Psychosis in Anorexia Nervosa: A Case Report and Review of the Literature

Characteristics of isoniazid-induced psychosis: a systematic review of case reports and case series

PURPOSE

Isoniazid, a first-line antitubercular drug, is associated with nervous system adverse drug reactions such as seizures, peripheral neuropathy, and psychosis. This systematic review of case reports and case series aimed to characterize the demographic, social, and clinical factors associated with isoniazid-induced psychosis in patients with active tuberculosis (TB) and those who received isoniazid for latent TB infection (LTBI).

METHODS

We comprehensively searched the Embase, PubMed, and Scopus databases to identify relevant studies published between the date of inception of the database and June 2024.

RESULTS

A total of 28 studies, including 21 case reports and 7 case series involved 37 patients who developed isoniazid-induced psychosis. A higher frequency of isoniazid-induced psychosis was observed during the first 2 months of treatment, with a relatively early onset observed among patients aged 18 years or less. Delusions and/or hallucinations are the common symptoms of isoniazid-induced psychosis. Psychomotor disturbances, disorganized speech or formal thought disorder, disorganized or abnormal behaviour, and neuropsychiatric symptoms (sleep disturbances, hostility or aggression, confusion, affective symptoms, anxiety symptoms, and cognitive difficulties) were the other symptoms observed in the included studies. More than 80% of cases rechallenged with isoniazid resulted in the recurrence of psychotic symptoms.

CONCLUSION

Patients with TB and LTBI should be assessed for psychotic and neuropsychiatric symptoms during isoniazid therapy, mainly in the first 2 months. Further research is required to understand the impact of underlying risk factors, such as genetic predisposition and isoniazid pharmacokinetics, as well as the clinical utility and dosage recommendations of pyridoxine for managing isoniazid-induced psychosis.

Body image as a mediator in the relationship between psychotic experiences and later disordered eating: A 12-month longitudinal study in high school adolescents

BACKGROUND

The relationship between psychosis and disordered eating remains a challenging area of research to which little interest was paid. Using longitudinal data, we aimed to explore the hypothesis that the pathways from psychotic experiences (PEs) to disordered eating (DE) and body-mass index (BMI) are mediated by body-image disturbances.

METHODS

A prospective longitudinal study was performed. High-school students (N = 510, 61.2% females, mean age of 16.05 ± 1.01 years) were asked to complete three scheduled assessments (Baseline, 6 months, and 12 months).

RESULTS

Two body image components, that is, Overweight Preoccupation and Body Area Satisfaction, mediated the prospective association between baseline PEs and DE 12 months later. Direct effects were significant. After accounting for indirect effects through more severe body image concerns at 6 months, higher baseline PEs were significantly associated with greater DE at 12 months. Baseline PEs and 6-month body image explained a significant proportion of variance in 12-month DE. However, we did not find evidence of a direct prospective association between PEs and BMI.

CONCLUSION

This study is the first to assess the mediating role of body image between PEs and DE. Findings offer promising new avenues for early intervention to help mitigate the effects of PEs on DE in adolescents.

A life lost to anorexia nervosa: A case report of rapid progressive disease and its psychological aspects

The prevalence of anorexia nervosa has been on the rise. Exploring key factors in treating this condition as well as psychological factors influencing the onset and maintenance of the disorder can increase the chance of treatment success.

Eating Disorders and Psychosis as Intertwined Dimensions of Disembodiment: A Narrative Review

Although psychosis is not one of the most commonly recognized psychiatric comorbidities of Eating Disorders (ED), there is an increasing empirical evidence of associations between these psychopathological conditions. Indeed, ED as well as early manifestations of schizophrenic psychosis emerge during developmental years and might present some affinities in the presentation at onset. For example, adolescents with anorexia nervosa (AN) may report psychotic-like eating-related symptoms such as delusional-like body image distortions and/or "anorexic voice". Conversely, early expressions of schizophrenia spectrum vulnerability might involve altered bodily experiences, delusional ideation on food and eating as well as pseudo-anorectic behaviors. From a phenomenological perspective, this partial symptomatic overlap may lie on common features of disturbed corporeality in terms of disembodiment, although these alterations of embodiment are presumably rooted in distinct pathogenetic pathways (e.g., primary childhood ontogenetic pathway in schizophrenia vs. a secondary adolescent ontogenetic pathway in AN). A clinical-phenomenological attitude could be important not only to better discern potential overlaps and affinities between the two conditions, but also to better conceptualize and treat those background alterations of the embodied self. In particular, a phenomenological exploration of the experiential side of eating-related behaviors could be a decisive step to support early differential diagnosis and treatment appropriateness.

Prevention of diet restriction induced hyperactivity but not body-weight reduction in rats co-treated with tryptophan: relationship with striatal serotonin and dopamine metabolism and serotonin-1A auto-receptor expression

Anorexia Nervosa (AN) is an eating and behavioral disorder characterized with anxiety/depression, hyperactivity, behavioral impulsivity and psychosis. Most of the associated symptoms are related to the deficiency of serotonin (5-hydroxytryptamine: 5-HT) stores. A deficiency of 5-HT can modulate dopamine neurotransmission in the striatum to elicit hyperactivity and psychosis in AN patients. Also, the release and availability of 5-HT are modulated by serotonin-1A (5-HT1A) auto-receptor. The present study investigates the role of striatal metabolism of 5-HT and dopamine in precipitating hyperactivity in the rat model of diet restriction (DR) induced AN. The role of tryptophan (Trp) in influencing the 5-HT metabolism and the mRNA expression of 5-HT1A auto-receptor is also investigated. We find that long-term DR for 38 days reduces body-weight in rats and produces hyperactivity, similar to AN. This hyperactivity is characterized by declined striatal metabolism of both, dopamine and 5-HT. The mRNA expression of 5-HT1A auto-receptor in the raphe nuclei is also decreased. Trp co-treatment improves these deficiencies in monoamine metabolism and alleviates hyperactivity. Interestingly, DR-induced changes in body-weights are not effected by Trp co-treatment. The study suggests that the striatal metabolism of 5-HT and dopamine and mRNA expression of 5-HT1A auto-receptor has an important role in the pathogenesis of AN. The finding suggests that co-use of Trp can prevent precipitation of AN by normalizing 5-HT metabolism.