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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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Grammer AC, Fitzsimmons-Craft EE, Laing O, Pietro BD, Wilfley DE. Eating Disorders on College Campuses in the United States: Current Insight on Screening, Prevention, and Treatment. CURRENT PSYCHOPHARMACOLOGY 2020; 9:91-102. [PMID: 32905358 PMCID: PMC7470246 DOI: 10.2174/2211556009999200416153022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/03/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Eating disorders are prevalent on college campuses and pose significant risks to student health, well-being, and academic performance. However, few students receive access to evidence-based prevention and treatment. OBJECTIVE The present review synthesizes the recent literature on ED screening, prevention, and treatment approaches on college campuses in the United States. We provide an overview of ED screening efforts on college campuses, including relevant screening tools, summarize the extant literature on prevention programming, as well psychological and pharmacological treatment approaches, and outline limitations of current programming and provide future directions for research. CONCLUSION Recent advances in ED screening, prevention, and treatment efforts highlight the importance of early detection and intervention. Innovative approaches to screening and dissemination of evidence-based prevention and treatment programs on college campuses are warranted. Implications for future research are discussed.
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Affiliation(s)
- Anne C Grammer
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Olivia Laing
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Bianca De Pietro
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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Psychotropic usage by patients presenting to an academic eating disorders program. Eat Weight Disord 2018; 23:769-774. [PMID: 29882037 DOI: 10.1007/s40519-018-0520-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/24/2018] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To assess psychotropic use patterns and possible associations with age, eating disorder diagnosis and psychiatric comorbidity in adolescents and young adults with a primary eating disorder. METHODS A retrospective chart review of 86 consecutive patients with a primary eating disorder from August 2012 to December 2014 was conducted. Patients presented for a multidisciplinary evaluation at a United States-based academic program for eating disorders. RESULTS Nearly half (45.3%) of the patients reported being on a psychotropic medication. Antidepressants were the most reported category, prescribed in 38.4% of the patients evaluated. There was a significant association between the type of eating disorder and the number of psychotropics prescribed. Patients with a diagnosis of other specified feeding or eating disorder reported more prescriptions upon presentation than patients with anorexia nervosa. Despite the finding that a significant minority of patients had a psychiatric comorbidity, this did not appear to increase the likelihood of psychotropic usage over those diagnosed with an eating disorder alone. In addition, patients with a longer duration of illness and patients with a history of non-suicidal self-injury were more likely to present to treatment on psychotropic medications. CONCLUSIONS Psychotropic medications appear to be commonly prescribed among individuals evaluated in a tertiary care center for an eating disorder. Given that psychotropics are not recommended as the primary intervention for eating disorders, the frequency may be indicative of practitioners not following research-informed practice guidelines. The differences observed may also reflect complexities related to clinical features or illness history. LEVEL OF EVIDENCE Level V: Descriptive study.
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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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de Vos J, Houtzager L, Katsaragaki G, van de Berg E, Cuijpers P, Dekker J. Meta analysis on the efficacy of pharmacotherapy versus placebo on anorexia nervosa. J Eat Disord 2014; 2:27. [PMID: 25379181 PMCID: PMC4221720 DOI: 10.1186/s40337-014-0027-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 09/02/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) has a devastating impact on the psychological and physical well being of affected individuals. There is an extensive body of literature on interventions in AN, however more studies are needed to establish which form of pharmacotherapy is effective. The few meta-analyses that have been done are based on one type of medication only. This article is the first to present data on three different, most commonly used, forms of pharmacotherapy. The primary objective of this meta-analysis was to create an overview and to determine the efficacy of three forms of pharmacotherapy (antidepressants, antipsychotics, hormonal therapy) compared to treatment with placebo in patients with AN. METHOD A systematic literature search was performed to identify all randomized controlled intervention trials investigating the effectiveness of pharmacotherapy for AN within the following databases: PubMed, PsycINFO, Embase and Cochrane Library. In addition, 32 relevant reviews and meta-analyses were screened for additional intervention studies. A meta-analysis was performed on a total of 18 included studies (N = 869). Efficacy was measured in terms of weight gain or weight restoration. RESULTS The pooled effect sizes indicating the difference between antidepressants and placebo, and between antipsychotics and placebo on weight were not significant. Because of the small sample size no meta regression and subgroup analyses could be conducted. The pooled effect size indicating the difference between hormonal therapy and the placebo condition on weight (all weight measures) at post-treatment was 0.42 (95% CI: 0.11 ~ 0.73), which was significant. For hormonal therapy heterogeneity was high (I(2) = 64.70). No evidence for publication bias was found. Meta-regression analyses of the weeks of medication treatment (slope = -0.008) yielded a significant effect (p = 0.04). CONCLUSIONS In this study we found that hormonal therapy has a significantly larger effect on weight compared to placebo in the treatment of AN. However for these analyses heterogeneity was high, which means that these results have to be regarded with caution. We found that anti-depressants and antipsychotics had no significant effect on weight compared to placebo in the treatment of AN, although the power to detect significant effects was too low.
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Affiliation(s)
- Jasmijn de Vos
- Arkin Mental Health Institute, Klaprozenweg 111, PO Box 75848, 1070 AV Amsterdam, the Netherlands
| | - Laura Houtzager
- Arkin Mental Health Institute, Klaprozenweg 111, PO Box 75848, 1070 AV Amsterdam, the Netherlands ; De Viersprong Mental Health Institute, Bergen op Zoom, the Netherlands
| | - Georgia Katsaragaki
- Arkin Mental Health Institute, Klaprozenweg 111, PO Box 75848, 1070 AV Amsterdam, the Netherlands
| | - Elske van de Berg
- Arkin Mental Health Institute, Klaprozenweg 111, PO Box 75848, 1070 AV Amsterdam, the Netherlands
| | | | - Jack Dekker
- Arkin Mental Health Institute, Klaprozenweg 111, PO Box 75848, 1070 AV Amsterdam, the Netherlands
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Watson HJ, Bulik CM. Update on the treatment of anorexia nervosa: review of clinical trials, practice guidelines and emerging interventions. Psychol Med 2013; 43:2477-2500. [PMID: 23217606 DOI: 10.1017/s0033291712002620] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anorexia nervosa is a potentially deadly psychiatric illness that develops predominantly in females around puberty but is increasingly being recognized as also affecting boys and men and women across the lifespan. The aim of this environmental scan is to provide an overview of best practices in anorexia nervosa treatment across the age spectrum. METHOD A triangulation approach was used. First, a detailed review of randomized controlled trials (RCTs) for anorexia nervosa published between 1980 and 2011 was conducted; second, clinical practice guidelines were consulted and reviewed; third, information about RCTs currently underway was sourced. This approach facilitated a comprehensive overview, which addressed the extant evidence base, recent advances in evidence and improvements in treatment, and future directions. RESULTS The evidence base for the treatment of anorexia nervosa is advancing, albeit unevenly. Evidence points to the benefit of family-based treatment for youth. For adults no specific approach has shown superiority and, presently, a combination of renourishment and psychotherapy such as specialist supportive clinical management, cognitive behavioral therapy, or interpersonal psychotherapy is recommended. RCTs have neither sufficiently addressed the more complex treatment approaches seen in routine practice settings, such as multidisciplinary treatment or level of care, nor specifically investigated treatment in ethnically diverse populations. Methodological challenges that hinder progress in controlled research for anorexia nervosa are explained. CONCLUSIONS The review highlights evidence-based and promising treatment modalities for anorexia nervosa and presents a triangulated analysis including controlled research, practice guidelines, and emerging treatments to inform and support clinical decision making.
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Affiliation(s)
- H J Watson
- Centre for Clinical Interventions, Department of Health in Western Australia, Perth, WA, Australia
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Strigo IA, Matthews SC, Simmons AN, Oberndorfer T, Klabunde M, Reinhardt LE, Kaye WH. Altered insula activation during pain anticipation in individuals recovered from anorexia nervosa: evidence of interoceptive dysregulation. Int J Eat Disord 2013; 46:23-33. [PMID: 22836447 PMCID: PMC3507323 DOI: 10.1002/eat.22045] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Recent evidence raises the possibility that symptoms of anorexia nervosa (AN) could be related to impaired interoception. Pain is an interoceptive process with well-characterized neuroanatomical pathways that may overlap to a large degree with neural systems that may be dysregulated in individuals with AN, such as the insula. METHOD Functional magnetic resonance imaging (fMRI) was used to assess neural substrates of pain anticipation and processing in 10 healthy control women (CW) and 12 individuals recovered from AN (REC AN) in order to avoid the confounding effects of malnutrition. Painful heat stimuli were applied while different colors signaled the intensity of the upcoming stimuli. RESULTS REC AN compared with CW showed greater activation within right anterior insula (rAI), dorsolateral prefrontal cortex (dlPFC) and cingulate during pain anticipation, and greater activation within dlPFC and decreased activation within posterior insula during painful stimulation. Greater anticipatory rAI activation correlated positively with alexithymic feelings in REC AN participants. DISCUSSION REC AN showed a mismatch between anticipation and objective responses, suggesting altered integration and, possibly, disconnection between reported and actual interoceptive state. Alexithymia assessment provided additional evidence of an altered ability to accurately perceive bodily signals in women recovered from AN.
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Affiliation(s)
- Irina A. Strigo
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Research Service, VA San Diego Healthcare System, San Diego, CA,VA Center of Excellence for Stress and Mental Health(CESAMH), San Diego, CA,BioCircuits Institute (BCI), La Jolla, CA 92037
| | - Scott C. Matthews
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Research Service, VA San Diego Healthcare System, San Diego, CA,VA Center of Excellence for Stress and Mental Health(CESAMH), San Diego, CA
| | - Alan N. Simmons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA,Research Service, VA San Diego Healthcare System, San Diego, CA,Psychiatry Service, VA San Diego Healthcare System, San Diego, CA,VA Center of Excellence for Stress and Mental Health(CESAMH), San Diego, CA
| | - Tyson Oberndorfer
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Megan Klabunde
- Department of Child and Adolescent Psychiatry, Stanford University, Stanford, CA
| | | | - Walter H. Kaye
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
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Frank GK, Kaye WH. Current status of functional imaging in eating disorders. Int J Eat Disord 2012; 45:723-36. [PMID: 22532388 PMCID: PMC3872533 DOI: 10.1002/eat.22016] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2012] [Indexed: 11/11/2022]
Abstract
Eating Disorders are complex psychiatric problems that involve biologic and psychological factors. Brain imaging studies provide insights about how functionally connected brain networks may contribute to disturbed eating behavior, resulting in food refusal and altered body weight, but also body preoccupations and heightened anxiety. In this article, we review the current state of brain imaging in eating disorders, and how such techniques may help identify pathways that could be important in the treatment of those often detrimental disorders.
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Affiliation(s)
- Guido K.W. Frank
- University of Colorado Denver, Departments of Child & Adolescent Psychiatry and Neuroscience, Aurora CO
| | - Walter H. Kaye
- University of California San Diego, Department of Psychiatry, La Jolla CA
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Kim SF. Animal models of eating disorders. Neuroscience 2012; 211:2-12. [PMID: 22465439 DOI: 10.1016/j.neuroscience.2012.03.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 03/16/2012] [Accepted: 03/16/2012] [Indexed: 01/30/2023]
Abstract
Feeding is a fundamental process for basic survival and is influenced by genetics and environmental stressors. Recent advances in our understanding of behavioral genetics have provided a profound insight on several components regulating eating patterns. However, our understanding of eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating, is still poor. The animal model is an essential tool in the investigation of eating behaviors and their pathological forms, yet development of an appropriate animal model for eating disorders still remains challenging due to our limited knowledge and some of the more ambiguous clinical diagnostic measures. Therefore, this review will serve to focus on the basic clinical features of eating disorders and the current advances in animal models of eating disorders.
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Affiliation(s)
- S F Kim
- Center for Neurobiology and Behavior, Department of Psychiatry and Pharmacology, The Perelman School of Medicine University of Pennsylvania, 125 S 31st St., TRL Rm 2207, Philadelphia, PA 19104, USA.
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Swenne I, Rosling A. No unexpected adverse events and biochemical side effects of olanzapine as adjunct treatment in adolescent girls with eating disorders. J Child Adolesc Psychopharmacol 2011; 21:221-7. [PMID: 21663424 DOI: 10.1089/cap.2009.0098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Olanzapine has been recently tried to relieve anxiety and hyperactivity in adolescents with eating disorders (EDs). Presently, the side effects of the drug have been evaluated. METHOD Forty-seven adolescents with EDs were followed up by repeated blood sampling before, during, and at 3 months after medication with olanzapine. RESULTS Olanzapine medication was discontinued in three patients because of galactorrhea, seizures, and raised liver enzyme activities, respectively. There was a normalization of glucose, insulin, and lipid profiles during treatment, which was related to weight gain and resumption of menstruations but not to medication. Increases in thyroid-stimulating hormone and prolactin were related to olanzapine medication and comedication with selective serotonine reuptake inhibitors. Three months after discontinuing medication, there were no persisting biochemical effects. CONCLUSION The side effects observed were those previously described for olanzapine. Most biochemical changes were related to weight (change) and amenorrhea and not to medication. Placebo-controlled studies are needed to investigate the efficacy of olanzapine in adolescents with EDs.
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Affiliation(s)
- Ingemar Swenne
- Department of Women's and Children's Health, Uppsala University Children's Hospital, Uppsala, Sweden.
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Abstract
Anorexia nervosa (AN) and bulimia nervosa (BN) are disorders characterized by aberrant patterns of feeding behavior, weight regulation, and disturbances in attitudes and perceptions toward body weight and shape. Several lines of evidence nominate disturbances of serotonin (5-HT) pathways as playing a role in the pathogenesis and pathophysiology of AN and BN. For example, 5-HT pathways are known to contribute to the modulation of a range of behaviors commonly seen in individuals with AN and BN. New technology using brain imaging with radioligands offers the potential for understanding previously inaccessible brain 5-HT neurotransmitter function and its dynamic relationship with human behaviors. Recent studies using positron emission tomography and single photon emission computed tomography with 5-HT-specific radioligands have consistently shown 5-HT(1A) and 5-HT(2A) receptor and 5-HT transporter alterations in AN and BN in cortical and limbic structures, which may be related to anxiety, behavioral inhibition, and body image distortions. These disturbances are present when subjects are ill and persist after recovery, suggesting that these may be traits that are independent of the state of the illness. Effective treatments for AN and BN have been elusive. A better understanding of neurobiology is likely to be important for developing specific and more powerful therapies for these often chronic and deadly disorders.
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Affiliation(s)
- Ursula F Bailer
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria
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Bosanac P, Newton R, Harari E, Castle D. Mind the evidence gap: do we have any idea about how to integrate the treatment of anorexia nervosa into the Australian mental health context? Australas Psychiatry 2010; 18:517-22. [PMID: 20932198 DOI: 10.3109/10398562.2010.499433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this paper is to review recent developments in the treatment of anorexia nervosa (AN) and how this translates to clinical and population-based care in the Australian context. CONCLUSIONS Overall, there is a paucity of high-quality research into treatments for AN, albeit that a number of biological and psychological interventions show promise as avenues for further research. There are significant impediments to the provision of comprehensive longitudinal care for people with AN within Australian mental health services. Evaluation of novel strategies, such as home-based support, is required as part of enhancing options for Australians suffering with AN and their families.
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Affiliation(s)
- Peter Bosanac
- St. Vincents' Mental Health and Senior Lecturer, Dept. Psychiatry, University of Melbourne, Melbourne, VIC, Australia.
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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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Bruni V, Dei M, Peruzzi E, Seravalli V. The anorectic and obese adolescent. Best Pract Res Clin Obstet Gynaecol 2010; 24:243-58. [DOI: 10.1016/j.bpobgyn.2009.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 09/25/2009] [Indexed: 11/24/2022]
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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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Molecular mechanisms underlying anorexia nervosa: focus on human gene association studies and systems controlling food intake. ACTA ACUST UNITED AC 2009; 62:147-64. [PMID: 19931559 DOI: 10.1016/j.brainresrev.2009.10.007] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 10/08/2009] [Accepted: 10/08/2009] [Indexed: 01/08/2023]
Abstract
Anorexia nervosa (AN) is a complex multi-factorial disease with high heritability. The psychological AN symptoms are poorly connected with specific molecular mechanisms. Here we review the molecular basis of AN with the focus on human genetic association studies; we put these in the experimental biological context with emphasis on molecular systems controlling food intake and body weight in a direct or indirect manner. We systematically searched for human genetic studies related to AN and grouped data into main categories/systems reflecting their major known roles: (1) Systems related to mental disorders (serotonin, brain-derived neurotrophic factor (BDNF), norepinephrine (NE), glutamate (NMDA) receptor and SK3 channel, KCCN3). (2) Hunger regulatory systems (leptin, AGRP, MSH, melanocortin 4 receptor (MC4R), NPY, ghrelin, cholecystokinin (CCK). (3) Feeding motivation- and reward-related systems (opioids, OPRD1, cannabinoids (anandamide (AEA), THC, CBR1), dopamine, DRD2, DRD3, DRD4, catecholamine-O-methyl transferase (COMT). (4) Systems regulating energy metabolism (uncoupling proteins 2 and 3 (UCP2 and UCP3). (5) Neuroendocrine systems with emphasis on sex hormones (estrogen receptor-beta (ESR2). (6) The immune system and inflammatory response (tumor necrosis factor-alpha (TNF-alpha)). Overall, we found that in total 175 association studies have been performed on AN cohorts on 128 different polymorphisms related to 43 genes. We review the strongest associations, identify some genes that have an important role in regulating BMI whose possible relationship to AN has not been investigated and discuss the potential targets for pharmacological interventions.
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Kaye WH, Fudge JL, Paulus M. New insights into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci 2009; 10:573-84. [PMID: 19603056 DOI: 10.1038/nrn2682] [Citation(s) in RCA: 559] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Individuals with anorexia nervosa have a relentless preoccupation with dieting and weight loss that results in severe emaciation and sometimes death. It is controversial whether such symptoms are secondary to psychosocial influences, are a consequence of obsessions and anxiety or reflect a primary disturbance of brain appetitive circuits. New brain imaging technology provides insights into ventral and dorsal neural circuit dysfunction - perhaps related to altered serotonin and dopamine metabolism - that contributes to the puzzling symptoms found in people with eating disorders. For example, altered insula activity could explain interoceptive dysfunction, and altered striatal activity might shed light on altered reward modulation in people with anorexia nervosa.
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Affiliation(s)
- Walter H Kaye
- Eating Disorder Treatment & Research Program, Department of Psychiatry, University of California, San Diego, La Jolla Village Professional Center, 8950 Villa La Jolla Drive, Suite C-207, La Jolla, California 92037, USA.
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Treatment of anorexia nervosa: Insights and obstacles. Physiol Behav 2008; 94:113-20. [DOI: 10.1016/j.physbeh.2007.11.020] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 11/15/2007] [Indexed: 11/24/2022]
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Hrdlicka M, Beranova I, Zamecnikova R, Urbanek T. Mirtazapine in the treatment of adolescent anorexia nervosa. Case-control study. Eur Child Adolesc Psychiatry 2008; 17:187-9. [PMID: 18357426 DOI: 10.1007/s00787-007-0670-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a serious and potentially life-threatening psychiatric disorder. Pharmacotherapeutic possibilities still remain limited. We sought to determine if there was a positive effect on body weight and body mass index (BMI) in AN patients being treated for depression or anxiety with mirtazapine. METHODS Using a case-control design, we found nine female patients with AN who had been treated with mirtazapine for depression or anxiety during hospitalization in our department. We also found nine female controls with AN, who had not received any pharmacotherapy. The two groups of patients were matched according to age and BMI. Case and control groups did not differ significantly in age (15.2 +/- 1.9 Vs. 14.7 +/- 1.7 years; P = 0.549), or in BMI (15.6 +/- 2.3 Vs. 15.6 +/- 2.1; P = 0.946) at baseline. Weight and BMI were evaluated at baseline and again after the patients had completed 1, 2, 3 and 4 weeks of treatment. RESULTS The mean dose of mirtazapine was 21.7 +/- 1.8 mg at the end of week 4. Using ANOVA Repeated Measures, we found no significant differences between cases and controls with regard to weight (P = 0.981) or BMI (P = 0.576). However, there was a non-significant trend in patients which had been treated with mirtazapine which showed slightly more improvement, in the measured parameters, at the end of weeks 1, 2 and 3, compared to controls. CONCLUSION Results are limited by small sample size. However, the use of mirtazapine could be useful in the treatment of AN in adolescence.
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Affiliation(s)
- Michal Hrdlicka
- Department of Child Psychiatry, 2nd Medical School, Charles University, V Uvalu 84, 15006 Prague, Czech Republic.
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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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Astrachan-Fletcher E, Veldhuis C, Lively N, Fowler C, Marcks B. The Reciprocal Effects of Eating Disorders and the Postpartum Period: A Review of the Literature and Recommendations for Clinical Care. J Womens Health (Larchmt) 2008; 17:227-39. [DOI: 10.1089/jwh.2007.0550] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Cindy Veldhuis
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois
| | - Nikki Lively
- Department of Psychiatry, College of Medicine, University of Illinois, Chicago, Illinois
| | - Cynthia Fowler
- Student Counseling Resource Services, University of Chicago, Chicago, Illinois
| | - Brook Marcks
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island
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Rossi G, Balottin U, Rossi M, Chiappedi M, Fazzi E, Lanzi G. Pharmacological treatment of anorexia nervosa: a retrospective study in preadolescents and adolescents. Clin Pediatr (Phila) 2007; 46:806-11. [PMID: 17641118 DOI: 10.1177/0009922807303929] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To date, studies addressing the role of pharmacotherapy in the treatment of anorexia nervosa are limited, especially in childhood and adolescence. The aim of this retrospective naturalistic study was to evaluate the efficacy and safety of pharmacotherapy in 19 anorexic preadolescents and adolescents referred, for the first time, to a specialist psychiatry unit. Almost all the patients showed an improvement both in their eating behaviors, and in their mood and obsessive symptoms. No evidence was found of dangerous adverse events. Combined with a multidisciplinary approach that includes nutritional rehabilitation and psychotherapy, adjunctive pharmacotherapy may be useful in addressing both eating disorder psychopathology and comorbid psychiatric disorders.
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Affiliation(s)
- G Rossi
- Department of Child Neurology and Psychiatry, IRCCS C. Mondino Foundation, University of Pavia, Pavia, Italy.
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Abstract
The mission of the National Institute of Mental Health (NIMH) is to reduce the burden of mental and behavioral disorders through research, and eating disorders embody an important fraction of this burden. Although past and current research has provided important knowledge regarding the etiology, classification, pathophysiology, and treatment of the eating disorders, there are still significant challenges that need to be addressed. This article briefly describes some of these challenges, recent NIMH-supported research and research-related activities directed at addressing these challenges, and approaches and areas of research that hold promise for furthering the understanding and treatment of eating disorders.
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Affiliation(s)
- Mark Chavez
- National Institute of Mental Health, Bethesda, MD 20892, USA.
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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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Barbarich-Marsteller NC, Marx R. Question and answer: neuroimaging in the treatment of eating disorders. What is neuroimaging and how can it be used to improve the treatment of eating disorders? Eat Disord 2007; 15:273-5. [PMID: 17520458 DOI: 10.1080/10640260701323532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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