Skrypnik Damian, Bogdański Paweł, Musialik Katarzyna, Skrypnik Katarzyna
Pol Merkur Lekarski. 2014 May;36(215):352-6.
The basic criterion for the diagnosis of anorexia (AN - anorexia nervosa) by ICD-10 (International Classification of Diseases, version 10) is the body weight less than 15% of the expected normal body weight. According to DSM-IV (Diagnostic and Statistical Manual for Mental Disorders, version IV) the basic feature of AN is a refusal to maintain body weight equal or greater than the minimal normal weight. The prevalence of anorexia nervosa is 0.3-0.5% or even 1.3-3.7% if include pre-anorexic states (eg. the phenomenon of pro-ana). The main feature of anorexia is a reduction of caloric intake. According to the recommendations of the American Psychiatric Association (APA) for nutritional treatment of patients with AN the main goals in therapy of AN are: restoration of body weight, normalization of eating patterns, achievement a normal feeling of hunger and satiety and correction of the consequences of improper nutrition. APA suggests that achievable weight gain is about 0.9-1.4 kg per week in the case of hospitalized patients and approximately 0.23-0.45 kg per week in the case of outpatients. During the nutritional treatment of AN numerous side effects including anxiety, phobia, occurrence of obsessive thoughts and compulsive behavior, suicidal thoughts and intentions may occur. According to National Institute for Clinical Excellence (NICE) the most important goal of AN therapy is weight gain in the range of 0.5-1 kg per week in hospitalized patients and 0.5 kg per week for outpatients. A person suffering from anorexia in the initial period of nutritional treatment spends twice more energy to maintain elevated body temperature, which significantly increases during the night rest. This phenomenon is called nocturnal hyperthermia and has a negative effect on the healing process. "Refeeding syndrome" is an adverse effect of nutritional treatment in anorexia. It is caused by too rapid nutrition in a patient suffering from chronic starvation. It can endanger the patient's life.
根据国际疾病分类第10版（ICD - 10），神经性厌食症（AN）的基本诊断标准是体重低于预期正常体重的15%。根据《精神疾病诊断与统计手册》第4版（DSM - IV），神经性厌食症的基本特征是拒绝维持等于或高于最低正常体重的体重。神经性厌食症的患病率为0.3 - 0.5%，如果包括厌食症前期状态（如亲厌食现象），患病率甚至为1.3 - 3.7%。厌食症的主要特征是热量摄入减少。根据美国精神病学协会（APA）对神经性厌食症患者营养治疗的建议，神经性厌食症治疗的主要目标是：恢复体重、使饮食模式正常化、实现正常的饥饿和饱腹感，并纠正营养不当的后果。APA建议，住院患者每周可实现的体重增加约为0.9 - 1.4千克，门诊患者约为每周0.23 - 0.45千克。在神经性厌食症的营养治疗过程中，可能会出现许多副作用，包括焦虑、恐惧症、强迫观念和强迫行为的出现、自杀念头和意图。根据英国国家临床优化研究所（NICE）的说法，神经性厌食症治疗的最重要目标是住院患者每周体重增加0.5 - 1千克，门诊患者每周增加0.5千克。患有厌食症的人在营养治疗初期维持体温升高所消耗的能量是正常情况的两倍，夜间休息时体温会显著升高。这种现象称为夜间体温过高，对康复过程有负面影响。“再喂养综合征”是厌食症营养治疗的一种不良反应。它是由慢性饥饿患者营养补充过快引起的。它可能危及患者生命。
