The Clinical Study Of Surgical Treatment For Refractory

Background and Objectives:Anorexia nervosa is an eating disorder which is an important cause of physical and psychosocial morbidity in adolescent girls and young adult women. Common signs and symptoms include loss of subcutaneous fat tissue, orthostatic hypotension, bradycardia, impaired menstruation, hair loss and hypothermia. Many other psychiatric conditions often co-exist in50to70percent of patients such as major depression or dysthymia, anxiety disorders and obsessive-compulsive disorder (OCD). Almost50%of patients are refractory to all current medical treatment and never fully recover and the standardized mortality ratio over the first10years is about10%.With the progress of the illness,the symptom of episodic overeating and vomiting will emerge.Thetraditional treatment for AN are psychological treatment and medication.Patients often have a certain effect with these treatment on early stage.However,most of patient have experienced repeated long-term medical treatment,and become refractory AN patients with a high mortality rate.Patients often died of severe malnutration,electrolyte imbalance,multiple organ failure and other complications.In recent years,the sterotactic brain surgery became a safe,minimal invasive,less side effect treatment that is used for the treatment of retractory Obssessive-compulsive disorder(OCD).AN and OCD are all belong to the forcing spectrum disorders.There are many common clinical features.Our center have been used surgical treatment with AN patients since the year2006.We discovered from the surgical treatment that:The severity of clinical symptoms played a key role in the choice of surgical methods and the prognosis of the illness.Therefore,we based on different clinical features of patients to outline and classify the illness,expect that the clinical classification can be of help for determing the timing of surgery,the chooice of surgery procedure and prognosis.Method:61patients from the overall104surgical treated patients were successfully follow-up.The material of major symptoms such as course of disease,body mass index(BMI),menia,Yale-brown OCD Scale,Hamilton Anxiety Scale,Hamilton Depression Scale,Concise Intelligent Scale were well collected for controlled study.The clinical classifucation is based on the clinical symptoms before the surgery.Results:2DBS cases of grade IV patient were relapsed6and10months after the surgery, respectively. Who then have received biladeral stereotactic internal capsulotomy and then significantly inproved.They were still in stable condition the time of follow-up.1case of grade IV patient have no improvement and died from suicide18months after surgery.85.37%patients have their BMI over17.5in all living patients.â…¡,â…¢ grade patients returned to normal level;30cases of amenorrhea before surgery returned to normal after the operation.7cases were menia irregular and retured to normal after surgery.Grade â…¡,â…¢ patients were cured,83.87%of grade IV patients were cured;Except to Concise Intelligent Scale was no statistically significant before and after surgery,the scores of the remaining four scales showed a significant difference before and after surgery. The operation is best for the improvement of obsessive symptoms,second,anxiety symptoms,last,depression.Change in body image disorders before and after surgery was ststistically significant.