Suvremeni dijagnostički i terapijski pristup poremećajima jedenja

master's thesis

• Title (english): Modern diagnostic and therapeutic approach to eating disorders
• Author: Natalija Sovina
• Mentor: Zorana Kušević (mentor)
• Committee member: Ivan Begovac (predsjednik povjerenstva)
• Committee member: Dražen Begić (član povjerenstva)
• Committee member: Zorana Kušević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Psychiatry and Psychological Medicine); Zagreb
• Defense date and country: 2015-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Psychiatry

Abstract

Poremećaji jedenja karakterizirani su teškim smetnjama u prehrambenim navikama i ponašanju koje dovode do teškog oštećenja fizičkog zdravlja i psihosocijalnog funkcioniranja. Oboljeli imaju poremećenu percepciju vlastitog tijela i težine. Etiologija poremećaja jedenja nije u potpunosti jasna. Pretpostavlja se da nastaju djelovanjem bioloških, psiholoških, socijalnih i kulturnih faktora. Klasifikacija poremećaja jedenja i dijagnostički kriteriji mijenjali su se tokom vremena. Najveći broj liječnika danas se u dijagnostici oslanja na Dijagnostički i statistički priručnik za duševne poremećaje – Peto izdanje (DSM-5) izdan 2013.g. DSM-5 navodi tri specifične dijagnoze; anoreksiju nervozu, bulimiju nervozu i poremećaj s prejedanjem. Ostali poremećaji jedenja svrstani su u skupine Drugi specificirani poremećaj hranjenja ili jedenja i Nespecificirani poremećaj hranjenja ili jedenja. Važno je znati da se poremećaji jedenja javljaju u sve ranijoj dobi. Prije započinjanja liječenja potrebno je saznati postoji li prisutan komorbiditet kako bi se odabrao prikladan terapijski pristup. Liječenje je važno započeti što ranije jer su poremećaji jedenja povezani sa smanjenom kvalitetom života, većim rizikom za razvoj depresije i često su praćeni brojnim komplikacijama od kojih neke mogu biti smrtonosne. Liječenje treba biti sveobuhvatno i multidisciplinarno. Cilj liječenja je medicinska stabilizacija, nutritivna potpora, promjena poremećenog obrasca jedenja i rješavanje druge psihopatologije. Psihoterapija je neizostavna u liječenju poremećaja jedenja. Propisivanje lijekova nije preporučljivo jer nisu pokazali učinkovitost, a praćeni su brojnim nuspojavama. Ako pacijent zadovoljava indikacije za hospitalizaciju, potrebno je započeti bolničko liječenje. Ako je zdravlje pacijenta ugroženo, a on odbija liječenje, dopuštena je prisilna hospitalizacija. Tijekom bolničkog liječenja primarna je uloga nutritivna rehabilitacija. Preferira se oralna prehrana, a u određenim slučajevima primjenjuje se enteralna prehrana. Tijekom prvih tjedana od ponovne uspostave prehrane potrebno je strogo monitoriranje zbog opasnosti od razvoja refeeding sindroma.

Abstract (english)

Eating disorders are characterized by severe disturbances in eating habits and behavior that lead to serious damage to the physical health and psychosocial functioning. People with eating disorders have disturbed perception of their own body and weight. Etiology of eating disorders is not completely clear. It is assumed that biological, psycological, social and cultural factors contribute to their development. The classification of eating disorders and diagnostic criteria have changed over time. Most clinicians today relies on Diagnostic and Statistic Manual of Mental Disorders – Fifth Edition (DSM-5) released in 2013. DSM-5 describes trhree specific dignoses; anorexia nervosa, bulimia nervosa and binge eating disorder. Other eating disorders are classified into groups Other Specified Feeding or Eating Disorder and Unspecified Feeding or Eating Disorder. It is important to be aware that eating disorders occur in all younger age. Before starting treatment it is crucial to find out whether there is a present comorbidity in order to select an appropriate therapeutic approach . It is essential to start treatment as early as possible because eating disorders are associated with decreased quality of life, increased risk of depression and are often accompanied by many complications, some of which may be fatal. Treatment has to be comprehensive and multidisciplinary. Psychotherapy is indispensable in the treatment of eating disorders. Prescribing medications is not recommended because it did not show efficiency and is followed by many side effects. If the patient meets indications for hospitalization, it is necessary to begin inpatient treatment. If the patient's health is at risk, and he refuses treatment, forced hospitalization is allowed. During the hospital treatment, nutritional rehabilitation is the primary goal. Eating orally is preferred, but in some cases enteral nutrition is applied. During the first weeks of the re-establishment of nutrition, patients should be strictly monitored due to the risk of developing refeeding syndrome.

• Keywords: poremećaji jedenja; dijagnostički kriteriji; anoreksija nervoza; bulimija nervoza; poremećaj s prejedanjem; liječenje; psihoterapija; hospitalizacija; nutritivna rehabilitacija; refeeding sindrom
• Keywords (english): eating disorders; diagnostic criteria; anorexia nervosa; bulimia nervosa; binge eating disorder; treatment; psychoteraphy; hospitalization; nutritive rehabilitation; refeeding syndrome
• Language: croatian
• URN:NBN: urn:nbn:hr:105:754576
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-03-31 13:00:10