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題名 | 以功能性胃腸障礙為初始表現的男性厭食症:一例報告和文獻回顧=Male Anorexia Nervosa with Functional Gastrointestinal Disorder as Initial Presentation: A Case Report and Literature Review |
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作者 | 許哲華; 曾美智; 李宇宙; 廖士程; 吳佳璇; Hsu, Jer-hwa; Tseng, Mei-chih; Lee, Yue-joe; Liao, Shih-cheng; Wu, Erin; |
期刊 | 臺灣醫學 |
出版日期 | 20061100 |
卷期 | 10:6 民95.11 |
頁次 | 頁705-711 |
分類號 | 415.993 |
語文 | chi |
關鍵詞 | 厭食症; 男性; 功能性胃腸障礙症; Anorexia nervosa; Male; Functional gastrointestinal disorder; |
中文摘要 | 臨床上,男性的厭食症容易被忽略,診斷率也被低估。作者提出一例以功能性胃腸症狀為初始表現合併體重明顯下降的男性厭食症個案,同時對男性厭食症患者的特徵做文獻回顧。個案為-24歲男性,2年前開始有噁心、上腹脹及便祕的狀況,因害怕進食後會加重胃腸症狀,進食量逐漸減少,體重也持續的下降,在此期間,病人否認自己刻意減重,對上述問題並不在乎。曾被母親帶到一般科診所和兩家綜合醫院就醫,診斷為胃炎及逆流性食道炎,沒有進一步的處理;因症狀持續,遂住進某一醫學中心外科病房,施與全靜脈營養治療,一系列檢查無明顯器質性病灶,經精神科醫師會診,診斷為厭食症,建議轉精神科接受進一步的營養復健和認知行為治療。經由文獻的回顧,胃腸道症狀一向被認為是飲食障礙症的結果,飲食障礙症和胃腸道症狀發生的關係並沒有太多的文獻探討。對男性厭食症的較低診斷率,可能原因為社會對兩性體態期待的不同,男性較少使用清除方法做為減重行為,和體重的下降缺乏明顯的生理功能變化指標(如無月經),以及臨床工作者的警覺性較低。對於男性厭食症病患的完整處理,應包括認識疾病的初期表現和危險因子,並治療其生理上的併發症和精神上的共病症。 |
英文摘要 | The sex ratio of male to female in anorexia nervosa was one to ten. Males with anorexia nervosa were easily neglected and possibly under-diagnosed. A 24-year-old man with body height 185cm and body weight 72kg, who started to suffer from some gastrointestinal discomfort such as nausea, epigastric fullness and constipation when he was twenty-year old. He reported the above symptoms were responsible for his initial body weight loss (body weight was 58kg) during the following 2 years. The man did not pay much attention to his physical condition and maintained his regular habit of exercise. He denied dieting on purpose through the whole course. Gastritis and reflux esophagitis were impressed after visiting some local clinics and two general hospitals under his mother's request. His condition didn't get much improvement. Fear of aggravated GI symptoms after meal made him to eat even less, and his body weight decreased to 47kg. He was admitted to one medical center in northern Taiwan and received a series of examinations which showed no obvious organic cause. Psychiatric referral was arranged under the impression of anorexia nervosa. The patient was then advised to receive further nutritional rehabilitation and cognitive-behavioral therapy at psychiatric settings. The authors discussed the relationship of functional gastro-intestinal disorders and anorexia nervosa, and made a literature review about the characteristics of male patients with anorexia nervosa. The clinical manifestations of eating disorders in male were more similar than different to the presentation of female anorexia nervosa patients. Some possible reasons accounting for the lower diagnostic rate regarding male anorexia nervosa were described as followings. Differential societal acceptance for body image concern in male and female, which made male patients more reluctant to present themselves for psychiatric help. Male patients use less purging behavior for weight control. Lack of obvious indicator for physiological malfunctioning in male (such as amenorrhea in females), and the clinicians' lower sensitivity to the clinical manifestations of eating disorders in male patients were two more reasons for underdiagnosis. A comprehensive management of male anorexia nervosa involved the detection of initial symptoms, identification of risk factors, as well as treatment for physical complications and psychiatric comorbidities. |
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