De Caprio Carmela, Zarrella Luigi, Senatore Ignazio, Silvestri Eufemia, Contaldo Franco, Pasanisi Fabrizio
Centro Interuniversitario di Studi e Ricerche sull'Obesità ed i Disturbi del Comportamento Alimentare, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi Federico II, Napoli.
Ann Ital Med Int. 2005 Jul-Sep;20(3):158-66.
Protein energy malnutrition due to anorexia nervosa, either restrictive or bulimic, requires an integrated medical psychiatric intervention to be treated. The aim of this study was to evaluate the effectiveness of this integrated treatment in severely malnourished anorectic patients requiring to be hospitalized in Psychiatry Unit. Fifteen patients (14 females, 1 male, mean age 19.6 +/- 4.7 years, body mass index 14.0 +/- 1.9 kg/m2) 13 of whom affected by restrictive anorexia nervosa and 2 by bulimic anorexia nervosa, have been hospitalized in the Psychiatry Unit of the Federico II University Hospital, Naples from September 2000 to July 2003, always without requiring compulsory sanitary treatment. Hospitalization was due to failure of the outpatient treatment in all of them, complicated by uncontrolled weight loss in 7, hydroelectrolytic unbalance in 2, edema in 1 patient. All were hypotensive and 4 had marked bradycardia. Forced nutrition was never necessary. Enteral nutrition by nasogastric tube was prescribed in 4 patients, oral nutrition supplements with diet in 4 and only diet in the remaining 7. All patients received vitamin and mineral supplements, if necessary parenterally. A mild body weight increase and satisfactory normalization of biochemical parameters was obtained in all patients during hospitalization. Thereafter they were enrolled in an outpatient integrated medical/psychiatric protocol, including group therapy. Only in 1 case, a few months later, a second hospitalization was necessary. In conclusion, integrated medical psychiatric treatment represents an effective intervention also in severely malnourished anorectic patient requiring hospitalization.
神经性厌食症导致的蛋白质能量营养不良，无论是限制型还是暴食型，都需要综合的医学和精神科干预来进行治疗。本研究的目的是评估这种综合治疗对需要入住精神科病房的严重营养不良的厌食症患者的有效性。15名患者（14名女性，1名男性，平均年龄19.6±4.7岁，体重指数14.0±1.9kg/m²），其中13名患有限制型神经性厌食症，2名患有暴食型神经性厌食症，于2000年9月至2003年7月入住那不勒斯费德里科二世大学医院精神科病房，均无需强制住院治疗。所有患者住院均是因为门诊治疗失败，其中7例并发体重控制不佳，2例水电解质失衡，1例出现水肿。所有患者均有低血压，4例有明显心动过缓。从未需要强制营养。4例患者采用鼻胃管肠内营养，4例患者口服营养补充剂并配合饮食，其余7例仅采用饮食。所有患者必要时接受维生素和矿物质补充剂，必要时采用肠外补充。所有患者在住院期间体重均有轻度增加，生化指标得到满意的正常化。此后，他们参加了包括团体治疗在内的门诊综合医学/精神科方案。仅1例患者在几个月后需要再次住院。总之，综合医学和精神科治疗对于需要住院的严重营养不良的厌食症患者也是一种有效的干预措施。
