“A study to evaluate the effectivenen of self ...



RAJIV GANDHI UNVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

| | | |VARUN PRASAD.S |

| | | |1ST YEAR M.SC NURSING, |

|1. |NAME OF THE CANDIDATE AND ADDRESS |: |INDIAN COLLEGE OF NURSING, TILAK NAGAR, BYPASS ROAD, |

| | | |CANTONMENT, |

| | | |BELLARY – 583104 |

| | | |INDIAN COLLEGE OF NURSING, TILAKNAGAR, BYPASS ROAD, |

|2. |NAME OF THE INSTITUTION |: |CANTONMENT, |

| | | |BELLARY – 583104 |

| | | |DEGREE OF MASTER OF NURSING , |

|3. |COURSE OF STUDY AND SUBJECT |: |PSYCHIATRIC NURSING |

|4. |DATE OF ADMISSION TO COURSE |: |18-6-2011 |

| | | |“A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF INSTRUCTIONAL|

| | | |MODULE ON KNOWLEDGE REGARDING ANOREXIA NERVOSA AMONG |

| | | |ADOLESCENT GIRLS STUDYING IN INDIAN PRE-UNIVERSITY SCIENCE |

| | | |COLLEGE FOR WOMEN AT BELLARY, KARNATAKA.” |

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|5. |TITLE OF THE TOPIC |: | |

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BRIEF RESUME OF THE INTENDED WORK

6. INTRODUCTION:

“Eating is always a decision; nobody forces your hand to pick up food and put it into your mouth.”

Albert Einstein

The food what we eat is the main source of energy that help for the physical, mental and social development of an individual. There are people who knowingly abstain food for known and unknown reasons. There are related concerned about their how they look and can feel self conscious about their bodies. This can be especially true when they are going through puberty and undergo dramatic physical changes and face new social pressure. This will leads to a rare phenomenon of psychological disorder called Anorexia Nervosa.

The term anorexia nervosa was established in 1873 by Sir William Gull, one of the Queen Victoria Personal physicians. The term is of Greek Origin ‘An’ prefix denoting negation and ‘orexis’ prefix denoting appetite. This means a lack of desire to eat.1 People with anorexia have an extreme fear of weight gain and a distorted view of their body size and shape. As a result, they strive to maintain a very low body weight. Some restrict their food intake by dieting, fasting or excessive. They hardly eat at all and often try to eat as few calories as possible, frequently obsessing over food intake. The small amount of food they do eat becomes an obsession. Anorexia nervosa or food phobia are also becoming increasingly common in adolescence.2

Anorexia Nervosa is a psychiatric disorder characterized by the refusal of an individual to maintain a minimum normal body weight often to the point of starvation. In both the DSM-IV and ICD-10 unification system World Health Organization has been viewed as a culturally bound disorder rare as absent except in western cultures where there is a pervasive pressure to diet to obtain a socially desirable weight and or shape British Medical Association and Board of science and education 2000. 1

It is often coupled with distorted self image which may be maintained by various cognitive biases that alter how the affected individual evaluates and thinks about her or his body, food and eating. Persons with anorexia nervosa continue to feel hunger, but deny themselves to have small quantities of food. The average calorie intake of person with anorexia nervosa is 600 – 800 calories per day, but extreme cases of complete self starvation are known. It is a serious mental illness with a high incidence of co-morbidity and the highest mortality rate of any psychiatry disorder. They are so common in the United States that 1 or 2 out of every 100 adolescent had struggled with anorexia or bulimia.3

Anorexia most often has its onset in adolescents and in most prevalent among adolescent girls. Recent studies show that the onset of anorexia range from 13 to 17 years in average and it also reduced to 9 to 12 it can affect men and women of any age, race and socio economic and cultural background. Anorexia nervosa occurs in females 10 times more than in males.4

1. NEED FOR THE STUDY

Anorexia nervosa has an average prevalence of 0.3-1 percentage in women and 0.1 percentages in men for the diagnosis in developed countries. The condition largely affects young adolescent women, with between 15 and 19 years old making up 40 percentages of all cases. Approximately 75 percentages of people with anorexia are female. Anorexia nervosa is more prevalent in the upper social classes and it was declared to be rare in less developed countries.5

The world wide incidence of anorexia nervosa is around 8/1, 00,000 persons per year. An upward trend has been observed in the incidence of anorexia nervosa in the past century till the 1970s . The most substantial increase was among females aged 15-24 years. The average prevalence rates for anorexia and bulimia nervosa among young females where in the North-east Scotland register covers Aberdeen and its environs, with a total population of 4, 73,370 in 1966. In the four year period 1966 to 1969 30 new cases of anorexia nervosa were registered, 28 female and 2 male. The annual occurrence was 6, 4, 7, and 13. Their mean age was 24.7 years, and the median age was 20.3 years. This gave an average annual incidence of 1-6 per 100,000 population and a sex-age specific rate for the 27 females aged 15-34 years of 10-8 per 100,000.6

According to parental social class a greater proportion of patients were in the Registrar General's social classes two and three than were the other cases on the register, but the proportion was the same as in the general population of the area. The Monroe County register covers the city of Rochester and its environs in New York State, United States of America with a total population of 586,000 in 1960 rising to 712,000 in 1970, of which 25,000 are reported to be non white. During the decade 1960 to 1069.There was 24 cases of anorexia nervosa were recorded of who 17 were female and seven male. The cases in successive years were three, zero, one, two, three, three, three, zero, three, and six. Their mean age was 22.2 years and median age between 15 and 19, with no significant difference in age between the sexes. The average annual incidence was 0.37 per 100,000 populations, but the sex-age specific rate for females aged 15-34 years was only 0-8 per 100,000. Social class data were not recorded. The Camber well register covers an area in south-east London with a population of 172,000, of whom 10,000 are colored immigrants. From the start of the register in 1965 up to 1971 eight patients with anorexia nervosa were recorded, all female, with a mean age of 21.6 years. None was reported in the first four years there were two in 1969 and 1970 and four in 1971. The average annual incidence was 0-66 per 100,000 populations and the sex-age specific rate for females aged 15-34 years was four to one per 100,000. Five of these patients had parents in social classes one or two, which was a highly significant excess over other register patients and the general population. One patient was of Indian origin.6

In India prevalence of anorexia nervosa is lower than that of western countries but appears to be increasing due to westernization and industrialization. The symptoms of anorexia nervosa were mostly seen in pre-pubertal period belong to middle and lower socio – economic group and or the family with only child. There are more females with anorexia nervosa having female and male ratio of 5:1 than in the psychogenic vomiting group having female and male ratio of 2:15 but this was not significantly different.7

A study was conducted in sample consisted mostly of females adolescents from middle socio economic status towns and villages of north-eastern India. The result indicated that north eastern states of India with a mean age of 12.6 years are more prone to anorexia nervosa. The mean age of onset of symptoms and duration of symptoms was 11.2 years and 19.2 years respectively.8

There are no prevalence or co-morbidity studies on eating disorders in India. This retrospective chart review studied the prevalence and psychiatric co-morbidity among juveniles with eating disorders. Forty-one cases with ICD-10 diagnosis of eating disorders were identified and analyzed. The prevalence of eating disorders was 1.25 percentages. Psychogenic vomiting was the commonest eating disorders and anorexia nervosa the emerging eating disorder. The most common co-morbidities were depression, intellectual disability, and dissociative disorder.9 Case reports of anorexia nervosa in subjects of Asian and in Indian sub continental extraction have been rare. Three Asian adolescents with anorexia nervosa are described, one of whom is male. The impact of the Muslim festival of Ramadan is described in the two Muslim cases. There was a need for better understanding of attitudes towards body shape and food within the subculture.10

A study was conducted among general population in Lucas, United States of America the findings revealed that the most vulnerable group for anorexia nervosa comprised girls and young women aged 15 to 24 years. A continual rise in incidence was observed throughout the 55 years of this study. The study concluded the prevalence of anorexia nervosa were high. There are historical description of cases of self starvations without weight concern in cultures, where was no emphasis a slimness. A cross cultural comparison has suggested that anorexia nervosa does not necessarily follow the accepted Western form.11

The study conducted in Malaysia showed that 0.05 percentages of psychiatric patient samples were diagnosed with anorexia nervosa. Lee reported in 1989 anorexia nervosa sufferers were very few in Hong-Kong compared with western countries. A study was conducted among 732 general and female population of hospital Kabuki in Japan. The study result revealed that the female patient population had about 1.5 times more anorexia sufferers than the general population. Among the general population the rate had increased from 0.0036 percentages to 0.0045 percentages among the female patient population the rate had increased from 0.0063 percentages to 0.0097 percentages so patient bared estimates of anorexia nervosa in non western countries thus ranged from 0.002 percentages to 0.9 percentages.12

It is important to remember that anorexia nervosa can easily get out of hand and are difficult habits to break. Anorexia nervosa is serious clinical problems that require professional treatment by doctors, nurses, therapists and nutritionists. My work is to improve the knowledge of adolescent girls regarding anorexic nervosa. By that they will get the health teaching and they will be aware of being anorexia nervosa.

The current medical nursing literature reflects the prevalence of anorexia nervosa in adolescent girls. Based on the literature and investigator experiences the investigator feels that it is important to create awareness among adolescent girls regarding anorexia nervosa. So the knowledge of the adolescent girls may be applied in early medical validation. Hence the investigator planned to impart the knowledge by providing self instructional module to the adolescent girls studying in Indian Pre-University Science College for Women at Bellary.

2. REVIEW OF LITERATURE:

The purpose of a research literature is to an assemble knowledge on a topic literature review helps in the identification of research problem development of hypothesis identification of suitable designs, date collection method and it also provides knowledge about data analysis and interpretation.13

A study was conducted in Spain to determine the percentage of adolescents with anorexia nervosa who present worse cognitive functioning according to neuropsychological criteria of cognitive impairment and to study their clinical characteristics in 37 adolescent in age group of 11-18years with a diagnosis of anorexia nervosa in an acute state of the illness and with low body mass index were comprehensive with 41 healthy subjects of the same sex and similar age once intelligence using a comprehensive neuropsychological functioning. Anorexia nervosa over all took the control group (P=0.001) 30 percentage of patients showed impaired neuropsychological functioning. The sub groups of patients presented lower( P=0.023) and higher trait anxiety (P=0.028) cognitive performance varied in one by third of sample. The cognitive impairment sub group showed lower body mass index and higher anxiety longitudinal follow up studies are necessary to assess the stability of this profile after longer treatment.2

A study was conducted in Poland to determine an accurate anthropometric measurement for clinical assessment of fat depletion in girls with anorexia in connection with body composition measured by dual energy X-ray absorptiometry. In 64 female anorexia nervosa patients aged 12.8 – 23 years and the mean is 16.0 [pic]1.8 percentages, body mass index, skin fold thickness, mid-upper arm and thigh circumference, fat mass and lean mass were determined and compared with the data of 71 records. Girls with anorexia nervosa had lower anthropometric tracts and were fat depleted compared to controls 14.9 [pic] 7.3 with 27.4 [pic] 6.4 percentages of fat mass using dual energy x-ray absorptiometry all ................
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