adolescents. Pediatrics [Internet]. 2010 Dec [cited 2011 Nov 15];126(6):1240–53. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21115584 </li></ul><ul><li>3. Kaplan DW, Blythe M, Diaz A, Feinstein RA, Fisher MM, Klein JD, et al. Identifying and treating eating disorders. Pediatrics. 2003;111(1):204–11. </li></ul><ul><li>4. Learned KD. Children and Adolescents with Eating Disorders: Course, Complications and Current Research. Pediatrics in review [Internet]. 2011;:1–28. Available from: http://copac.ac.uk/search?rn=1&au=Tony+JAFFA+&sort-order=ti,-date </li></ul><ul><li>5. Golden NH, Attia E. Psychopharmacology of eating disorders in children and adolescents. Pediatric clinics of North America [Internet]. 2011 Feb [cited 2012 Feb 1];58(1):121–38. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21281852 </li></ul><ul><li>6. Pinzon JL, Beimers MA. Medical complications in children and adolescents affected by eating disorders. British Columbia Medical Journal. 2005;47(1):28–34. </li></ul>
  22. 24. Mas información sobre Psiquiatria Infantil en el Canal de Youtube: “Psiquiatriainfa” <ul><li>Buscar por palabras claves otros temas: </li></ul><ul><ul><li>Autismo y Sindrome de Asperger </li></ul></ul><ul><ul><li>Trastornos del Espectro Autista </li></ul></ul><ul><ul><li>Ansiedad </li></ul></ul><ul><ul><li>Depresión en niños y Suicidio en Adolescentes </li></ul></ul><ul><ul><li>Sueño, Insomnio, Higiene del sueño, Parasomnias </li></ul></ul><ul><ul><li>Estrés Postraumático (TEPT) </li></ul></ul><ul><ul><li>Trastorno por Déficit de Atención con Hiperactividad (TDAH) </li></ul></ul><ul><ul><li>Retardo mental (discapacidad cognitiva) </li></ul></ul><ul><ul><li>Trastorno Afectivo Bipolar </li></ul></ul><ul><ul><li>Trastorno Obsesivo Compulsivo </li></ul></ul><ul><ul><li>Trastorno de Identidad de Género </li></ul></ul><ul><ul><li>Síntomas Tempranos de la Esquizofrenia (Prodrómos) </li></ul></ul><ul><ul><li>Otros </li></ul></ul><ul><ul><li>http://www.youtube.com/user/PsiquiatriaInfa/videos </li></ul></ul>

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