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Thorey S, Blanchet C, Guessoum SB, Moro MR, Ludot M, Carretier E. Efficacy and tolerance of second-generation antipsychotics in anorexia nervosa: A systematic scoping review. PLoS One 2023; 18:e0278189. [PMID: 36928656 PMCID: PMC10019643 DOI: 10.1371/journal.pone.0278189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/03/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Second-generation antipsychotics (SGAs) are frequently prescribed for the treatment of resistant anorexia nervosa. However, few clinical trials have been conducted so far and no pharmacological treatment has yet been approved by the Food and Drug Administration. The aim of this paper is to conduct a systematic scoping review exploring the effectiveness and safety of atypical antipsychotics in anorexia nervosa (AN). METHOD We conducted a systematic scoping review of the effectiveness and tolerability of SGAs in the management of AN. We included articles published from January 1, 2000, through September 12, 2022 from the PubMed and PsycInfo databases and a complementary manual search. We selected articles about adolescents and adults treated for AN by four SGAs (risperidone, quetiapine, aripiprazole or olanzapine). This work complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRIMA-ScR) and was registered in the Open Science Framework (OSF) repository. RESULTS This review included 55 articles: 48 assessing the effectiveness of SGAs in AN and 7 focusing only on their tolerability and safety. Olanzapine is the treatment most frequently prescribed and studied with 7 randomized double-blind controlled trials. Other atypical antipsychotics have been evaluated much less often, such as aripiprazole (no randomized trials), quetiapine (two randomized controlled trials), and risperidone (one randomized controlled trial). These treatments are well tolerated with mild and transient adverse effects in this population at particular somatic risk. DISCUSSION Limitations prevent the studies both from reaching conclusive, reliable, robust, and reproducible results and from concluding whether or not SGAs are effective in anorexia nervosa. Nonetheless, they continue to be regularly prescribed in clinical practice. International guidelines suggest that olanzapine and aripiprazole can be interesting in severe or first-line resistant clinical situations.
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Affiliation(s)
- Solène Thorey
- APHP, Cochin Hospital, Maison de Solenn, Paris, France
- Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - Corinne Blanchet
- APHP, Cochin Hospital, Maison de Solenn, Paris, France
- UVSQ, Inserm, CESP, Team DevPsy, Paris-Saclay University, Villejuif, France
| | - Sélim Benjamin Guessoum
- APHP, Cochin Hospital, Maison de Solenn, Paris, France
- UVSQ, Inserm, CESP, Team DevPsy, Paris-Saclay University, Villejuif, France
- Laboratoire de Psychologie Clinique, Psychopathologie et Psychanalyse, Paris Cité University, Boulogne-Billancourt, France
| | - Marie Rose Moro
- APHP, Cochin Hospital, Maison de Solenn, Paris, France
- UVSQ, Inserm, CESP, Team DevPsy, Paris-Saclay University, Villejuif, France
- Laboratoire de Psychologie Clinique, Psychopathologie et Psychanalyse, Paris Cité University, Boulogne-Billancourt, France
| | - Maude Ludot
- APHP, Cochin Hospital, Maison de Solenn, Paris, France
- UVSQ, Inserm, CESP, Team DevPsy, Paris-Saclay University, Villejuif, France
- Laboratoire de Psychologie Clinique, Psychopathologie et Psychanalyse, Paris Cité University, Boulogne-Billancourt, France
| | - Emilie Carretier
- APHP, Cochin Hospital, Maison de Solenn, Paris, France
- UVSQ, Inserm, CESP, Team DevPsy, Paris-Saclay University, Villejuif, France
- Laboratoire de Psychologie Clinique, Psychopathologie et Psychanalyse, Paris Cité University, Boulogne-Billancourt, France
- * E-mail:
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Barton R, Aouad P, Hay P, Buckett G, Russell J, Sheridan M, Brakoulias V, Touyz S. Distinguishing delusional beliefs from overvalued ideas in Anorexia Nervosa: An exploratory pilot study. J Eat Disord 2022; 10:85. [PMID: 35739570 PMCID: PMC9229879 DOI: 10.1186/s40337-022-00600-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Characterised by the belief that more weight needs to be lost-despite emaciation, failing organs, medical instability and prospect of death-Anorexia Nervosa (AN) is a condition in which irrational, and highly-skewed, beliefs can be of delusional intensity. However, the nexus between delusion and rational awareness and how this is related to body image acceptance and perception has yet to be examined in AN. The current study aims to investigate the relationship between body dissatisfaction and beliefs of delusional intensity in an adult AN inpatient sample. METHODS Twenty-one adults (n(women) = 20; n(men) = 1), with a mean age of 27 years old (SD = 10), presenting for inpatient treatment for AN (ranging in severity from mild to severe; M(Body Mass Index) = 17 kg/m2; M(Length of Stay) = 22 days) participated in the study. Participants' dominant beliefs (related to AN) and level of insight (delusional; overvalued idea; or fair insight) were measured using either the Brown Assessment of Beliefs Scale (BABS) or the Nepean Beliefs Scale (NBS). The degree of body dissatisfaction was determined by examining the discrepancy between "perceived" and "ideal" body perception. To determine subjective and objective beliefs both the Contour Drawing Rating Scale (subjective) and computerised Body Image Assessment Software (objective) were used. RESULTS Almost one quarter (23.7%; n = 5) of participants appeared to have beliefs of delusional intensity related to their body shape (M = 27.4; SD = 23.03). Although a positive linear trend was indicated, there were no significant differences in body dissatisfaction scores between level-of-insight. Individuals whose belief was categorised as delusional were more likely to hold a negative affective body image state based on their ratings on the body image state survey when compared to the group who had good/fair insight (95% CI [0.53, 18.19]; p = 0.03). CONCLUSIONS The current exploratory pilot study concurs with others in the published literature that demonstrate that approximately 25 percent of participants with AN may have delusional ideas. The implications for treatment in similar samples warrant attention. Future research should also seek to understand the clinical significance of this delusional categorisation, the benefits of its utility in this population, and its relation to the severity of AN or stage of illness.
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Affiliation(s)
- Rachel Barton
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. .,School of Medicine, Western Sydney University, Sydney, NSW, Australia.
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Geoffrey Buckett
- Eating Disorder Unit - Northside West Clinic (Ramsay Mental Health), Wentworthville, NSW, Australia
| | - Janice Russell
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Margaret Sheridan
- Northside Clinic (Ramsay Mental Health), St Leonards, NSW, Australia
| | - Vlasios Brakoulias
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.,Northside Clinic (Ramsay Mental Health), St Leonards, NSW, Australia.,Western Sydney Local Health District Mental Health Service, Sydney, NSW, Australia
| | - Stephen Touyz
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.,InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Cassioli E, Sensi C, Mannucci E, Ricca V, Rotella F. Pharmacological treatment of acute-phase anorexia nervosa: Evidence from randomized controlled trials. J Psychopharmacol 2020; 34:864-873. [PMID: 32448045 DOI: 10.1177/0269881120920453] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) is the psychiatric disorder with the highest mortality rate, with a standard mortality ratio of 5.86. Despite the large use of psychotropic drugs in the clinical setting, Food and Drug Administration has not approved any psychoactive treatment for AN. AIMS The aim of this study was to perform an updated systematic review and meta-analysis of published randomized controlled trials (RCTs) investigating psychopharmacological treatment in acute-phase AN. METHODS The present paper follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. An extensive literature search was performed. All RCTs enrolling patients with acute-phase AN, comparing at least one psychotropic drug with another drug, placebo, treatment-as-usual or no treatment were included. The main outcome was the effect of psychoactive drugs on body mass index (BMI); data on psychopathological outcomes were also collected when available. RESULTS A total of 19 RCTs met all specified criteria. Of these, 11 were excluded from quantitative analyses. Of the eight studies included in the meta-analyses, five reported data on BMI, showing no significant difference between olanzapine and placebo for weight recovery. No significant result was found for AN psychopathology, depressive and anxious symptoms for any of the molecules studied. CONCLUSIONS RCTs published in this field display methodological biases, low sample sizes and short follow-up periods. Further research efforts are needed in this field as no evidence has been demonstrated for the use of any psychotropic drug in acute-phase AN neither for weight recovery, nor for comorbid psychiatric symptoms.
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Affiliation(s)
- Emanuele Cassioli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Carolina Sensi
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Valdo Ricca
- Department of Health Sciences, University of Florence, Florence, Italy
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Kotilahti E, West M, Isomaa R, Karhunen L, Rocks T, Ruusunen A. Treatment interventions for Severe and Enduring Eating Disorders: Systematic review. Int J Eat Disord 2020; 53:1280-1302. [PMID: 32488936 DOI: 10.1002/eat.23322] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Approximately 20% of people with Anorexia Nervosa (AN) and 10% with Bulimia Nervosa (BN) will eventually develop a long-standing illness. Although there is no set definition for Severe and Enduring eating Disorder (SE-ED), the common criteria relate to a long duration of the disorder and a number of unsuccessful treatment attempts. Research evidence for treatment of SE-ED remains limited, thus the objective of this systematic review was to describe different treatment interventions and their effects on SE-ED-related outcomes. METHOD A systematic search for quantitative treatment studies of adult participants with SE-ED was conducted in June 2019 (PROSPERO, CRD42018115802) with no restriction on eating disorder type. Altogether, 2,938 studies were included for title and abstract screening. RESULTS After systematic searches and article screening, 23 studies (3 randomized controlled trials, 3 open-label studies, 8 naturalistic follow-up studies, 8 case series and case studies, and 1 partially blinded pilot study) were included in the analysis and data extraction. Methodological quality of the included studies was generally low. Inpatient treatment programs (n = 5) were effective in short-term symptom reduction, but long-term results were inconsistent. Outpatient and day-hospital treatment programs (n = 5) seemed promising for symptom reduction. Drug interventions (n = 5) showed some benefits, especially as adjuvant therapies. Brain stimulation (n = 6) led to improvements in depressive symptoms. Other treatments (n = 2) produced mixed results. DISCUSSION This is the first systematic review to examine all of the different treatment interventions that have been studied in SE-ED. The results will inform future interventions in research and clinical practice.
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Affiliation(s)
- Emilia Kotilahti
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Madeline West
- Deakin University, Food & Mood Centre, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Rasmus Isomaa
- Department of Social Services and Health Care, Finland.,Faculty of Education and Welfare Studies, Åbo Akademi University, Åbo, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tetyana Rocks
- Deakin University, Food & Mood Centre, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Anu Ruusunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Deakin University, Food & Mood Centre, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
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5
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Çöpür S, Çöpür M. Olanzapine in the treatment of anorexia nervosa: a systematic review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00195-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractAnorexia nervosa, with the highest mortality rate among psychiatric diseases, is characterized by low body mass index, fear of weight gain, and disturbed body image. Even though multiple drugs have been proposed for the treatment of anorexia nervosa, current treatment modalities include nutritional support and psychotherapy. In this study, our aim is to analyze the efficiency and possible adverse effects of olanzapine, an atypical anti-psychotic drug, in the treatment of anorexia nervosa. The studies investigating the efficiency and possible adverse effects of olanzapine in anorexia nervosa have been searched by using 3 databases (Embase, PubMed, and Cochrane Library). DerSimonian-Laird random effects meta-analyses have been used in the statistical analysis. Effect of olanzapine treatment in accordance with the duration and dosage of drug have been analyzed by the determination of 95% confidence intervals (p value < 0.05 is considered as statistically significant). Despite the presence of some contradictory studies, olanzapine treatment has been found beneficial in anorexia nervosa. In addition, analysis reveals that statistically significant beneficial effect of olanzapine treatment is used at high doses and for short duration. Possible side effects include neuroleptic malignant syndrome, hypoglycemia, and heart block in patients suffering from anorexia nervosa. Even though there is obvious need for more comprehensive further studies, current literature favors olanzapine treatment. The efficiency of olanzapine is considered to be related to changes in dopaminergic and serotonergic system in anorexic patients both in terms of neurotransmitter levels and receptor activity.
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6
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Kan C, Eid L, Treasure J, Himmerich H. A Meta-Analysis of Dropout and Metabolic Effects of Antipsychotics in Anorexia Nervosa. Front Psychiatry 2020; 11:208. [PMID: 32256415 PMCID: PMC7090227 DOI: 10.3389/fpsyt.2020.00208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Second-generation antipsychotics are often used off-label in the treatment of anorexia nervosa (AN) across the clinical spectrum. Patients with anorexia nervosa often cite concerns about metabolic effects, such as weight gain, as reasons for their reluctance to start or continue second-generation antipsychotics. Improving our understanding of the metabolic effect patients experience and reasons underlying their disinclination will enable us to build rapport and guide our clinical decisions. We therefore aimed to conduct a comprehensive review of dropouts, metabolic effects, and patient-reported outcomes associated with second-generation antipsychotic in people with AN. METHOD EMBASE, Medline, and PsycINFO were searched for all relevant studies published until 2019, and retrieved studies were assessed for eligibility as per predefined inclusion criteria. A random-effects meta-analysis was conducted to assess overall dropout rates. RESULTS Of 983 citations retrieved, 21 studies met the inclusion criteria for the systematic review and 10 studies had appropriate data for meta-analysis. Using the random effects model, the pooled dropout rate in the intervention arm (95% confidence interval) from psychopharmacological trials was 28% (19 to 38%) in people with AN. Personal reasons or factors associated with study were commonest reason for dropout, not adverse events or metabolic effects as hypothesized. CONCLUSION Compared to personal reasons, drug-related factors such as side effects seem to play a lesser role for the discontinuation of antipsychotic treatment under trial conditions. This suggests an urgent need to consider and fully examine potential individual and patient-related factors that influence dropout rates in psychopharmacological trials and treatment compliance in clinical settings.
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Affiliation(s)
- Carol Kan
- Psychological Medicine, King's College London, London, United Kingdom
| | - Laura Eid
- Psychological Medicine, King's College London, London, United Kingdom
| | - Janet Treasure
- Psychological Medicine, King's College London, London, United Kingdom
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7
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Spettigue W, Norris ML, Santos A, Obeid N. Treatment of children and adolescents with avoidant/restrictive food intake disorder: a case series examining the feasibility of family therapy and adjunctive treatments. J Eat Disord 2018; 6:20. [PMID: 30123505 PMCID: PMC6091012 DOI: 10.1186/s40337-018-0205-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To date, little research has examined the effectiveness of either modified Family-Based Therapy or psychopharmacological treatments for patients diagnosed with avoidant/restrictive food intake disorder (ARFID), and there is little evidence to guide clinicians treating children and adolescents with ARFID. This case series describes the clinical presentations, treatments and outcomes of six patient diagnosed with ARFID who were treated sequentially by a child psychiatrist and adolescent medicine physician in a hospital-based eating disorder program. CASE PRESENTATIONS Five out of six cases were female and median age of patients at assessment was 12.9 (SD = 1.13) years. On average, patients' percentage of treatment goal weight was 80.5% at initial assessment (SD = 8.56) and 81.9% (SD = 7.08) when family therapy began. Cases 1, 2 and 3 were admitted to a specialized inpatient unit at assessment due to medical instability (2) or failed outpatient treatment (1), and all six cases presented with severe co-morbid anxiety. All patients were treated using a combination of medical monitoring, family therapy, medication (including olanzapine, fluoxetine and in two cases cyproheptadine), and cognitive behavioural therapy. At treatment termination, all six patients had achieved their goal weight. CONCLUSION These cases illustrate the complex ways in which young patients with ARFID can present, the illness' effect on development and mental health, and the positive outcomes associated with weight gain and concurrent treatment for co-morbid anxiety disorders.
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Affiliation(s)
- Wendy Spettigue
- Department of Psychiatry, Children’s Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON K1H 8L1 Canada
- Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 5B2 Canada
| | - Mark L. Norris
- Division of Adolescent Health, Department of Pediatrics, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1 Canada
- Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 5B2 Canada
| | - Alexandre Santos
- Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 5B2 Canada
| | - Nicole Obeid
- Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 5B2 Canada
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Spettigue W, Norris ML, Maras D, Obeid N, Feder S, Harrison ME, Gomez R, Fu MC, Henderson K, Buchholz A. Evaluation of the Effectiveness and Safety of Olanzapine as an Adjunctive Treatment for Anorexia Nervosa in Adolescents: An Open-Label Trial. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2018; 27:197-208. [PMID: 30038658 PMCID: PMC6054282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 04/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the effectiveness and safety of adjunctive olanzapine treatment for low weight adolescents with anorexia nervosa (AN). METHODS A non-randomized open-label trial was conducted between 2010 and 2014. Participants received standard treatment and were invited to take olanzapine at study enrollment. Participants could accept, continue, or discontinue olanzapine as treatment progressed. Weight and psychological outcomes were monitored. RESULTS Of 239 adolescents assessed, 65 met inclusion criteria, 38 enrolled in the study, and 32 were retained for analysis. Twenty-two participants took olanzapine (medication group) and ten participants did not (comparison group). Participants in the medication group demonstrated a higher rate of weight gain compared to those who did not receive olanzapine (p = .012). No serious adverse events were noted, although seven participants (31.8%) discontinued olanzapine due to a side effect. CONCLUSION Preliminary results suggest that olanzapine may help facilitate weight gain in adolescents with AN. The importance of medical monitoring over the course of treatment is discussed. Evaluation of the Efficacy and Safety of Olanzapine for Anorexia Nervosa in Children and Adolescents; http://clinicaltrials.gov; NCT01184443.
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Affiliation(s)
- Wendy Spettigue
- Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario
- Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Mark L Norris
- Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ontario
| | | | - Nicole Obeid
- Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Stephen Feder
- Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ontario
| | - Megan E Harrison
- Regional Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, Ontario
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ontario
| | - Rebecca Gomez
- Department of Psychiatry, University of Ottawa, Ontario
| | | | | | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Centre for Health Active Living, Children's Hospital of Eastern Ontario, Ottawa, Ontario
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Abstract
Anorexia nervosa has the highest mortality rate among all psychiatric illnesses, as it can result in significant psychopathology along with life-threatening medical complications. Atypical anorexia nervosa is a new variant described in the latest DSM edition, which has much in common with anorexia nervosa and also can result in significant morbidity and mortality. The evolution of the criteria for these illnesses is reviewed, and the two are compared and contrasted in this article. Important labs to monitor for in those with these illnesses, along with an emphasis on the monitoring of vital signs and weight, are reviewed here. The necessity for close psychiatric monitoring of safety concerns, including suicidal thoughts, is also stressed. The etiology and the treatment of these illnesses are reviewed from a biopsychosocial approach; and lastly, the prognosis of these illnesses is discussed.
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Affiliation(s)
- Lindsay Moskowitz
- Department of Psychiatry, Northwell Health, New Hyde Park, NY; Hofstra-Northwell School of Medicine, Hempstead, NY
| | - Eric Weiselberg
- Division of Adolescent Medicine, Cohen Children׳s Medical Center, Northwell Health, New Hyde Park, NY; Hofstra-Northwell School of Medicine, Hempstead, NY
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10
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Dunican KC, DelDotto D. The Role of Olanzapine in the Treatment of Anorexia Nervosa. Ann Pharmacother 2016; 41:111-5. [PMID: 17190846 DOI: 10.1345/aph.1h297] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To evaluate the role of olanzapine in the treatment of anorexia nervosa. Data Sources: Literature was obtained through searches of MEDLINE (1966–December 2006), EMBASE (1980–4th Quarter 2006), and PsycINFO (1985–December 2006) and a bibliographic review of published articles. Key terms used in the searches included anorexia nervosa, antipsychotics, eating disorders, olanzapine, and Zyprexa. Study Selection And Data Extraction: All English language articles that were identified from the search were evaluated. All primary literature was included in the review. Data Synthesis: In several case reports and most clinical trials, patients with anorexia nervosa successfully gained weight while being treated with olanzapine. Moreover, many patients treated with olanzapine achieved a healthy body weight. Case reports and trials identified additional benefits of olanzapine, including reduction in delusional thinking; improvement in body image, sleep, depressive symptoms, adherence to treatment, and eating-disorder symptoms; and decreased agitation and premeal anxiety. Conclusions: Preliminary evidence supports the use of olanzapine for treatment of anorexia nervosa by demonstrating that olanzapine 2.5–15 mg daily promotes weight gain and has positive effects on associated psychological symptoms. Limitations of the reported data include small sample size, low completion rate in clinical trials, and open-label trial design. Although olanzapine appears to have a potential role in the treatment of anorexia nervosa that has been unresponsive to other therapy, randomized, placebo-controlled studies with larger sample sizes are necessary to establish its role in therapy.
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Affiliation(s)
- Kaelen C Dunican
- School of Pharmacy-Worcester, Massachusetts College of Pharmacy and Health Sciences, Worcester, MA 01608, USA.
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11
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Claudino AM, Hay PJ, Silva de Lima M, Schmidt UH, Treasure J. Antipsychotic drugs for anorexia nervosa. Hippokratia 2016. [DOI: 10.1002/14651858.cd006816.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Angélica M Claudino
- Federal University of São Paulo (UNIFESP); Department of Psychiatry and Psychological Medicine; Rua Borges Lagoa 570 conj. 71 São Paulo São Paulo Brazil 04038-000
| | - Phillipa J Hay
- Western Sydney University; Centre for Health Research; Penrith New South Wales Australia 2751
| | | | - Ulrike H Schmidt
- King's College London, Institute of Psychiatry; Section of Eating Disorders; PO BOX 59, De Crespigny Park London UK SE5 8AZ
| | - Janet Treasure
- 5th Floor Thomas Guy House; Department of Academic Psychiatry; Guys Campus London UK SE1 9RT
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12
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The Role of Psychotropic Medications in the Management of Anorexia Nervosa: Rationale, Evidence and Future Prospects. CNS Drugs 2016; 30:419-42. [PMID: 27106297 PMCID: PMC4873415 DOI: 10.1007/s40263-016-0335-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anorexia nervosa (AN) is a severe psychiatric disorder without approved medication intervention. Every class of psychoactive medication has been tried to improve treatment outcome; however, randomized controlled trials have been ambiguous at best and across studies have not shown robust improvements in weight gain and recovery. Here we review the available literature on pharmacological interventions since AN came to greater public recognition in the 1960s, including a critical review of why those trials may not have been successful. We further provide a neurobiological background for the disorder and discuss how cognition, learning, and emotion-regulating circuits could become treatment targets in the future. Making every effort to develop effective pharmacological treatment options for AN is imperative as it continues to be a complex psychiatric disorder with high disease burden and mortality.
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13
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Abstract
The aim of this review was to summarize evidence from research on psychopharmacological options for adult patients with anorexia nervosa (AN). Database searches of MEDLINE and PsycINFO (from January 1966 to January 2014) were performed, and original articles published as full papers, brief reports, case reports, or case series were included. Forty-one papers were screened in detail, and salient characteristics of pharmacological options for AN were summarized for drug classes. The body of evidence for the efficacy of pharmacotherapy in AN was unsatisfactory, the quality of observations was questionable (eg, the majority were not blinded), and sample size was often small. More trials are needed, while considering that nonresponse and nonremission are typical of patients with AN.
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Álvarez Ruiz EM, Gutiérrez-Rojas L. Comorbilidad entre el trastorno bipolar y los trastornos de la conducta alimentaria. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2015; 8:232-41. [DOI: 10.1016/j.rpsm.2014.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 12/13/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
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Abstract
Epidemiologic studies show a frequent co-occurence of affective and eating disorders. The incidence of one disorder in patients suffering from the other disorder is well over the incidence in the general population. Several causes could explain this increased comorbidity. First, the iatrogenic origin is detailed. Indeed, psychotropic drugs, and particularly mood stabilizers, often lead to modification in eating behaviors, generally inducing weight gain. These drugs can increase desire for food, reduce baseline metabolism or decrease motor activity. Also, affective and eating disorders share several characteristics in semiology. These similarities can not only obscure the differential diagnosis but may also attest of conjoint pathophysiological bases in the two conditions. However, genetic and biological findings so far are too sparse to corroborate this last hypothesis. Nonetheless, it is noteworthy that comorbidity of affective and eating disorders worsens patients'prognosis and is associated with more severe forms of affective disorders characterized by an earlier age of onset in the disease, higher number of mood episodes and a higher suicidality. Lastly, psychotropic drugs used in affective disorders (lithium, antiepileptic mood stabilizers, atypical antipsychotics, antidepressants) are reviewed in order to weigh their efficacy in eating disorders. This could help establish the best therapeutic option when confronted to comorbidity.
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Affiliation(s)
- Eric Fakra
- Pôle Universitaire de Psychiatrie, CHU Saint-Etienne. - 5 chemin de la Marendière.42055 St Etienne cedex 2, France.
| | - R Belzeaux
- SHU Psychiatrie adultes, Solaris, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France
| | - J M Azorin
- SHU Psychiatrie adultes, Solaris, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France
| | - M Adida
- SHU Psychiatrie adultes, Solaris, Hôpital Ste Marguerite, 13274 Marseille cedex 9, France
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Balestrieri M, Oriani MG, Simoncini A, Bellantuono C. Psychotropic Drug Treatment in Anorexia Nervosa. Search for Differences in Efficacy/Tolerability Between Adolescent and Mixed-age Population. EUROPEAN EATING DISORDERS REVIEW 2013; 21:361-73. [DOI: 10.1002/erv.2240] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/30/2013] [Accepted: 05/07/2013] [Indexed: 11/06/2022]
Affiliation(s)
| | - Maria Ginevra Oriani
- Psychiatric Unit, United Hospitals of Ancona, DMH and Experimental and Clinical Medicine; University Politecnica of Marche; Ancona; Italy
| | - Annalisa Simoncini
- Psychiatric Unit, United Hospitals of Ancona, DMH and Experimental and Clinical Medicine; University Politecnica of Marche; Ancona; Italy
| | - Cesario Bellantuono
- Psychiatric Unit, United Hospitals of Ancona, DMH and Experimental and Clinical Medicine; University Politecnica of Marche; Ancona; Italy
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Mitchell JE, Steffen K, Cook Myers T, Roerig J. Pharmacologic and psychotherapeutic treatment of anorexia nervosa. WOMENS HEALTH 2012; 1:115-23. [PMID: 19803952 DOI: 10.2217/17455057.1.1.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article will review the treatment research literature on patients with anorexia nervosa. Perhaps somewhat surprisingly, the controlled treatment literature on this disorder is fairly limited. This is attributable to several factors, including the fact that many patients with anorexia nervosa are difficult to engage in treatment and unwilling to participate in randomized trials, and that many of these patients are so critically ill that they require a multiplicity of interventions and long-term therapy, creating design problems for randomized trials. Nonetheless, the extant literature will be reviewed, including pharmacologic and psychotherapeutic interventions in adolescents and adults. One point that needs to be addressed at the outset is the proper venue for the treatment of anorexia nervosa. Many patients, particularly those very low in weight, require in-patient and/or partial hospital treatment as the initial intervention. Although third-party payers are increasingly reluctant to pay for such interventions, they remain the treatments of choice for many anorectic patients. Another issue concerns acute treatment, focusing on weight gain, versus relapse prevention, focusing on weight maintenance and further work on anorectic psychopathology. Different studies have focused on different areas.
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Affiliation(s)
- James E Mitchell
- The Neuropsychiatric Research Institute, 700 1st Avenue South, PO Box 1415, Fargo, ND 58107, USA. mitchell@ medicine.nodak.edu
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18
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Psychopharmacologic treatment of obesity and eating disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am 2012; 21:831-59. [PMID: 23040904 DOI: 10.1016/j.chc.2012.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This review discusses the evidence base for medications that are currently used for obesity and eating disorders, including their Food and Drug Administration approval status by disorder and age group, contraindications, and major adverse effects. Investigational agents currently being considered, issues related to psychiatric and medical comorbidity, limitations of pharmacologic strategies, and recommendations for treatment are also addressed.
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María Verínica GP, Carolina LC, Marcela MB. Trastornos de la conducta alimentaria en adolescentes y jóvenes. REVISTA MÉDICA CLÍNICA LAS CONDES 2012. [DOI: 10.1016/s0716-8640(12)70352-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Olanzapine, but not fluoxetine, treatment increases survival in activity-based anorexia in mice. Neuropsychopharmacology 2012; 37:1620-31. [PMID: 22395732 PMCID: PMC3358753 DOI: 10.1038/npp.2012.7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anorexia nervosa (AN) is an eating disorder characterized by extreme hypophagia, hyperactivity, and fear of weight gain. No approved pharmacological treatments exist for AN despite high mortality rates. The activity-based anorexia (ABA) phenomenon models aspects of AN in rodents, including progressive weight loss, reduced food intake, and hyperactivity. First, we optimized the ABA paradigm for mice. We compared mouse strains (Balb/cJ, A/J) for susceptibility with ABA, and evaluated the effects of different food access durations (2, 4, 6, 8, and 10 h) on ABA parameters. Balb/cJ mice exhibited significantly shorter survival time (days until 25% bodyweight loss) in the ABA paradigm compared with A/J mice. Furthermore, 6 h of food access reduced survival in mice housed with wheels without reducing survival in mice housed without wheels. We then evaluated the effects of chronic treatment with fluoxetine (4 weeks) or subchronic treatment with olanzapine (OLZ) (1 week) on ABA in BALB/cJ mice. OLZ (12 mg/kg/day) significantly increased survival and reduced food anticipatory activity (FAA). However, OLZ did not alter food intake or running wheel activity during ad-lib feeding (baseline) or restriction conditions, or in mice housed without wheels. Fluoxetine (18 mg/kg/day) increased food intake and reduced FAA, but did not alter survival. Here, we report for the first time that OLZ, but not fluoxetine, reduces ABA in mice. Our findings indicate further need for clinical investigations into the effects of OLZ, but not selective serotonin reuptake inhibitors, on core features of AN.
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Abstract
Olanzapine is an atypical antipsychotic agent of the thienobenzodiazepine class. Olanzapine blocks multiple neurotransmitter receptors, including dopaminergic (D(1), D(2), D(3), and D(4)), serotonergic (5-hydroxytryptamine 2A [5-HT(2A)], 5-HT(2C), 5-HT(3), and 5-HT(6)), adrenergic (α(1)), histaminic (H(1)), and muscarinic (M(1), M(2), M(3), and M(4)) receptors. Olanzapine has a high affinity for the 5HT(2A) receptor, which is up to 5 times greater than the dopamine receptor, resulting in less propensity to the development of extrapyramidal side effects. The affinity of olanzapine for multiple receptors has lead to the identification of olanzapine as an important agent in the treatment of delirium, nausea, and vomiting. Olanzapine has been demonstrated to have opioid-sparing properties. Olanzapine is principally metabolized by glucuronidation, with a smaller metabolic contribution from the cytochrome oxidase system. Adverse effects of olanzapine include somnolence, postural hypotension, constipation, dizziness, restlessness, and weight gain. The purpose of this article is to outline the pharmacodynamics, pharmacology, and evidence for the use of olanzapine in palliative care.
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Duvvuri V, Cromley T, Klabunde M, Boutelle K, Kaye WH. Differential weight restoration on olanzapine versus fluoxetine in identical twins with anorexia nervosa. Int J Eat Disord 2012; 45:294-7. [PMID: 21344468 PMCID: PMC3579522 DOI: 10.1002/eat.20917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2010] [Indexed: 11/08/2022]
Abstract
OBJECTIVE No studies have compared the response to selective serotonin reuptake inhibitors and atypical antipsychotics in anorexia nervosa. This case study examines such a comparison. METHOD This report describes a case of 12-year-old identical twins with anorexia nervosa, one of whom was treated with olanzapine and the other with fluoxetine, while undergoing family therapy. RESULTS Twin A treated with fluoxetine went from 75 to 84.4% ideal body weight, while Twin B treated with olanzapine went from 72 to 99.9% ideal body weight over the course of 9 months. DISCUSSION This case supports the need for adequately powered, controlled clinical trials to test the efficacy of olanzapine in adolescents presenting with anorexia nervosa.
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Affiliation(s)
- Vikas Duvvuri
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Taya Cromley
- Department of Psychology, University of California Los Angeles, Los Angeles, CA
| | - Megan Klabunde
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Kerri Boutelle
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Walter H. Kaye
- Department of Psychiatry, University of California San Diego, La Jolla, CA
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Hagman J, Gralla J, Sigel E, Ellert S, Dodge M, Gardner R, O’Lonergan T, Frank G, Wamboldt MZ. A double-blind, placebo-controlled study of risperidone for the treatment of adolescents and young adults with anorexia nervosa: a pilot study. J Am Acad Child Adolesc Psychiatry 2011; 50:915-24. [PMID: 21871373 PMCID: PMC3171450 DOI: 10.1016/j.jaac.2011.06.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 06/01/2011] [Accepted: 06/08/2011] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this double-blind, placebo-controlled exploratory pilot study was to evaluate the safety and efficacy of risperidone for the treatment of anorexia nervosa. METHOD Forty female subjects 12 to 21 years of age (mean, 16 years) with primary anorexia nervosa in an eating disorders program were randomized to receive risperidone (n = 18) or placebo (n = 22). Subjects completed the Eating Disorder Inventory 2, Color-A-Person Test, Body Image Software, and Multidimensional Anxiety Scale for Children at baseline and regular intervals. Weight, laboratory values, and electrocardiograms were monitored. Study medication was started at 0.5 mg daily and titrated upward weekly in 0.5-mg increments to a maximum dose of 4 mg until the subject reached a study endpoint. RESULTS The mean dose for the risperidone group was 2.5 mg and for the placebo group was 3 mg for a mean duration of 9 weeks. Subjects taking risperidone had a significant decrease on the Eating Disorder Inventory 2 Drive for Thinness subscale over the first 7 weeks (effect size, 0.88; p = .002), but this difference was not sustained to the end of the study (p = .13). The Eating Disorder Inventory 2 Interpersonal Distrust subscale decreased significantly more in subjects taking risperidone (effect size, 0.60; p = .03). Subjects taking risperidone had increased prolactin levels (week 7; p = .001). There were no significant differences between groups at baseline or the end of the study for the other rating scales, change in weight, or laboratory measurements. CONCLUSIONS This study does not demonstrate a benefit for the addition of risperidone in adolescents with anorexia nervosa during the weight-restoration phase of care. Clinical trial registration information-A Double-Blind, Placebo-Controlled Study of Risperidone for the Treatment of Anorexia Nervosa, http://www.clinicaltrials.gov, NCT00140426.
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Affiliation(s)
- Jennifer Hagman
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO 80045, USA.
| | - Jane Gralla
- University of Colorado School Of Medicine and Children’s Hospital Colorado
| | - Eric Sigel
- University of Colorado School Of Medicine and Children’s Hospital Colorado
| | - Swan Ellert
- University of Colorado School Of Medicine and Children’s Hospital Colorado
| | - Mindy Dodge
- Children’s Hospital Colorado. Dr. Gardner is with the University of Colorado, Denver
| | - Rick Gardner
- University of Colorado School Of Medicine and Children’s Hospital Colorado
| | - Teri O’Lonergan
- University of Colorado School Of Medicine and Children’s Hospital Colorado
| | - Guido Frank
- University of Colorado School Of Medicine and Children’s Hospital Colorado
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Aigner M, Treasure J, Kaye W, Kasper S. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of eating disorders. World J Biol Psychiatry 2011; 12:400-43. [PMID: 21961502 DOI: 10.3109/15622975.2011.602720] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The treatment of eating disorders is a complex process that relies not only on the use of psychotropic drugs but should include also nutritional counselling, psychotherapy and the treatment of the medical complications, where they are present. In this review recommendations for the pharmacological treatment of eating disorders (anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED)) are presented, based on the available literature. METHODS The guidelines for the pharmacological treatment of eating disorders are based on studies published between 1977 and 2010. A search of the literature included: anorexia nervosa bulimia nervosa, eating disorder and binge eating disorder. Many compounds have been studied in the therapy of eating disorders (AN: antidepressants (TCA, SSRIs), antipsychotics, antihistaminics, prokinetic agents, zinc, Lithium, naltrexone, human growth hormone, cannabis, clonidine and tube feeding; BN: antidepressants (TCA, SSRIs, RIMA, NRI, other AD), antiepileptics, odansetron, d-fenfluramine Lithium, naltrexone, methylphenidate and light therapy; BED: antidepressants (TCA, SSRIs, SNRIs, NRI), antiepileptics, baclofen, orlistat, d-fenfluramine, naltrexone). RESULTS In AN 20 randomized controlled trials (RCT) could be identified. For zinc supplementation there is a grade B evidence for AN. For olanzapine there is a category grade B evidence for weight gain. For the other atypical antipsychotics there is grade C evidence. In BN 36 RCT could be identified. For tricyclic antidepressants a grade A evidence exists with a moderate-risk-benefit ratio. For fluoxetine a category grade A evidence exists with a good risk-benefit ratio. For topiramate a grade 2 recommendation can be made. In BED 26 RCT could be identified. For the SSRI sertraline and the antiepileptic topiramate a grade A evidence exists, with different recommendation grades. CONCLUSIONS Additional research is needed for the improvement of the treatment of eating disorders. Especially for anorexia nervosa there is a need for further pharmacological treatment strategies.
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Affiliation(s)
- Martin Aigner
- Department of Psychiatry and Psychotherapy, Medical University Vienna (MUW), Vienna, Austria.
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Strike MK, Norris S, Kearney S, Norris ML. More than just milk: a review of prolactin's impact on the treatment of anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2011; 20:e85-90. [PMID: 21774041 DOI: 10.1002/erv.1119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE In completing this review, we aim to educate readers about the physiological importance of the hormone prolactin (PRL) in the treatment of patients with anorexia nervosa (AN). METHOD A comprehensive review of PRL was undertaken using existing published literature with specific focus on domains pertinent to the treatment of AN. RESULTS Prolactin influences multiple biological processes throughout the body. Disruption in its regulation can impact women's health issues such as menstruation and bone health, which are pertinent to AN treatment. The use of antipsychotics with high D2 receptor affinity for the augmented treatment of AN increases the potential risk of PRL-mediated adverse effects. DISCUSSION Although not intrinsic to underlying disease underpinnings, PRL has the capacity to affect and influence multiple outcome variables in treatment of patients with AN. Improved understanding, better screening and the completion of further prospective research are necessary to help facilitate and incorporate ongoing knowledge translation.
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Trunko ME, Schwartz TA, Duvvuri V, Kaye WH. Aripiprazole in anorexia nervosa and low-weight bulimia nervosa: case reports. Int J Eat Disord 2011; 44:269-75. [PMID: 20186719 DOI: 10.1002/eat.20807] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE There has been much interest in the use of atypical antipsychotics in anorexia nervosa (AN). However, newer, more weight-neutral medications have not been studied in AN, and there are no reports of the use of antipsychotics in bulimia nervosa (BN). METHOD We report on the treatment of eight patients (five with AN and three with BN) with aripiprazole for time periods of four months to more than three years. RESULTS All individuals had reduced distress around eating, fewer obsessional thoughts about food, weight and body image, significant lessening of eating-disordered behaviors, and gradual weight restoration where appropriate. Depression, generalized anxiety, and cognitive flexibility improved as well. DISCUSSION In summary, these findings support the need to perform controlled trials of aripiprazole in AN and BN.
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Affiliation(s)
- Mary Ellen Trunko
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
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28
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Abstract
Eating disorders are serious psychiatric illnesses that often present during adolescence and young adulthood. They are associated with medical as well as psychological disturbances, and pediatricians play an important role in their identification, diagnosis, and management. There has been a paucity of treatment research that specifically focuses on children and adolescents with eating disorders. This article reviews the scientific evidence for the use of psychotropic medication in the treatment of children and adolescents with eating disorders.
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Affiliation(s)
- Neville H Golden
- Division of Adolescent Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA.
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Court A, Mulder C, Kerr M, Yuen HP, Boasman M, Goldstone S, Fleming J, Weigall S, Derham H, Huang C, McGorry P, Berger G. Investigating the effectiveness, safety and tolerability of quetiapine in the treatment of anorexia nervosa in young people: a pilot study. J Psychiatr Res 2010; 44:1027-34. [PMID: 20447652 DOI: 10.1016/j.jpsychires.2010.03.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 03/17/2010] [Accepted: 03/18/2010] [Indexed: 11/28/2022]
Abstract
To investigate the safety and tolerability of the atypical antipsychotic quetiapine in anorexia nervosa patients, and to determine the effect of quetiapine treatment on anorexic psychopathology and other key outcome measures including weight and body image, we conducted a naturalistic, open-label, 12-week randomized controlled trial of low-dose (100-400 mg/day) quetiapine treatment versus treatment as usual in 33 anorexia nervosa patients from our Eating Disorder Clinics. To monitor the effects of treatment over the medium term, the participants were then followed up with assessment visits at 6 and 12 months after the end of the treatment phase. Low-dose quetiapine treatment resulted in both psychological and physical improvements, with minimal associated side-effects. Given the overall trend toward improvement that we observed, quetiapine appears to be a promising candidate for the treatment of anorexia nervosa. Further large-scale placebo-controlled clinical trials will be necessary to fully evaluate the benefits of quetiapine treatment for this disorder.
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Affiliation(s)
- Andrew Court
- Orygen Youth Health, Department of Psychiatry, University of Melbourne, 35 Poplar Road, Parkville, VIC 3052, Australia
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Abstract
Anorexia nervosa and bulimia nervosa are primarily psychiatric disorders characterized by severe disturbances of eating behavior. Eating disorders are most prevalent in the Western culture where food is in abundance and female attractiveness is equated with thinness. Eating disorders are rare in countries like India. Despite a plethora of management options available to the mental health professionals, no major breakthrough has been achieved in recent years. Nutritional rehabilitation along with some form of re educative psychotherapy remains the mainstay of management of anorexia nervosa. In bulimia nervosa, both fluoxetine and cognitive behavior therapy have been found to be effective. Although the above-mentioned management options have been in use for decades, the active ingredient is still to be ascertained.
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Affiliation(s)
- Kaustav Chakraborty
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh -160 012, India
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31
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McKnight RF, Park RJ. Atypical antipsychotics and anorexia nervosa: a review. EUROPEAN EATING DISORDERS REVIEW 2010; 18:10-21. [PMID: 20054875 DOI: 10.1002/erv.988] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is currently mixed opinion regarding the value of using atypical antipsychotics to treat anorexia nervosa (AN). AIMS To evaluate the literature on the use of atypical antipsychotics in AN. METHOD A review of all studies and clinical guidelines published before September 2009 involving use of an atypical antipsychotic in patients with AN. Analysis is by narrative synthesis. RESULTS Forty-three publications or study protocols were found, including four randomized-controlled trials, five open-label trials and 26 case reports. The most studied drugs were olanzapine, quetiapine and risperidone. Atypical antipsychotics appear safe and there is some evidence of positive effects on depression, anxiety and core eating disordered psychopathology in patients with anorexia nervosa. Currently there is insufficient evidence to confirm atypical antipsychotics enhance weight gain in this setting. CONCLUSIONS Further high quality evidence is needed in this area in order to provide practical guidance to clinicians. However, the main challenge is to persuade adequate numbers of AN patients to participate in research trials.
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Affiliation(s)
- Rebecca F McKnight
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
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Thomas JJ, Roberto CA, Brownell KD. Eighty-five per cent of what? Discrepancies in the weight cut-off for anorexia nervosa substantially affect the prevalence of underweight. Psychol Med 2009; 39:833-43. [PMID: 18775087 PMCID: PMC2847836 DOI: 10.1017/s0033291708004327] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND DSM-IV cites <85% of expected body weight (EBW) as a guideline for the diagnosis of anorexia nervosa (AN) but does not require a specific method for calculating EBW. The purpose of the present study was to determine the degree to which weight cut-off calculations vary across studies, and to evaluate whether differential cut-offs lead to discrepancies in the prevalence of individuals who are eligible for the AN diagnosis. METHOD Two coders independently recorded the EBW calculation methods from 99 studies that either (a) compared individuals with AN to those with subclinical eating disorders or (b) conducted AN treatment trials. Each weight cut-off was applied to a nationally representative (n=12001) and treatment-seeking (n=189) sample to determine the impact of EBW calculation on the proportion who met the AN weight criterion. RESULTS Coders identified 10 different EBW methods, each of which produced different weight cut-offs for the diagnosis of AN. Although only 0.23% of the national sample met the lowest cut-off, this number increased 43-fold to 10.10% under the highest cut-off. Similarly, only 48.1% of treatment seekers met the lowest cut-off, whereas 89.4% met the highest. CONCLUSIONS There is considerable variance across studies in the determination of the AN weight cut-off. Discrepancies substantially affect the proportion of individuals who are eligible for diagnosis, treatment and insurance reimbursement. However, differences may not be fully appreciated because the ubiquitous citation of the 85% criterion creates a sense of false consensus.
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Affiliation(s)
- J J Thomas
- Department of Psychology, Yale University, New Haven, CT, USA.
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Verhagen LAW, Luijendijk MCM, Hillebrand JJG, Adan RAH. Dopamine antagonism inhibits anorectic behavior in an animal model for anorexia nervosa. Eur Neuropsychopharmacol 2009; 19:153-60. [PMID: 18977121 DOI: 10.1016/j.euroneuro.2008.09.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 08/29/2008] [Accepted: 09/30/2008] [Indexed: 11/24/2022]
Abstract
Excessive physical activity is commonly described as symptom of Anorexia Nervosa (AN). Activity-based anorexia (ABA) is considered an animal model for AN. The ABA model mimics severe body weight loss and increased physical activity. Suppression of hyperactivity by olanzapine in anorectic patients as well as in ABA rats suggested a role of dopamine and/or serotonin in this trait. Here, we investigated the effect of a non-selective dopamine antagonist in the ABA model. A dose-response curve of chronic treatment with the non-selective dopaminergic antagonist cis-flupenthixol was determined in the ABA model. Treatment reduced activity levels in both ad libitum fed and food-restricted rats. Treated ABA rats reduced body weight loss and increased food intake. These data support a role for dopamine in anorexia associated hyperactivity. Interestingly, in contrast to leptin treatment, food-anticipatory activity still persists in treated ABA rats.
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Affiliation(s)
- Linda A W Verhagen
- Rudolf Magnus Institute of Neuroscience, Department of Neuroscience & Pharmacology, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
Anorexia nervosa and bulimia nervosa are significant mental health problems in the adolescent population; however, there are no medications approved by the FDA for the treatment of adolescents with either of these disorders. Many medications are used off label for both the symptoms of eating disorders and their co-morbid conditions, particularly SSRIs and atypical anti-psychotics. The dosing, side effect profile, and long term effects of these medications in children and adolescents is unclear. Binge eating disorder, night eating syndrome, and sleep-related eating disorder often are associated with over-weight in adolescents. There are various pharmacological approaches to the treatment of obesity in the adolescent population some of which have FDA approval. In the article the authors discuss pharmacological approaches to guide the treatment of eating disorders and obesity in the pediatric population, including risks of treatment, monitoring of potential side effects, and recent outcomes in the literature.
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Affiliation(s)
- Pauline S Powers
- College of Medicine, University of South Florida, 3515 East Fletcher Avenue, Tampa, FL 33613, USA
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Storch CH, Nikendei C, Schild S, Haefeli WE, Weiss J, Herzog W. Expression and activity of P-glycoprotein (MDR1/ABCB1) in peripheral blood mononuclear cells from patients with anorexia nervosa compared with healthy controls. Int J Eat Disord 2008; 41:432-8. [PMID: 18348284 DOI: 10.1002/eat.20519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Pharmacotherapeutic strategies for treatment of anorexia nervosa (AN) are characterized by limited success. Some drugs used (antipsychotics, selective serotonin reuptake inhibitors) are transported by P-glycoprotein (P-gp), a transporter with major impact on pharmacokinetics of substrate drugs. Biochemical alterations seen in AN patients could lead to increased expression and/or activity of P-gp and therefore to diminished access of drugs to the brain. The aim of our study was to investigate expression and activity levels of P-gp in peripheral blood mononuclear cells (PBMCs) in AN patients. METHOD PBMCs of 16 AN patients and 16 controls were isolated. Activity of P-gp was determined by flow cytometry and expression was quantified by reverse-transcriptase-real-time-polymerase-chain-reaction. RESULTS Neither a significant difference in P-gp expression (AN: 0.00154 +/- 0.00088 [MDR1/beta2 mg], control: 0.00244 +/- 0.0013 [MDR1/beta2 mg], p = .138) nor a difference in P-gp activity (rhodamine 123 ratio AN: 1.79 +/- 0.73, control: 2.03 +/- 0.42, p = .20) between AN patients and healthy controls could be detected. In contrast to previous studies, expression and activity of P-gp correlated significantly (p = .0031). CONCLUSION Failure in pharmacotherapy with P-gp substrates in AN patients are probably neither caused by different P-gp expression nor activity levels.
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Affiliation(s)
- Caroline Henrike Storch
- Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, D-69120 Heidelberg, Germany
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Mehler-Wex C, Romanos M, Kirchheiner J, Schulze UME. Atypical antipsychotics in severe anorexia nervosa in children and adolescents--review and case reports. EUROPEAN EATING DISORDERS REVIEW 2008; 16:100-8. [PMID: 18000964 DOI: 10.1002/erv.843] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To review the literature on the use of atypical antipsychotics in anorexia nervosa of children and adolescents and to present three case reports on quetiapine treatment of this subgroup. METHOD Review of the literature and case report. RESULTS Several case reports and two small open-label trials, mainly in adults, observed beneficial effects of olanzapine on anorexic psychopathology. Only 16 case reports have been published on children and adolescents. Because of its lower propensity to induce weight gain quetiapine might be favourable with regard to patients' compliance. Our case reports revealed positive psychopathological effects and good tolerability of quetiapine in minors with severe anorexia nervosa. Careful titration and intense drug monitoring are recommended. DISCUSSION In a small subset of patients with severe, treatment- resistant anorexia nervosa, extreme weight phobia, delusional body image disturbances or severe hyperactivity might be considered as indications for atypical antipsychotics. However, controlled studies are needed.
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Affiliation(s)
- Claudia Mehler-Wex
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, Ulm, Germany.
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Castro-Fornieles J, Deulofeu R, Baeza I, Casulà V, Saura B, Lázaro L, Puig J, Toro J, Bernardo M. Psychopathological and nutritional correlates of plasma homovanillic acid in adolescents with anorexia nervosa. J Psychiatr Res 2008; 42:213-20. [PMID: 17141272 DOI: 10.1016/j.jpsychires.2006.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Revised: 10/11/2006] [Accepted: 10/23/2006] [Indexed: 10/23/2022]
Abstract
Dopaminergic abnormalities have been described in anorexia nervosa but studies about plasma level of homovanillic acid (pHVA) have yielded conflicting results probably due to the small number and the heterogeneity of patients. Plasma HVA, nutritional and hormonal parameters and several scales - the Eating Attitudes Test (EAT), the Beck Depression Inventory (BDI), the Leyton Obsessional Inventory-child version (LOI-C) and the State and Trait Anxiety Inventory (STAI) - were assessed in 44 adolescent anorexia nervosa patients (mean age 14.7 years, SD 1.7) consecutively admitted to an Eating Disorder Unit. They were evaluated at admission, at discharge and, in 34 cases, after 9 months of follow-up. pHVA was also assessed in 16 control adolescents. Patients had significantly higher pHVA than controls (p = .002). About 31% of patients had a very high level of pHVA, a significantly higher (p = .006) mean score in the BDI and a non significantly higher mean score in the EAT. After weight recovery some laboratory parameters improved as well as the EAT (p = .019), the BDI (p = 001) and the Interference score of the LOI-C (p = .004). Moreover, pHVA decreased significantly (p=.036). At follow-up, patients with normal weight had lower (p = .037) pHVA than patients with low weight. The conclusion would be that there is a dopaminergic dysfunction in anorexic patients, specially in a subgroup with high depressive and anorexic symptomatology. With weight recovery and psychopathological improvement, pHVA tends to normalization.
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Affiliation(s)
- Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, Institute Clinic of Neurosciences, Hospital Clinic University, Barcelano, Spain.
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Spettigue W, Buchholz A, Henderson K, Feder S, Moher D, Kourad K, Gaboury I, Norris M, Ledoux S. Evaluation of the efficacy and safety of olanzapine as an adjunctive treatment for anorexia nervosa in adolescent females: a randomized, double-blind, placebo-controlled trial. BMC Pediatr 2008; 8:4. [PMID: 18234120 PMCID: PMC2258294 DOI: 10.1186/1471-2431-8-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 01/31/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) is a serious, debilitating condition that causes significant physical, emotional, and functional impairment. The condition is characterized by destructive weight loss behaviours and a refusal to maintain body weight at or above a minimally normal weight for age and height. AN often develops in adolescence and is a predominantly female disorder. Treatment for AN typically involves medical, nutritional and psychological interventions. Pharmacotherapy is also often used; however, the literature on the effectiveness of these drugs in a pediatric population is very limited. Olanzapine, which is an 'atypical' antipsychotic, is becoming more widespread in the treatment of AN. Olanzapine is hypothesized to facilitate weight gain, while decreasing levels of agitation and decreasing resistance to treatment in young women with AN. This randomized, double-blind placebo-controlled trial seeks to examine the effectiveness and safety of olanzapine in female youth with AN. METHODS/DESIGN Adolescent females between the ages of 12 and 17 diagnosed with AN (either restricting or binge/purge type) or Eating Disorder Not Otherwise Specified with a Body Mass Index of less than or equal to 17.5, will be offered inclusion in the study. Patients will be randomly assigned to receive either olanzapine or placebo. Patients assigned to receive olanzapine will start at a low dose of 1.25 mg/day for three days, followed by 2.5 mg/day for four days, 5 mg/day for one week, then 7.5 mg/day (the target dose chosen) for 10 weeks. After 10 weeks at 7.5 mg the medication will be tapered and discontinued over a period of two weeks. The effectiveness of olanzapine versus placebo will be determined by investigating the change from baseline on measures of eating attitudes and behaviors, depression and anxiety, and change in Body Mass Index at week 12, and after a follow-up period at week 40. It is anticipated that 67 participants will be recruited over two years to complete enrollment. DISCUSSION Randomized controlled trials designed to measure the safety and effectiveness of olanzapine in comparison to placebo are desperately needed, particularly in the adolescent population. TRIAL REGISTRATION Current Controlled Trials ISRCTN23032339.
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Affiliation(s)
- Wendy Spettigue
- Mental Health Department, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Department of Psychiatry, University of Ottawa, 550 Cumberland, Ottawa, ON, K1N 6N5, Canada
| | - Annick Buchholz
- Mental Health Department, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Department of Psychology, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Katherine Henderson
- Mental Health Department, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Department of Psychology, Carleton University, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada
| | - Stephen Feder
- Mental Health Department, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - David Moher
- Mental Health Department, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Chalmers Research Group, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, 550 Cumberland, Ottawa, ON, K1N 6N5, Canada
| | - Kader Kourad
- Chalmers Research Group, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Isabelle Gaboury
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Mark Norris
- Mental Health Department, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
- Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Sheila Ledoux
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
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Tolerability and efficacy of aripiprazole in a case of psychotic anorexia nervosa comorbid with epilepsy and chronic renal failure. Eat Weight Disord 2007; 12:e54-7. [PMID: 17984630 DOI: 10.1007/bf03327643] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The aim of this case report was to examine the therapeutic benefit and tolerability of aripiprazole for psychotic symptoms in a case of anorexia nervosa comorbid with generalized epilepsy, chronic renal failure and Raynaud syndrome. CASE REPORT The patient had a chronic anorexia nervosa with psychotic symptoms, already treated with risperidone without efficacy, mainly because it was underdosed due to side-effects. She refused to take olanzapine (fear of weight gain) but accepted a treatment with aripiprazole. Aripiprazole 30 mg/day was associated with considerable improvement of SANS and SAPS (scale for the assessment of negative and positive symptoms) scores on hallucinations, delusions, aggressivity, abulia and asociality. Weight remained stable and no side-effects were reported. DISCUSSION These findings lend support to the possibility that aripiprazole may be useful and well tolerated in psychotic anorexia and in cases of comorbidity with epilepsy and/or renal failure. These data are preliminary and need to be confirmed in further controlled research.
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Ramoz N, Versini A, Gorwood P. Eating disorders: an overview of treatment responses and the potential impact of vulnerability genes and endophenotypes. Expert Opin Pharmacother 2007; 8:2029-44. [PMID: 17714058 DOI: 10.1517/14656566.8.13.2029] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED) are the three main eating disorders. Antidepressants, antipsychotics, anticonvulsants, prokinetic agents, opiate antagonists, appetite suppressants, tetrahydrocannabinol, cyproheptadine, zinc and ondansetron have been tested, and are frequently associated with psychological treatment. Selective serotonin reuptake inhibitors have a proven efficacy in BN and binge eating disorder. Other treatments, such as atypical antipsychotics in AN, anticonvulsants in BN and BED, and naltrexone and ondansetron in BN, may be promising, but lack the appropriate trials. The development of genetic researches in eating disorders may help the clinician to choose the most appropriate treatment in forthcoming years, using genetic polymorphisms of vulnerability genes, those linked to endophenotypes, or genes implicated in the metabolism of the drug treatment.
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Affiliation(s)
- Nicolas Ramoz
- 1INSERM U675, Université Paris 7, IFR02, Faculté de Médecine Xavier Bichat, Paris, France
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Brambilla F, Garcia CS, Fassino S, Daga GA, Favaro A, Santonastaso P, Ramaciotti C, Bondi E, Mellado C, Borriello R, Monteleone P. Olanzapine therapy in anorexia nervosa: psychobiological effects. Int Clin Psychopharmacol 2007; 22:197-204. [PMID: 17519642 DOI: 10.1097/yic.0b013e328080ca31] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Dopamine impairments occur in anorexia nervosa. The aim of this study was to see whether treatment with the atypical dopamine antagonist antipsychotic olanzapine improves the disorder. Thirty anorexics, 18 restricted and 12 bingeing-purging, underwent a 3-month course of cognitive behavioral therapy, plus at random and double-blinded oral olanzapine (2.5 mg for 1 month, 5 mg for 2 months) in half and oral placebo in the other half of them. BMI, psychopathological aspects (eating disorder inventory, Hamilton Rating Scale, Buss-Durkee Rating Scale, Yale Brown Cornell for Eating Disorders Rating Scale, temperament-character inventory), and homovanillic acid blood concentrations for dopamine secretion, were monitored at baseline and then monthly during the trial. At the end of the trial BMI, total eating disorder inventory, total Yale Brown Cornell for Eating Disorders Rating Scale, Buss-Durkee Rating Scale, Hamilton Rating Scale scores and in olanzapine-treated patients the subitems of eating disorder inventory ineffectiveness and maturity fear, of Buss-Durkee Rating Scale direct aggressiveness, of temperament-characteristic inventory persistence had improved significantly. When stratified for anorexia nervosa subtype, BMI changes were significant among anorexia nervosa bingeing-purging patient, 'depression' (Hamilton Rating Scale) and 'direct aggressiveness' (Buss-Durkee Rating Scale) among anorexia nervosa bingeing-purging patients, 'persistence' (temprerament-characteristic inventory), among anorexics restricted patients, with a trend toward significance for obsessivity-compulsivity (Yale Brown Cornell for Eating Disorders Rating Scale). homovanilic acid blood levels increased significantly in the cognitive behavioral therapy+olanzapine group. No correlations were observed between homovanilic acid concentrations and psychopathological parameters. The pharmacological treatment can significantly improve specific aspects of anorexia nervosa.
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Brambilla F, Monteleone P, Maj M. Olanzapine-induced weight gain in anorexia nervosa: involvement of leptin and ghrelin secretion? Psychoneuroendocrinology 2007; 32:402-6. [PMID: 17395395 DOI: 10.1016/j.psyneuen.2007.02.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 02/01/2007] [Accepted: 02/02/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Olanzapine (OLA) administration has been reported to induce weight gain in experimental animals and humans, through not yet fully defined mechanisms of action. Aim of this study was to determine whether in patients with Anorexia Nervosa (AN) OLA induces weight gain through the modulation of the hunger-satiety regulatory peptides leptin and ghrelin. METHODS Twenty anorexic probands received a 3 months course of cognitive-behavioral psychotherapy and programmed nutritional rehabilitation, combined with OLA PO (2.5 mg for 1 month and 5 mg for 2 months) in ten patients and with placebo PO (PL) in the other 10. Weight, measured as body mass index (BMI), leptin and ghrelin plasma values were monitored before starting the therapy and then monthly for 3 months. Plasma leptin was measured by ELISA, and plasma ghrelin by radioimmunoassay. RESULTS BMI increased significantly but not differently in both treatment groups. Leptin and ghrelin secretion did not change during the course of the treatments. No correlations were observed between BMI values and leptin and ghrelin levels. CONCLUSIONS Our data suggest that the weight gain observed in our OLA-treated patients was not linked to drug administration. Moreover, leptin and ghrelin secretions were not responsible for BMI changes.
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Affiliation(s)
- F Brambilla
- Department of Psychiatry, University of Naples SUN, Naples, Italy.
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Steinglass JE, Eisen JL, Attia E, Mayer L, Walsh BT. Is anorexia nervosa a delusional disorder? An assessment of eating beliefs in anorexia nervosa. J Psychiatr Pract 2007; 13:65-71. [PMID: 17414681 DOI: 10.1097/01.pra.0000265762.79753.88] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anorexia nervosa (AN) is a serious mental illness, characterized in part by intense and irrational beliefs about shape and weight, including fear of gaining weight. Although these beliefs are considered to be a diagnostic criterion for the illness, they have not been systematically characterized. This study used the Brown Assessment of Beliefs Scale (BABS) to identify the dominant belief that interfered with eating in a sample of underweight patients with AN (N=25). The degree of insight was assessed quantitatively. The majority of participants (68%) spontaneously reported a dominant belief consistent with fear of gaining weight or becoming fat. Twenty percent of patients were categorized as delusional. The total score on the BABS was significantly correlated with the drive-for-thinness subscale of the Eating Disorders Inventory (EDI) (r=0.41, p=0.04), but did not correlate with overall measures of AN severity (body mass index [BMI], duration of illness, lowest BMI, other subscales of the EDI, or total EDI score). These findings highlight the centrality of fear of fat in AN and suggest the possibility that there is a subgroup of patients whose concerns about their weight reaches delusional proportions. This subpopulation of patients warrants further study, since patients with more delusional beliefs may have a form of AN that is more refractory to treatment.
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Affiliation(s)
- Joanna E Steinglass
- New York State Psychiatric Institute and Columbia University Department of Psychiatry, New York, NY 10032, USA.
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Powers PS, Bannon Y, Eubanks R, McCormick T. Quetiapine in anorexia nervosa patients: an open label outpatient pilot study. Int J Eat Disord 2007; 40:21-6. [PMID: 16927383 DOI: 10.1002/eat.20325] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The main objective of the study was to determine whether quetiapine was effective in reducing scores on the positive and negative syndrome scale (PANSS) in anorexia nervosa (AN) patients. Secondary objectives included determining whether quetiapine was effective in reducing symptoms of anxiety and depression. In addition, the effect on weight was determined. METHOD In an open label design, 19 patients with AN but without schizophrenia or schizoaffective disorder were given 150-300 mg quetiapine daily over a 10 week period. Results were analyzed using last observation carried forward (LOCF). RESULTS Fourteen patients completed the study and all but one of the 5 patients who dropped out returned for an early termination visit. Scores on the total, general psychopathology, and depression scales of the PANSS declined significantly (p = .024, .010, .0005, respectively) at LOCF. There were improvements in several measures of anxiety, depression, and obsessive compulsive symptoms. Mean weight gain was modest at 1.6 lbs (0.73 kg). Adverse events were generally mild and no patients discontinued due to adverse events CONCLUSION Quetiapine was well-tolerated and patients had significant improvements in several subscales of the PANSS as well as decreases in measures of anxiety and depression.
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Affiliation(s)
- Pauline S Powers
- Department of Psychiatry and Behavioral Medicine, College of Medicine, University of South Florida, Tampa, Florida, USA.
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Abstract
OBJECTIVES To review the scientific evidence examining the comorbidity among eating disorders and bipolar disorder (BD). METHODS We reviewed all published English-language studies addressing the comorbidity of anorexia nervosa, bulimia, bulimia nervosa, and binge eating disorder in patients with BD and studies of comorbidity of BD in patients with eating disorders. In addition, we discuss the pharmacologic treatment implications from reviewed studies of agents used in BD and eating disorders. RESULTS Community and clinical population studies of the lifetime prevalence rates of eating disorders in patients with BD, and of BD in patients with eating disorders, particularly when subthreshold and spectrum manifestations of these disorders are included, indicate high rates of comorbidity among these illnesses. CONCLUSIONS Pharmacologic treatment approaches to patients with BD and a co-occurring eating disorder require examination of the possible adverse effects of the treatment of each syndrome on the other and attempts to manage both syndromes with agents that might be beneficial to both.
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Affiliation(s)
- Susan L McElroy
- Psychopharmacology Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
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Abstract
Several case reports and open label trials describe olanzapine in the treatment of anorexia nervosa (AN). We report 5 adolescents with AN who received olanzapine in addition to psychotherapy for their eating disorder. Body mass index (BMI) of each case increased while on olanzapine. At doses of 5 mg per day and above, patients reported decreased anxiety around eating, improved sleep, and decreased rumination about food and body concerns. Morning sedation was the most commonly reported adverse effect. Olanzapine appeared to be useful in addition to psychotherapy for these adolescents. This report augments a limited literature on the treatment of this disorder, and an almost nonexistent literature specific to pharmacotherapy for adolescents with AN.
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Affiliation(s)
- K Dennis
- Eating Disorders Program, Department of Psychiatry, The University of Chicago, Chicago, IL 60637, USA
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Abstract
OBJECTIVE We analyze 27 point-prevalent DSM-IV Axis I comorbidities for eating disorder inpatients. METHODS The sample included 2436 female inpatients treated between January 1, 1995, and December 31, 2000, for primary DSM-IV diagnoses of anorexia, bulimia, and eating disorder not otherwise specified. Analyses were multivariate analysis of variance and multinomial logistic regression; sociodemographics and severity-of-illness measures were controlled. RESULTS Ninety-seven percent of patients evidenced > or = 1 comorbid diagnoses; 94% evidenced comorbid mood disorders, largely unipolar depression, with no differences across eating disorders; 56% evidenced anxiety disorders, with no differences across eating disorders; and 22% evidenced substance use disorders, with significant differences across eating disorders (p < .0001). Five specific diagnoses differed across eating disorders. Alcohol abuse/dependence was twice as likely with bulimia (p < .0001); polysubstance abuse/dependence three times as likely with bulimia (p < .0001); obsessive-compulsive disorder twice as likely with restricting and binge/purge anorexia (p < .01); posttraumatic stress disorder twice as likely with binge-purge anorexia (p < .05); schizophrenia/other psychoses three times more likely with restricting anorexia (p < .05) and two times with binge-purge anorexia (p < .05). CONCLUSIONS New findings emerged: extremely high comorbidity regardless of eating disorder, ubiquitous depression across all eating disorders, no difference in overall rate of anxiety disorders across eating disorders, greater posttraumatic stress disorder in binge-purge anorexia, more psychotic diagnoses in anorexia. Certain previous findings were confirmed: more obsessive-compulsive disorder in anorexia; more substance use in bulimia; and a replicated comorbidity rank-ordering for eating disorder patients: mood, anxiety, and substance use disorders, respectively.
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Affiliation(s)
- Barton J Blinder
- Department of Psychiatry and Human Behavior, University of California, Irvine, 400 Newport Center Drive, Newport Beach, California 92660, USA.
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Steffen KJ, Roerig JL, Mitchell JE, Uppala S. Emerging drugs for eating disorder treatment. Expert Opin Emerg Drugs 2006; 11:315-36. [PMID: 16634704 DOI: 10.1517/14728214.11.2.315] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) comprise the currently recognised eating disorders. Although distinct diagnostic entities, they share certain forms of comorbid psychopathology, particularly anxiety and mood disorders. BN and BED have been studied most intensively as targets for pharmacotherapy. The list of drugs tested in eating disorders is substantial; however, the number of therapeutic classes of medications tested in these conditions is relatively modest. Antidepressant medications, including tricyclic antidepressants, selective serotonin re-uptake inhibitors, as well as some of the novel antidepressants, have shown evidence of some therapeutic value in both BN and BED. Their efficacy in AN, however, has been disappointing. The pharmacological options for AN are very limited. The number of controlled trials that have been conducted is small, and the research that has been successfully completed has generally failed to demonstrate medication efficacy. Patients with BN typically show reduced binge eating and purging frequency in medication trials, but rarely attain abstinence. In BED, patients often measure the value of their medication therapy by its ability to stimulate weight loss, which is another area on which future pharmacotherapy may improve. Novel pharmacological interventions are needed for each of these conditions. Peptide hormones are increasingly being evaluated for eating disorder treatment, including ghrelin agonists, neuropeptide Y1 and -5 antagonists, orexin receptor antagonists, corticotropin-releasing factor receptor 2 antagonists, histamine 3 antagonists, melanocortin 4 receptor antagonists, beta3-adrenoceptor agonists, 5-hydroxytryptamine-2A antagonists and growth hormone agonists. Although these compounds are in early phases of clinical testing for eating disorder treatments, data from these studies will be instructive in the quest for effective pharmacotherapy for these conditions. An overview of the current pharmacotherapy options for eating disorders is presented with a discussion of the emerging potential treatments.
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Affiliation(s)
- Kristine J Steffen
- The Neuropsychiatric Research Institute, 120 8th Street South, PO Box 1415, Fargo, ND 58107, USA.
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Wang TS, Chou YH, Shiah IS. Combined treatment of olanzapine and mirtazapine in anorexia nervosa associated with major depression. Prog Neuropsychopharmacol Biol Psychiatry 2006; 30:306-9. [PMID: 16314020 DOI: 10.1016/j.pnpbp.2005.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2005] [Indexed: 11/17/2022]
Abstract
Several studies have shown that olanzapine is effective in weight restoration and maintenance for patients with anorexia nervosa (AN). However, major depression is a very common comorbid psychiatric disorder associated with AN. Additional antidepressant therapy may be required for treating anorexic patients with major depression. The authors present a case of AN associated with major depression, who responded well to the combination treatment of olanzapine and mirtazapine. A 27-year-old Taiwanese woman was admitted because of severe weight loss, poor nutrition, amenorrhea, major depression, and starvation complications including hematological dyscrasis, electrolytes and endocrine imbalance, and sinus bradycardia. In additional to nutritional and medical treatments, the patient was given olanzapine 10 mg/day and mirtazapine 30 mg/day. She took the combined medications for six months. Meanwhile she received cognitive behavior therapy and family therapy. With these treatments, the patient's depression was in remission, her body weight was increased from 24 to 38 kg, and her body mass index was increased from 9.8 to 15.5. Our case suggests that the combined treatment of olanzapine and mirtazapine can be used in the treatment of AN associated with major depression.
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Affiliation(s)
- Tzong-Shi Wang
- Department of Psychiatry, Tri-Service General Hospital, Taiwan
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