節制型與清除型神經性厭食症個案報告

Comparison of Restricting-Type and Binge Eating/Purging-Type Anorexia Nervosa: a Case Report

蘇筱媛(Hsiao-Yuan Su) ； 蔡淑敏(Shu-Mi Tsai)

《台灣營養學會雜誌》 44卷3期 (2020/09) Pp. 92-100

https://doi.org/10.6691/NSJ.202009_44(3).0003

摘要

神經性厭食症（anorexia nervosa, AN）病人因對飲食認知扭曲，會影響進食行為，及有腸胃道不適、與再餵食症候群等症狀，導致營養照護充滿挑戰性。本論文報告某醫學中心兩例不同類型AN個案資料，包含體位狀況、營養攝取量及常規生化檢測、觀察飲食行為及對飲食之認知。節制型AN（restricting-type AN）個案經過7週治療，熱量由每公斤體重11.5大卡進展至50.2大卡，體重增加2.3公斤，病情穩定後出院。清除型AN（binge eating/purging-type AN）個案經過4週治療，熱量由每公斤體重14.7大卡進展至74大卡，體重增加1.8公斤，因勞動服務出院。節制型AN個案不會清除性催吐，但對熱量的上升充滿焦慮；而清除型AN個案則在大量進食後進行清除性催吐，雖住院中熱量進展較快但需防範病人催吐或藏食行為。此兩例個案對飲食認知有差異，但也有雷同之處，且皆是將對於自身的不滿連結到對食物的偏執。營養師除了給予AN病人正確營養知識外，更應注重了解AN病人思考模式及矯正外表或體重與飲食的認知連結，並藉由醫療團隊間的合作，幫助AN病患早日恢復體重。

關鍵字

神經性厭食 ； 營養

並列摘要

Patients with anorexia nervosa (AN) experience disordered attitudes towards eating behaviors, which are further complicated by gastrointestinal symptoms and refeeding syndrome, leading to difficulties in implementing nutritional interventions. This case report describes an adult patient presenting with restricting-type (R)-AN and another adult patient presenting with binge eating/purging-type (BP)-AN in a medical center, and discusses differences in their anthropometric data, dietary intake, biochemical data, eating behaviors, and dietary perceptions. The R-AN patient received treatment for 7 weeks and was discharged from the hospital in a stable condition. Subsequent calorie intake increased from 11.5 to 50.2 kcal/kg, and the body weight increased by 2.3 kg. The BP-AN patient received treatment for 4 weeks and was discharged early due to court-ordered community service. Subsequent calorie intake progressed from 14.7 to 74 kcal/kg, and the body weight increased by 1.8 kg. The R-AN patient expressed anxiety about the increased calorie intake, although the patient exhibited no purging behavior. The BP-AN patient had faster progression in calorie intake. However, the behavior of purging or hiding food required close supervision by medical professionals. Despite the differences in dietary perceptions, both the R-AN and BP-AN patients indicated self-dissatisfaction with their disordered eating behaviors. To provide better-quality nutritional care in the future, it is important for dietitians to gain a thorough understanding of an AN patient's thought patterns, and correct a patient's perceptions of their body image and eating behaviors using a multidisciplinary team approach.

並列關鍵字

anorexia nervosa ； Nutrition