Bulimia nervosa

A pilot study of a randomised trial of cognitive analytical therapy vs educational behavioral therapy for adult anorexia nervosa

The aim of this study was to compare two forms of outpatient treatment, educational behavioural treatment and cognitive analytical therapy for adult anorexia nervosa. Thirty patients were randomly allocated to the two treatments. At one year, the group had gained 6.8 kg, 19/30 (63%) had a good or intermediate recovery in terms of nutritional outcome. The group given cognitive analytical treatment reported significantly greater subjective improvement but there were no differences in other outcome parameters. In conclusion outpatient treatment of adult onset anorexia nervosa leads to an improvement in two thirds of cases. Larger studies will be needed to determine the most effective form of treatment in this group.

Bilateral parotid enlargement as a presenting feature of bulimia nervosa in a post-adolescent male

An unusual case of bulimia nervosa in a post-adolescent male is reported. The clinical presentation was one of painless parotid swelling of 3 years duration with marked weight loss and underlying metabolic alkalosis. The diagnostic significance of parotid salivary gland swellings is discussed.

Current perspectives on drug therapies for anorexia nervosa and bulimia nervosa

Anorexia nervosa and bulimia nervosa are eating disorders that strike a significant number of adolescent and young adult women and carry a significant morbidity and mortality. Over the last 30 years, virtually every class of psychiatric drug as well as atypical agents have been tested in the management of these vexing and often chronic disorders. For anorexia nervosa, there is in 1991 little if any role for pharmacotherapy. Drugs used to promote food intake and weight gain, such as cyproheptadine, amitriptyline, clonidine and opiate antagonists, have provided disappointing results. For bulimia nervosa, double-blind placebo-controlled clinical trials have confirmed an antibulimic effect for tricyclic antidepressants, such as imipramine and desipramine. Monoamine oxidase inhibitors, while having a significant antibulimic effect, require careful adherence to a dietary regimen which may limit patient compliance. Newer antidepressants such as trazodone, amfebutamone and fluoxetine may prove useful if further study substantiates preliminary beneficial results. Other agents such as anticonvulsants, benzodiazepines, lithium, fenfluramine and opiate antagonists also require additional study, indicating that the optimal integration of pharmacotherapies with other treatments awaits further research.