A TOPIC OF PSYCHIATRIC NURSING By-Kshirabdhi Tanaya Faculty of nursing,SUM Nursing college DTU 2020

1. PRESENTED BY-
KSHIRABDHI TANAYA
MHN TUTOR
SUM NURSING COLLEGE
S‘O’A DTU

3. • Anorexia nervosa is characterized by a morbid
fear of obesity.
• Symptoms include gross distortion of body
image, preoccupation with food, and refusal
to eat.
• Anorexia nervosa is characterized by a BMI of
17.5 or lower

4. Epidemiological factor
• The prevalence rate of AN for males was 10/100,000
while for females ,it was 37.2 and combined gender
burden was 22.3/100,000 in India.(In 2nd NOV-2018)
• The prevalence rate for anorexia nervosa among young
women in the united states of approximately 1%.
• The disorder occurs predominantly in females 12 to 30
years of age.
• Fewer than 10% of the cases are male.
• Anorexia nervosa is once believed to be more prevalent
in higher socioeconomic classes.

5. Predisposing factor
BIOLOGICAL INFLUENCES:
Genetic:
• Genetic factors accounts for 56% of the risk
for developing anorexia nervosa.
• Anorexia nervosa is more common among
sisters and mothers of those with disorder
than among the general population.

6. Cont….
Neuro endocrine abnormalities:
• Hypothalamic dysfunction.
• Elevated cerebrospinal fluid cortisol levels and
impairment of dopaminergic regulation in
individuals with anorexia nervosa.

7. Neuro chemical influences:
• Some studies have found high levels of
endogenous opioids in spinal fluid may
contribute to denial of hunger in clients with
anorexia nervosa.

8. PSYCHODYNAMIC INFLUENCES :-
• This theory suggest that eating disorders
result from very early and profound
disturbances in mother infant interactions.
• The result is delayed ego development in the
child and unfulfilled sense of separation
individuation.

9. Family influences:
• Disturbances in family relationships,
overprotection, family members having an
unusual interest in food and physical appearance.
Social factor:
• There is high prevalence of anorexia nervosa in
female students and in occupational groups
particularly concerned with weight.
• Influence of mass media, beauty contests are
other important social causes.

10. Clinical manifestation:
• Intense fear of becoming obese.
• The body weight is 15% below the standard
weight.
• There is a body image disturbances
• Patient generally eat little and set themselves
daily calorie limit( between 600-1000
calories). Some tries to weight loss by inducing
vomiting ,excessive exercise, misusing
laxatives.

11. Cont…
• Other sign and symptoms are secondary to
starvation and include sensitivity to cold, delayed
gastric emptying, constipation, low blood
pressure, bradycardia, hypothermia and
amenorrhea in females.
• Vomiting and abuse of laxatives causes
electrolyte disturbances, the most serious being
hypokalemia.
• Psychological findings- preoccupation with body
size, distorted body image, description of herself
as fat.

12. complication
• Malnutrition, dehydration and electrolyte
imbalances
• Increase susceptibility to infection
• Hypoalbuminemia
• Chronic inflammatory bowel disease
• Esophageal erosion, dental caries, ulcers, tears,
bleeding gum erosion.
• Amenorrhea
• Life threatening cardiovascular complications.

13. Specify if:
Severity of anorexia nervosa:
• Mild: BMI ≥ 17 kg/m2
• Moderate : BMI 16- 16.99 kg/m2
• Severe: BMI 15- 15.99 kg/m2
• Extreme: BMI < 15 kg/m2

14. Diagnosis
•Complete physical examination including laboratory tests
to rule out endocrine, metabolic and central nervous
abnormalities, cancer, mal absorption syndrome other
disorder that causes physical wasting.
•Complete blood testing- Hb levels, platelet count,
cholesterol level, total protein, Na, K, Cl, Ca, fasting blood
glucose and serum amylase levels and blood urea,
nitrogen.
• ECG readings irregular
•Differential diagnosis to rule out other psychiatric
disorders like substance abuse, anxiety disorder, body
dysmorphic disorder, mood disorders, schizophrenia.

15. BULIMIA NERVOSA

16. •Bulimia nervosa is an episodic, uncontrolled,
compulsive rapid ingestion of large quantities of
food over a short period of time, followed by
inappropriate compensatory behaviors to rid the
body of the excess calories.
•Involves recurrent use of compensatory
measures to prevent weight gain (such as self
induced vomiting,use of laxatives,dieting,fasting
or combination of these measures).

17. •Bulimia nervosa is more prevalent than anorexia
nervosa, with estimates up to 4 % of young women.
•Onset of bulimia nervosa occurs in late adolescence
or early adulthood.

18. Predisposing factor:
More common in first degree biological
relatives of people with bulimia.
Possible role of altered serotonin levels in
brain
Society emphasis on appearance and
thinness
Family disturbances and thinness.
Sexual abuse
Learned maladaptive behavior.
Struggle for self- identity.

19. Clinical features
•Persistent sore throat, heartburn
•Scarring on the back of hands and knuckles.
•Tooth staining or discoloration, loss of dental
enamel and increased dental caries
•History of eating larger amount of food.
•During binge eating episode , sense on lack of
control
•Abdominal and epigastric pain.
•Amenorrhea

21. CONTD….
fluid and electrolyte imbalance
distorted body image
Exaggerated sense of guilt
Feeling of alienation
Poor impulse control
Low tolerance for frustration
Peculiar eating habits or rituals
Excessive exercise regimen
 withdrawal from friends and usual
activities
Frequent weighing

22. complication
• Gastric rupture during periods of binge
eating.
•Dental caries, erosion of tooth enamel,
parotitis, and gum infection
•Dehydration and electrolyte imbalance.
•Chronic and irregular bowel movements and
constipation from laxative use
•Increase risk for suicide and psychoactive
substance abuse.

23. DIAGNOSIS
•Medical evaluation to rule out upper GI
disorder.
•Psychological evaluation
•History
•Laboratory tests (serum electrolytes, blood
glucose, ECG).

24. TREATMENT MODALITIES:-
Psychotherapy
TCAs (Imipramine,Amitriptyline)or
SSRIs(escitalopram,sertraline)
Self help groups
hospitalization

25. NURSING INTERVENTIONS:-
Engage patient in therapeutic commitment to
treatment.
Establish contract with patient about type of
food she must eat at each meal.
Set a time limit for each meal.
Identify patient’s elimination patterns.
Encourage patient to recognize & verbalize her
feelings about her eating behaviour.
Explain risks of laxative,emetic & diuretic
abuse.
Assess & monitor patient’s suicide potential.