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In the last post, we saw how:

• ED is more common among Adolescent girls
• ED is more common in developed countries.
• Patients with AN may require hospitalisation against their own will and need to be monitored regularly for improvement or decline.

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Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for four consecutive months. This month will be dedicated to Eating Disorders. In the first month, we discussed Depression, and in the subsequent month, anxiety. We just finished with Schizophrenia.

In this post, we are looking at research work done in Nigeria on Eating Disorders. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.

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Comorbidities

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Other psychiatric conditions are associated with AN. 65% of those with AN experience depression, 35% social phobia and 25% experience OCD.

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Cause

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Causes in psychiatry can be divided into biological, psychological and social factors. Some proof of this is seen in monozygotic twins. Sisters tend to be affected but this may be a social factor than a biological one.

Those who have this disorder usually have a higher tendency for mood disorders in their family than other people. Patients with AN usually have lower levels of Norepinephrine than the general population and this is confirmed by the level of 3-methoxy-4-hydroxyphenylglycol (MHPG) seen in the patient's urine and the cerebrospinal fluid also has lower levels of Norepinephrine.

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Biological Factors

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There is proof that the use of opioids can worsen hunger denial as seen in studies. These studies showed that if opiate receptors are blocked there is quick weight gain.

The fact that these patients suffer from the effects of starvation leads to increased cortisol and as evidenced by the non-suppression test.

There is a change in thyroid function to very reduced levels and amenorrhea. The amenorrhea may come before the weight loss becomes very evident.

Imaging studies show that when starvation begins, the Cerebrospinal Fluid in the ventricles become enlarged.

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Eating Disorders in Nigeria (Material and Methods)

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People illustrations by Storyset

This study was done in Nigeria, Lagos in Akoka and Yaba colleges in Yaba (mainland area). This area is a very busy area especially buzzing with commerce. The people living in this region come from all parts of Nigeria and some close countries in Africa.

The institutions of choice were because they were accessible (in terms of getting the necessary permission to carry out this study) and were close to each other making it easier to do this study. With the use of stratified random sampling, the data was gotten from every faculty and department in these universities.

The subjects were undergraduates and they signed consent agreements before participating in the study. In order, to be included in the study they had to be no prior chronic illnesses in their medical history. The ethical board of these institutions were reached out and permission was taken to proceed with this study.

A questionnaire for socioeconomic status was used and the EAT 26 test was used to assess eating habits, a weigh scale and measuring tape was used for this study. The questionnaire also collected information about parental education level, the number of children in the family and the household income per year.

EAT or the Eating Ttitude Test is a measure of the symptoms, complaints and environmental factors that are seen typically in eating disorders. It was first made in 1979 and it had 40 items at the time but the recent one has 26 items in it. This recent one made in 1982 still had the same parameters as the formal test.

There have been modifications that have been made to assess the sociocultural differences in eating habits in Africa by Szabo and Allwood in 2004. EAT-26 is the best tool for objectively measuring eating disorders in individuals and large sample sizes but it does not have the diagnostic features. EAT-26 is used mostly for secondary and tertiary institutions.

There are 3 scales within this psychometric measure, the first is the dieting subscale and which includes 14 of the 26 items, the second is the Bulemia and Food Preoccupation sub-scale and which has 5.3 items. The third subscale is the Oral Controle subscale and which has 8 items in it.

Each sale is given points for each feature to be quantified. Rare cases are awarded 0 points, often given 1 point, Usually, given 2 points and Always given 3 points. A score of between 0 to 78 is the range and 20 is seen as a positive value for an eating disorder. The patient still needs to be assessed by a medical doctor t have a diagnosis of an eating disorder.

Steps: The subjects were to answer the sociodemographic questionnaire and the EAT-26 in a place that is not distracting. After they take the test, they were to have their BMI calculated by taking the weight and height of the subject. The weight in KG is divided by the height squared.

The questionnaires were 1100 in total. 46 of those were not seen as useful or were not found after the test. The remaining 1054 were studied.

The information was input into a spreadsheet and analysed using SPSS 16. t-test was used to assess the mean. P was set as equal to or less than 0.05.

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Treatment

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Psychotherapy
The principles used in Cognitive Behavioural Therapy (CBT) show good results when use on admitted patients and patients that attend regular clinic appointments. The patient when on CBT is typically monitored for weight gain. In this therapy, the patient is given information on how to deal with food intake, how they feel and how they express these feelings. They are taught how to manage to binge and purge and how to navigate their relationships.

The thoughts that come quickly into their minds are brought to logic on how realistic they are. The patient is taught how to solve problems. With coping mechanisms, the patient can learn to face the problem they may be having with the condition.

Dynamic psychotherapy
This is used at times as a supportive therapy for AN. This is usually fought by the patient's resistance to therapy. The patients usually think that they are unique because of their eating disorder and for this reason, the therapist has to find a way to circumvent this. The main goal is to ally with the patient.

The patient may feel like their experiences are being reduced by the therapist. It is better to know what the patient thinks and then try to impose your thoughts as a therapist. The psychotherapist should not be rigid and consistent even with the patient's difficult behaviour.

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Questions

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• What did you learn about Eating Diorders?

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Conclusion

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• Those who have eating disorders tend to be affected by psychiatric conditions.
• 1054 samples were taken and analysed in this study.
• Cognitive behavioural therap and Dynamic psychotherapy are good ajuctive therapy for Eating disorders.

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References

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• Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
• Page demarcations made with Inkscape.org
• Healthline
• WebMD