Management of anorexia nervosa in a Tunisian case

• Published in: Tunisie Medicale Vol. 92; no. 7; p. 501
• Main Authors: Ahlem, Harrathi, Soumeyya, Halayem, Nadia, Janhani, Sami, Othman, Ines, Lahmar, Samira, Blouza, Ahlem, Belhadj, Asma, Bouden, Halayem, Mohamed B
• Format: Journal Article
• Language: French
• Published: Tunisia 01.07.2014
• Subjects: Adolescent; Anorexia Nervosa - therapy; Female; Hospitalization; Humans; Tunisia; Tunisia
• ISSN: 0041-4131

Anorexia nervosa is a complex psychiatric illness that can lead to severe physical complications. This work aimed to study the approach taken by the child psychiatry service of Razi hospital in the management of anorexia nervosa and to compare it with international recommendation. We propose to illustrate by a case report and review international recommendations on this topic while undertaking a review of the literature based on a Medline search using the following keywords: anorexia, nervosa adolescence, management, guidelines. Case report: AS, 16 years old, addressed to us by the school doctor for management of anorexia nervosa evolving for two years without improvement through outpatient care. His condition was considered precarious requiring urgent care in a medical hospital. She was then hospitalized at the Institute of Nutrition with a weight contract to achieve, She received a gradual refueling strongly denied. We have provided a psychological support by moving on site three times a week to help establish a good therapeutic alliance. After three weeks, the teenager has reached an acceptable weight for its output to the hospital and additional support at the outpatient child psychiatry with supportive psychotherapy. Two months later, she developed depression because of the weight gain. The appointment at the dietician was continued three months after hospitalization. At 10 months of the hospitalization, the girl had good grades and was not amenorrheic. However, on the psychological level she kept the same traits and intrafamilial relationships were marked by the seal of the manipulation. Subsequently, the teenager has spaced the consultations then lost sight. Currently, at 15 months of the hospitalization, parents describe a relapse, with a dietary restriction without amenorrhea ad a refusal to take weight. In management of this patient, we followed the recommendations of the literature namely those of the High Authority of Health and NICE (National Institute for Clinical Excellence) which recommend a target tracking of anorexia nervosa, the establishment of a multidisciplinary team care, a long hospitalization with a weight contract, support and not effective. Similarly, for children and adolescents, family therapy is recommended as an outpatient after hospitalization. In our country, the prevalence of anorexia nervosa is gradually increasing although we have not an idea concerning the frequency or prevalence of this disease which has serious and unpredictable complications. For what, it requires a multidisciplinary and prolonged surveillance to prevent recurrence.