?????????-?????????? ??? ??? ???????? ????????

?? ?????????? ??? ???????? ??? ?????? ????? ??? ??????? ????? ??????????. ?????? ?????? ??????????? ???????? ??? ?????? ?????????? ?? ????????? ??? ?????? ???????? ??? ????????????? ??? ???????? ????. ??????????? ????????? ?????????? ??? ????? ??????? (??????????, ??????????????, ?????????, ????????????? ??? ???????????? ?????????), ??????????? ?? ??????????? ?? ??????? ?????? ??? ??????????? ???????????? ?????? ???????, ??? ????????? ??? ???????? ??? ??? ?? ???????? ??????????? ??????, ??? ???????????????? ?? ????????? ??????? ??? ??? ????????? ??? ??????? ???? ???? ??????????, ???? ??? ??? ?????? ??? ??????? ?? ??? ????? ??? ??????????? ??? ???????????? ??? ??? ?? ?????? ??? ??????????????. ?? ???????????? ????? ????????????? ??? ????????? ?????? ???????. ?????? ?????? ??? ?????? ??????? ??????????? ??? ???? ??? ?????????????, ???? ??????????? ????????? ?? ??????? ?????????? ???????.

1.?? ????? ? ????????? ????????;

? ???????? ????? ?????? ???????? ?? ?????????? ?????????? ??? ???? (????????? ??? �????????� ??? ??????? ??? ??? ????).

???????? ??? ?? ????? ? ???????? ????? :

1. ? ???????? ????????????? ?????? ??????? (??) ???? ??? ??????????? ???? ??? ?? ????, ?? ???? ??? ??? ?????? (???? ?????????? ??).
2. ? ??????????? ????? ??? ??? ??????????
3. ? ????????? ??? ??????? ??????? (???????? ??? ?? ???? ????? ???????, ???? ?? ???? ?????? ??)
4. ? ?????????? (??????? ????????)

????????? ????? ?????? ?? ?????????? ???????????? ????????????? ? ????? ????????? ???????? (?????? ?? ???????????? ?????? ?/??? ?? ???????????????? ??????? ??? ??? ???????? ???????? ??????).

2.???? ????? ? ????????? ??? ????? ??? ????? ?????? ????????? ????? ;

? ???????? ????? ?????? ?? ????? ???????? (?????????? ????????? ??? ???????? ?????? ??? ???????), ?????????????? ???????? ??????? ??? 14 ??? 18 ??????. ????? ?????? ??? ???????? ????, ?? ??????? ??????????????????? ????????, ??? ???? ????? ????????? ??? ??? ????????? ??? ????????????? ?? ???????? ??? ???????? ???????? ???? ???????? ? ?? ???? ??? ?? ?? ?????????? ?? ??? ??????? (???????, ??????? ??????????, ??????? ?.?.).

? ???????? ???? ?????? ?????? ???? ??????? 0.5-1%, ?????? ?? ????????? ???????? ??? ?????? ??????????? ?????????? ???? ????? ??? ??? ???????? ????????? ???? ??????, ?? ?????? ????????? ??? ????????? ??????. ? ???????? ??? ????????? ??????? ????????? ??? ?? ????????? ????????????? ?? ?????????? ??????? (3% ??? ?????????????????? ?????? <11 ????), ????? ??? ?? ???????? ????????. ????????? ?????? ? ???????? ??? ??????, ??? ???????? ??????????????????? ???????? ??? ?? ????? ?????.

3.????? ????? ?? ?????? ????????? ??? ?????????? ?????????;

? ?????????? ??? ?????????? ????? ???????????????. ? ????????? ??????? ????? ??????? ??? ??????????? ?? �???????� ????????????? ?? ?????, ??????????? ??? ???????. ????? ?? ?????? ? ?????? ??? ?????? ??? ?????????? ????????? ????? 12 ????? ?????????? ?????????? ????????? ???????? ??????????, ?????????? ???????????? ???????? ???????????? ????????.

????????? ???? ?????? ?? ????????????, ??? ??? ?? ???????? ????????? ??????????. ??? ?? ?????? ??? ??????????? ????????? ??? ???????????????? ???? ??? ??? ?? ?????? ???????????? ?????????? ?? ???????? ??????????????, ??? ??????????? ??? ???????????. ??????? ???????????? :

1. ??????????????? ??????????? (?? ??????????, ???????? ???????? ???????, ????????????? ??????? ? ?????????), 
2. ??????????? ??? ? ????? ?? ?? ?????? ????? ???????????? (???????? ? ?????????????? ???????)
3. ?????? ?? ???????????, ??? ?? ?????????? ???? ???? ??????????? ?????????? ??? ??? ??????? ? ???????? ? ???? ??????? ??? ????????????? ?? ??????????????? ???????
4. ??????????? ??? ?? ??????? ?????? ?? ?????????? ?? ??????????
5. ??????????? ???????????
6. ??????????? ?? ???? ?????? ????????????, ????? ??? ????? ?????? ???????? ? ?????????? ?????? ??? ??? ???????? ???? ??? ???????? (?????? ?? ??????? ???????? ? ?????????)
7. ??????????? ?? ????????? (?????? ???? ???????? ??????????? ????????, ?????????? ??????????? ?? ?????? ???????, ???????????? ????????? ?????? ?.??)
8. ????? ??? ???????????? ?? ????????? ??? ??????? ?????? ?????????? ?????? 
9. ????? ?? ?????? ?????? ????????, ???? ?????????? ?????????? ????????? 

? ???????????? ??? ?????? ??? ?? ?.?.?. ??? ? ??????? ??? ?????????? ????????? ?? ?????? ?????????? ????????? ??? ?????????? ???????? ??????? ?? ??????????? ?????????. ?? ???? ????????? ??? ?? ??????? ???????? ??? ?????? (?????????? ????? ????). ? ??????? ???????????? ???? ???????, ????????,???????????? ?.??. ?? ??? �?????? ??? ??????? ????????� ??????? ???? ??????? ???? ????????? ????????????, ??????????? ?? ???????? ?? ?????????? ???????.

4.????? ????? ?? ?????????? ??? ?????????? ???? ?????????;

? ????????? ???????? ???? ?????????? ?????????? ?? ??? ?? ????. ???? ??? ??????? ??? ????????????? ?????????, ????????? ?????????????? ??? ? ??????????? ?????? ?? ?????????? ??? ???????? ????????????? (?????????????), ?? ?????????? ???????? ??? ??? ???????. ???????? ????????????? ????????????? ??? ????? ??????? (?.?. ???????? ??????, ??????, ??????), ????? ??? ???????????? ????? ?????????? ??? ????????. ? ?????????? ?????? ?? ?????????? ??? ???????? ?? ???????????, ?? ??? ?????? ??????????? ??? ??? ???????? ?????? ????- ??????? ??? ????????? ????????? ??? ?????????? ????? ??? ????????. ??????? ?????, ?????????, ?????????????? ??? ?????????? ??? ???????????-??????? ??????.

??? ?????????? ????????? ??????????? ?????? ?? ???????? ?????????? ??? ??????????? ??? ?? ??? ?????????? ??????-????????????.

???? ??? ??????????? ????????????? ??????? ??? ??? ???????? ?????????????-?????????, ?? ????? ????? ?? ?????? ??? ??? ?????????, ?????? ?? �???????� ??? ?? ??????, ??? ??????? ??????? ?????? ??? ?? ??????? ??? ???????.

? ??????? ??? ???????????? ??????????? ???? ?? ?????????? ?? ????????? ????????? ??? ??? ??????? ??? ?????????????? (??? ????????????? ??? ??????? ??? ?????????? ??? ??? ?????????? ??? ??????????? ??? ???????).

?????? ?? ???????????? ???????? ????? ???????? ??? ?????? ?? ????????????? ???? ????? ??? ?????? ???????????? ??? ??????? (?????? ??????), ?? ???? ???????-??????? ???????????? ??????- ??? ?? ??????? ???????????? ???????. ?? ??????? ?????? ?????? ?? ????????????? ?????? ??? ????????????? ??? ??????????????????, ??????????? ?????? ???????????? ??????????? ?.?. ? ??????? ??? ??????? ?????????? ??????? ??????????? ?????????? ?/??? ???????????. ??????, ????? ?????? ?? ??? ???????? ????????? ???????????? ???????? ??? ??? ?? ???? ??????????? ??????, ??? ????? ???? ????????? ? ?????????? ??? ?? ???????? ??? ??? ??????? ??????.

? ??????????????? ?? ????? ??? ???????? ??? ????? ??????????????? ?????? ???????? ?????? (?????????????????, ?????????? ????????, ????????? ??????????? ????? ??? ???????, ??????????, ???????????? ?.?.), ????? ??? ??? ?????? ???????? (?????????, ????????????, ?????????, ????????? ??????????????) ??? ????? ??????. ???????? ??????????? ??? ?????????? ?? ?????????? ???????? ????????? ??????????? ??????????, ??????? ?????? �???-??????????� (?.?. ?????????? ?????, ????????? ??????????? ????? ??? ???????, ????? ??????), ??? ???? ?? ?????? ????? ?? ?????????? ?????.

5.???? ????? ? ???????????? ??? ?????????? ?????????; 

? ???????????? ??? ????????? ????? ??????? ?????????????? ??? ???? ???? ???????? ??????? ??????? :

1. ???????????? ??? ????????? ??????????? ??? ??? ????????? ?????? ??

??????????? ???????

2. ?????????????? ???????????? ??????????? ?????????

?????? ??? ??? ???????????, ?????? ?? ?????? ??????, ??????? ?? ??????????????? ?? ????????? ???? ?? ????????????? ??? ?????????, ?????????? ??? ?????????????. ????? ???? ????????? ? ???????????? ??????? ????????? ??????????? ??????????? ?? ???????? ? ??????? ????????????, ? ????? ????? ??? ? ?????? ????????????. ? ???????????? ???????? ????????? ?? ??? ????????????? ??????????, ???? ????? - ???? ????????????? - ?????? ? ??????????. ?????? ????? ???????, ????? ????????? ?? ????????? ?????? ????????? ??? ????????? ?????? ??? ?? ??????????? :

1. ??? ????? ??? ??? ????????

2. ??? ???????????? ????????????? (??? ???? ????????)

3. ??? ?????? ?????? ??????? (????? ???? ?????? ?? ??????????? ??? ????????? ???/??? ?????? ??? ??? ???? ???????? ??????? ??? ?? ?? ???? ???? ???????? )

4. ??? ??????????? ??? /??? ??????

??? ???????????? ?????, ???? ? ?????? ???????? ??? ??? ????????? ??? ??????, ????? ???? ????????? ??? ??? ??????????? ??? ??? ???????? ?????? ??????????-??????, ????????? ??? ? ????????? ??? ????????? ??? ??? ????????? ??? ?????? ????????? ?? ??? ?????? ????? ???????????. ??????? ??? ???????????????? ??? ?????????, ???? � ?? ????? ??? ????; ????? ??? ???? ???� ????? ???? ?? ???????????? ??? ?? ???????????????? ????????? ???? : �?????? ????? ?? ????? ?????, ???? ??? ?? ??????? ???? ????? ???- ?? ????? ???????????�. ? ??????? ??? ?? ?????? ??????? ?????? ??? ?????????? ??? ????? ????????? ?? ?????????? ???? ???????, ????? ?? ?????? ???????????, ???? ??? ?? ??????? ??????????? ??? ??????? ??????????? ??? ?????????????? ?? ??????????? ? ??????? ???????. ? ???? ????????? ????? ????????, ??? ? ??????? ??? ??????? ??? ?????, ????? ??? ? ??????????? ??? ????????? ?????? ?????? ???? ??? ??? ???????? ??????? ?????????????. ? ????? ?????? ?? ?????????? ????? ??? ???? ?? ??? ?????, ?????? ??? ???? ????????????? ???????? ? ?????????? ????? ????? ??? ? ???????? ??????? 3-7?????? ?/??? ???????????. ? ??????????????? ???? ???? ???? ??????? ???-??????????, ?????????-??????????????? ? ?????? ?????. ???????????????? ?????? ?????????? ??? ?????? ????????????? ??? ???????????? ????????? (????????, ???????, ???????????????), ???? ???????? ?? ???????? ????????? ??? ?? ????????? ? ????????? ???/??? ????????- ?????????? ??? ???? ??? ?????? ??????????? ?? ?????? ????????? (????? ????????).

6.???? ????? ? ?????? ??? ????? ;

????? ???????? ? ???????? ??? ??????? ?????????, ??? ?? ??????? ???? ?? ???????? ???????????? ??? 2-3%. ?? ????????, 60% ??? ??????? ???????????? (?????? ????????? ??? ????? ?????, ???????????? ?? ???????? ??????, ????? ???????? ???????????? ??????? ?? ???????? ? ??????, ????? ???????????? ??????? ??? ?????????? ???????, ??????????? ??????? ?/??? ??????????), 20% ??? ??????? ???????????? ?????? ????? ??? ??????? 20% ??? ???????????? ? ???????????? ????????.

7. ????? ????? ?? ????????? ????????? ??? ?????????? ;

1. ?????? ????????? (??????? ?????? > 25% ??? ?? ??????????? ??? ?? ????, ?? ???? ??? ??? ??????)
2. ?????????, ?????????????? ??????????
3. ???????? ????????????? (????????? ???????????, ?????????? ??? ???)
4. ?????????? shock (??????????, ??????????? ???????)
5. ????? ?????? ????? ??????
6. ??????????? ?????????
7. ?????????? ??????????? ??????????? (?? ???????????? ????????)
8. ??????????? ??????????????? ???????? ??? ??? ???????????? ??? ?????????? (?? ?????? ???????????? ?????????????)
9. ???????? ???????????????? ?????????????

8.?? ????? ?? ???????? ???????????? ??? ????? ????? ?? ??????? ??????? ??? ??? ???????? ??? ????????????? ??????? ;

?? ???????? ???????????? ?????? ?? ?????????? ?? ???????? ?? ?????? ????????? (??????? ?????? > 30 % ??? ???????????? ?????? ??? ?? ????, ?? ???? ??? ??? ??????), ???? ?????????????? ??????. ???? ???? ????? ?????????????? ??????, ??????? ??????????-?????? ?????????????, ??????????? ??? ????????? ??????? ??? ?????????????, ??? ??? ????? ????? ??????? ?????????????? ???? ??? ?????????????? ??? ???????? ??? ???????????? ???????? ????????? ?? ??????? ????????? (???????? ??????????, ????????? ???, ?????????? ???????, ????????????), ??? ?????? ?? ???????? ????? ??? ??? ??????.

???????, ?? ???????? ?? ?????? ????????? ????? ????????? ? ??????????? ?? ??????? ???????? (?????? ???????? 800-1000 kcal ????????? ??? ???????? ?????? ?? 100-200 kcal ???? ??? ? ????? ??????) ??? ?? ?????????? ???????????? ????????. ??????? ???????? ???????? ?????? ?? ???????????? ?????? ?? ???????????? ????????? ????? 1 kcal/ml ??? ??????????? ???? 1400 ????????/????? ??? ???? ???????????? ?? ??????. ???? ??????????? ???????????? ??? ????????????, ????? ??? ???? ? ?????????? ???????? ????? ??? ?? ?????? ??? ????????? ???????? ?????? 0.5-1 kg/????????. ??? ???? ???? ?? ?????? ????????? ????? ?? ??????????? ?? 10-20kcal/???? ??? ???????? ?????? ?? ??? ??????? ???????. ????? ?????? ????????? ?? ??????????? ? ???????? ??????? ?/??? ????????? ?? ?????? ??????.

? ???????? ?????? ????? ????????? ??? ??? ?????????? ???? ???????? ?????? ????? ???????, ??? ?? ?????? ?? ??????????? ????????, ???? ?? ??? ???????????? ?/? ??????? ??? ?? ?????? ??? ??? ???? ??? ?????? ??? ??????? ???/???, ???? ??? ?? ???????????? ? ?????? ??? ?? ????? ????? ????????? ????????? ??? ?? ??????? ???????. ??????? ?????? ????? ? ?????? ??? ?? ????? ?? ???? ??????? ??? ??? ????????? ????????? ?????/????? ??? ??? ???????? ?????????? ???????? ??????? ?? ???? ??? ??????????? ??? ???? ??? ??? ?????? ??? ??? ?????? ??? ??????? ????????????, ??? ?????????????? ??? ??? ?????????. ? ??? ?????????? ????????? ?? ????????? ?? ??????? ???????? ???? 3 ?????.

9.???????? ????????? ?????????? ???????? ????????? ?? ?? ??????? ??? ??????????? ???? ??????; 

???????????? ??????? ??

?????? ?????? ??????? 15 ????

(?.?. : 14.85 ???)

N=529 (252 ??????, 277 ????????)

???? : ?????? ???????? ?????? (?.?.?.)

???? ?????? (??????????) ????? ??????? : ??????????? ?? ???? ????????? ??????? 

-67/529 (12.66%) ??? ?????? ????? ?????? ????? ??????? ?? ????? ?? ?? ????, ?? ???? ??? ??? ??????

-32/529 (6%) ??? ?????? ????? ???? ?????? (??????????) ????? ??????? ?? ????? ?? ?? ????, ?? ???? ??? ??? ??????

-?? ???????? ?? ?????? ??? ???? ?????? ????? ??????? ????? ??????????? ????????? ??? ?? ?????? (78% ??? ??????? ?? ???? ?????? ????? ??????? ???? ????????)

-???????? ?????????/?????? ?? ?????? ??? ???? ?????? ????? ??????? :4/1

-A?? ?? ?????? ?? ???? ?????? ????? ??????? , 60% ???????? ??? ?? ??????????? ?? ?????? ???????? ????? ??? ??? ???? ????????? ???? ? ?????? ???????.

(3.5% ??? ??? ???????)

-?????????? : ?? ??? ??? ????????????? ??? ?? ???????? ??? ??? ????? ????????, ?? ?????? ?? ???? ?????? ????? ??????? ??? ????????? ??? ??????? ??????? (3.5%), ?????????? ?????? ???????? ??? ?? ?????????? ?????????? ????????? (????????).

10.?? ?????? ?? ????? ??? ??? ??????? ??? ??? ?????? ???????? ??? ??????????? ?????????? ;

????? ?????????? ????????? ? ????????? ?????????????, ?????? ??? ??? ????? ??? ?????? ??? ??? ?????? ??? ??????????? ??????????, ??? ??? ?????? ??? ????????? ???? ?? ????????? ??????, ????? ??? ? ?????????? ??? ????? ??? ?? ???????? ????????, ???? ???????? ???????????? ?? ?? ?????????? ???????. ?? ?????? ?? ??????? ????? ???, ?? ??? ? ?????????? ???????? (?.?.) ?? ??? ?? ?????????????? ???????? ?????? ??? 1-5% ??? ????????? ??????? ?????, ??????????? ?????????? ????? ??? ?? ???????? ??????????.?. ????? ?????? ?????? ???? ??????? ???????? ??? ?????? ?? ???????????? ??? ??????? ??? ???????????? ????????????? ??? ??? ?????????? ??????? ??????? ??????. ? ?????? ????????? ??????? ??????????? ???????????, ???? ?????????? ??? ??????????? ?? ??????, ?????? ?? ??????????? ??????????? ????????? ?????????? ??? ????? ???????????. ????? ?????? ??? ????, ???? ??????? ?????? ??? ?????? ??????????? ?????????, ??? ? ?????????? ?????? ?? ????????? ?????????, ???????? ?? �????????� ??? ???? ??????? ??? ??????? ???????????? ???? ???????? ??? ??????? ?????????? ??? ?????? ?? ????????? ???????? ?? ??? ???? ???? ??? ??????? ???????????? ????????.

______________________________________________________________

????????????

1. American Psychiatric Association : Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington DC, APA, 1994.

2. Fisher M.??????????? ??????????. ??? : ?olland-Hall C, Brown RT. Secrets ???????? ????????. ????????? ????????? ??????? : T??????? ?, ??????? ?. ???????? ???????? ?????????? 2005 : 370-282.

3. Rock CL, Curran-Celentano J: Nutritional management of eating disorders. Psychiatr Clin North Am 19 : 701-713, 1996.

4. Solomon SM, Kirby DF : The refeeding syndrome : a review. J Parenteral Enteral Nutr 14: 90/97,1990.

5. Gonzalez A. Eating Disorders in adolescents. Australian Family Physician. Vol 36, No 8, August 2007 : 614-19.

6. Report CR130 of the Royal College of Psychiatrists on Nutritional treatment of Anorexia Nervosa, London July 2005.

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