Selected topics from Ch.

23
Complications of Adolescence
 Topics

Eating disorders: Anorexia Nervosa & Bulimia Nervosa.

Acne
Infectious Mononucleosis.
Eating Disorders

Common problem in adolescents and young adults

Especially seen in western cultures
Primarily females (but males are increasingly affected)
Major medical concerns
Effect of poor nutrition on growth and development
Electrolyte abnormalities
Two major problems
Anorexia nervosa
Bulimia nervosa
Anorexia Nervosa

Extreme loss of weight due to self-starvation (Emaciated)

◦ Results in severe malnutrition, protein and vitamin deficits
◦ May demonstrate purging

Two peak periods

◦ First: early teens (12 to 14 years)
◦ Later: in 16- to 17-year-old age range
◦ Girls affected > boys

Psychological component
◦ Perfectionists and high achievers
◦ Family conflict Seek control
◦ Fear of fatness
◦ Altered body image
 Anorexia Nervosa, cont.

Effects of Anorexia
◦ Lack of menstrual cycles - amenorrhea
◦ Low body temperature – cold intolerance
◦ Low blood pressure and slow heart rate
◦ Dry skin and brittle nails
◦ Development of fine body hair (lanugo)
◦ Low calcium intake – predisposition to osteoporosis later in life
◦ Dehydration affecting kidney and cardiovascular function
◦ Electrolyte imbalances
◦ Cardiac arrhythmias and cardiac arrest
◦ Can be LIFE-THREATENING
Treatment
Specialized outpatient vs. hospitalization
Long-term psychotherapy (cognitive behavioral therapy)
Prognosis:
About 50% of patients with anorexia will fully recover
About 30% achieve partial recovery
About 20% remain chronically ill
Note: Anorexia nervosa has the highest mortality rate of any mental health disorder (six fold increased risk of death)
 Bulimia Nervosa

Characterized by binge eating, followed by purging

◦ Binge eating
◦ Ingestion of large amounts of food – high calorie – within a very short
time period
◦ Purging
◦ self-induced vomiting
◦ Use of laxatives
◦ Compulsive exercising – “debting”

Bulimia and anorexia may overlap

Typical bulimic
◦ Occurs more frequently in older adolescents
◦ Poor self image
◦ Frequent dieting
◦ Bulimic person often maintains relatively normal weight.
Bulimia Nervosa, cont.

Effects of Bulimia:
◦ May result in anemia
◦ Menstrual irregularities
◦ Fluid and electrolyte imbalances (frequent vomiting)
◦ May cause cardiac arrhythmias, tetany, severe abdominal pain
◦ Erosion of tooth enamel (vomiting)
◦ Tears and ulcers in oral mucosa
◦ Esophagitis
◦ Esophageal tears – (risk for hemorrhage)
◦ Sore throat and difficulty swallowing
◦ Swollen parotid glands
Treatment
Long-term psychotherapy (cognitive behavioral therapy)
SSRIs (selective serotonin reuptake inhibitors: example: Prozac, Zoloft, Paxil) may help reduce binging and
purging AND may treat associated depression if present.
Prognosis:
Prognosis for bulimia nervosa is better than anorexia nervosa
80% of patients achieve remission without treatment
However for the remaining 20% the relapse represents a significant ongoing challenge
Acne Vulgaris, cont.

Common skin infection in adolescence:

◦ Involve sebaceous glands and associated hair follicles on:
◦ Face
◦ Neck
◦ Upper trunk

Comedones
◦ Whiteheads (closed comedones) or blackheads (open comedones)
◦ Non-inflammatory collection of sebum

Inflammatory
◦ Hair follicle swells and ruptures.
◦ Propionibacterium acnes breaks down sebum into inflammatory fatty acids
◦ Staphylococcal organisms invade and create a pustule
 Acne Vulgaris

Wide variation between mild to severe

If severe – permanent scarring

Treatment:
◦ General good skin hygiene
◦ Good nutrition
◦ Avoidance of oil based cosmetics

Topical

Peeling agents- Benzoyl peroxide (OTC)

Topical antibiotics – clindamycin

Topical retinoids – Tretinoin (Retin-A)

Acne Vulgaris

Oral antibiotics:
Doxycycline, minocycline
Oral Isotretinoin
Finally for severe scarring acne Isotretinoin may be prescribed.
(Absorica, Amnesteem, formerly Accutane)
 Isotretinoin is a major teratogen. It is only prescribed after
contracts have been signed in relation to avoiding pregnancy.
Patients must enroll in the iPledge program to verify awareness
about teratogenic risk
 Adolescent should be monitored for mood disturbance
 Other side effects include significantly dry skin
Infectious Mononucleosis

Infectious Mononucleosis is caused by the Epstein-Barr virus

(Member of the herpes virus family)

Affects lymphocytes

Common in adolescents and young adults

Usually mild and self-limiting but complications may occur

Transmitted by direct contact with infected saliva, airborne droplets, blood

◦ “Kissing disease”

Incubation period about 4 to 6 weeks

Frequently mistaken for acute strep throat

◦ Significant number of individuals treated with amoxicillin/ampicillin will develop rash
 Infectious Mononucleosis, Cont.

Manifestations:
◦ Sore throat, headache
◦ Fever
◦ Fatigue, malaise
◦ Enlarged lymph nodes and spleen
◦ Rash on the trunk
◦ Increase in lymphocytes and monocytes in blood
◦ Atypical T-lymphocytes
◦ Hepatomegaly and splenomegaly
◦ Restricts participation in sports (May need to take several month
break from contact sports such as football because of the risk of
splenic rupture.)