1
|
Lewis YD, Bergner L, Steinberg H, Bentley J, Himmerich H. Pharmacological Studies in Eating Disorders: A Historical Review. Nutrients 2024; 16:594. [PMID: 38474723 PMCID: PMC11154472 DOI: 10.3390/nu16050594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
Eating disorders (EDs) are serious mental health conditions characterised by impaired eating behaviours and nutrition as well as disturbed body image, entailing considerable mortality and morbidity. Psychopharmacological medication is an important component in the treatment of EDs. In this review, we performed a historic analysis of pharmacotherapeutic research in EDs based on the scientific studies included in the recently published World Federation of Societies for Biological Psychiatry (WFSBP) guidelines for ED treatment. This analysis focuses on early approaches and trends in the methods of clinical pharmacological research in EDs, for example, the sample sizes of randomised controlled trials (RCTs). We found the development of psychopharmacological treatments for EDs followed advancements in psychiatric pharmacotherapy. However, the application of RCTs to the study of pharmacotherapy for EDs may be an impediment as limited participant numbers and inadequate research funding impede generalisability and statistical power. Moreover, current medication usage often deviates from guideline recommendations. In conclusion, the RCT model may not effectively capture the complexities of ED treatment, and funding limitations hinder research activity. Novel genetically/biologically based treatments are warranted. A more comprehensive understanding of EDs and individualised approaches should guide research and drug development for improved treatment outcomes.
Collapse
Affiliation(s)
- Yael D. Lewis
- Hadarim Eating Disorders Unit, Shalvata Mental Health Centre, Hod Hasharon 4534708, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Lukas Bergner
- Forschungsstelle für die Geschichte der Psychiatrie, Klinik und Poliklinik Psychiatrie und Psychotherapie, Medizinische Fakultät der Universität Leipzig, 04103 Leipzig, Germany; (L.B.); (H.S.)
| | - Holger Steinberg
- Forschungsstelle für die Geschichte der Psychiatrie, Klinik und Poliklinik Psychiatrie und Psychotherapie, Medizinische Fakultät der Universität Leipzig, 04103 Leipzig, Germany; (L.B.); (H.S.)
| | - Jessica Bentley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (J.B.); (H.H.)
| | - Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (J.B.); (H.H.)
- South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK
| |
Collapse
|
2
|
Schmidt U. Die Komplexe Posttraumatische Belastungsstörung im Erwachsenenalter. DER NERVENARZT 2022; 93:1176-1184. [DOI: 10.1007/s00115-022-01400-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 02/10/2023]
|
3
|
Reilly EE, Berner LA, Trunko ME, Schwartz T, Anderson LK, Krueger A, Yu X, Chen JY, Cusack A, Nakamura T, Kaye WH. Evaluating the use of lamotrigine to reduce mood lability and impulsive behaviors in adults with chronic and severe eating disorders. Eat Weight Disord 2022; 27:1775-1785. [PMID: 35298791 PMCID: PMC9123051 DOI: 10.1007/s40519-021-01320-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gold-standard psychological and pharmacological treatments for bulimic-spectrum eating disorders only result in remission for around 50% of patients; patients with affective lability and impulsivity represent a subgroup with particularly poor outcomes. Both dialectical behavior therapy (DBT), a treatment for emotion dysregulation, and lamotrigine, a mood stabilizer, have demonstrated promise for targeting affective lability and impulsivity; however, data exploring the combination of these interventions remain limited. OBJECTIVE We followed a group of women with recurrent dysregulated eating behaviors (N = 62) throughout intensive DBT treatment and compared the symptom trajectory of those prescribed lamotrigine (n = 28) and those who were not (n = 34). METHOD Participants completed surveys every 2 weeks throughout treatment. RESULTS Group analyses suggested that all participants self-reported decreases in emotional reactivity, negative urgency, and symptoms of borderline personality disorder (BPD). The lamotrigine group reported greater elevations in BPD symptoms at baseline, but demonstrated steeper decreases in emotion and behavioral dysregulation than the non-matched comparison group. Within-subject analyses suggested that within the lamotrigine group, subjects reported greater decreases in symptoms following prescription of lamotrigine. CONCLUSIONS Findings provide initial data suggesting that lamotrigine could be useful as an adjunctive treatment for patients with affective lability and impulsivity. LEVEL OF EVIDENCE IV, time series without randomization.
Collapse
Affiliation(s)
- Erin E Reilly
- Department of Psychology, Hofstra University, Hempstead, USA.,Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, CA, San Francisco, USA
| | - Laura A Berner
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mary Ellen Trunko
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Terry Schwartz
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Leslie K Anderson
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Angeline Krueger
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Xinze Yu
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Joanna Y Chen
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA.,Department of Psychology, Drexel University, Philadelphia, USA
| | - Anne Cusack
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Tiffany Nakamura
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA
| | - Walter H Kaye
- Department of Psychiatry, UCSD Health Eating Disorders Center for Research and Treatment, University of California, San Diego, San Diego, CA, USA.
| |
Collapse
|
4
|
Berner LA, Reilly EE, Yu X, Krueger A, Trunko ME, Anderson LK, Chen J, Simmons AN, Kaye WH. Changes in cognitive and behavioral control after lamotrigine and intensive dialectical behavioral therapy for severe, multi-impulsive bulimia nervosa: an fMRI case study. Eat Weight Disord 2022; 27:1919-1928. [PMID: 34661882 PMCID: PMC9122851 DOI: 10.1007/s40519-021-01308-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/18/2021] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Adults with bulimia nervosa (BN) and co-occurring emotional dysregulation and multiple impulsive behaviors are less responsive to existing interventions. Initial data suggest that the combination of Dialectical Behavior Therapy (DBT) and a mood stabilizer, lamotrigine, significantly reduces symptoms of affective and behavioral dysregulation in these patients. Identifying candidate neurobiological mechanisms of change for this novel treatment combination may help guide future randomized controlled trials and inform new and targeted treatment development. Here, we examined neurocognitive and symptom changes in a female patient with BN and severe affective and behavioral dysregulation who received DBT and lamotrigine. METHODS Go/no-go task performance data and resting-state functional MRI scans were acquired before the initiation of lamotrigine (after 6 weeks in an intensive DBT program), and again after reaching and maintaining a stable dose of lamotrigine. The patient completed a battery of symptom measures biweekly for 18 weeks over the course of treatment. RESULTS After lamotrigine initiation, the patient made fewer errors on a response inhibition task and showed increased and new connectivity within frontoparietal and frontolimbic networks involved in behavioral and affective control. Accompanying this symptom improvement, the patient reported marked reductions in bulimic symptoms, behavioral dysregulation, and reactivity to negative affect, along with increases in DBT skills use. CONCLUSION Improved response inhibition and cognitive control network connectivity should be further investigated as neurocognitive mechanisms of change with combined DBT and lamotrigine for eating disorders. Longitudinal, controlled trials integrating neuroimaging and symptom measures are needed to fully evaluate the effects of this treatment. LEVEL OF EVIDENCE IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.
Collapse
Affiliation(s)
- Laura A Berner
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin E Reilly
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Psychology, Hofstra University, Hempstead, NY, USA
| | - Xinze Yu
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Angeline Krueger
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mary Ellen Trunko
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Leslie K Anderson
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Joanna Chen
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Alan N Simmons
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
| |
Collapse
|
5
|
Skokou M. Comment on Keeler et al. Ketamine as a Treatment for Anorexia Nervosa: A Narrative Review. Nutrients 2021, 13, 4158. Nutrients 2022; 14:nu14102118. [PMID: 35631259 PMCID: PMC9147487 DOI: 10.3390/nu14102118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/27/2022] [Indexed: 01/27/2023] Open
Abstract
Anorexia Nervosa (AN) represents a difficult therapeutic challenge, with up to 4% prevalence among females and increasing incidence among youth [...]
Collapse
Affiliation(s)
- Maria Skokou
- Department of Psychiatry, University Hospital of Patras, 26504 Patras, Greece
| |
Collapse
|
6
|
Keeler JL, Treasure J, Juruena MF, Kan C, Himmerich H. Reply to Skokou, M. Comment on “Keeler et al. Ketamine as a Treatment for Anorexia Nervosa: A Narrative Review. Nutrients 2021, 13, 4158”. Nutrients 2022; 14:nu14102119. [PMID: 35631260 PMCID: PMC9146951 DOI: 10.3390/nu14102119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/27/2022] [Indexed: 12/07/2022] Open
Abstract
In response to our narrative review, which suggested the use of the glutamatergic n-methyl-D-aspartate (NMDA) receptor antagonist ketamine as a potential treatment for anorexia nervosa (AN) [...]
Collapse
Affiliation(s)
- Johanna Louise Keeler
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (J.T.); (H.H.)
- Correspondence: ; Tel.: +44-(0)-20-7848-0187
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (J.T.); (H.H.)
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
| | - Mario F. Juruena
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Carol Kan
- Eating Disorder Service, Central and North West London NHS Foundation Trust, 1 Nightingale Place, Kensington & Chelsea, London SW10 9NG, UK;
| | - Hubertus Himmerich
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (J.T.); (H.H.)
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK;
| |
Collapse
|
7
|
Parental internalizing disorder and the developmental trajectory of infant self-regulation: The moderating role of positive parental behaviors. Dev Psychopathol 2020; 34:1-17. [PMID: 32958086 DOI: 10.1017/s0954579420001042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Child self-regulation (SR), a key indicator for later optimal developmental outcomes, may be compromised in the presence of parental mental disorders, especially those characterized by affective dysregulation. However, positive parental behaviors have been shown to buffer against such negative effects, especially during infancy when SR shows great plasticity to environmental inputs. The current study investigated the effect of maternal and paternal lifetime and current internalizing disorders on the developmental trajectory of infant SR from 3 to 24 months, and the potential moderating role of positive parental behaviors. A latent growth model revealed that SR increased overall from 3 to 24 months. Mothers' positive parental behaviors demonstrated significant moderation effects, such that maternal lifetime internalizing disorder was associated with higher SR intercept only among those with low levels of positive parental behavior. Mothers' lifetime internalizing disorder was also associated with a lower linear slope in SR development with a moderate effect size. Fathers' current internalizing disorder was significantly associated with a higher intercept and lower linear slope of the SR trajectory. The current study expands the infant SR literature by describing its early developmental trajectory as well as early risk and protective factors within the parent-infant environment, taking into consideration developmental inputs from both parents.
Collapse
|
8
|
DeSocio JE. Challenges in diagnosis and treatment of comorbid eating disorders and mood disorders. Perspect Psychiatr Care 2019; 55:494-500. [PMID: 30729521 DOI: 10.1111/ppc.12355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/28/2018] [Accepted: 01/06/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This paper explores complex challenges in diagnosis and treatment of patients with comorbid eating disorders and mood disorders. An integrative review of the literature examines overlapping symptoms, phenotypes, neural circuits, and genetic factors for these disorders. A case study illustrates how the integration of knowledge from research and practice can inform a diagnostic formulation and multifaceted treatment plan. CONCLUSIONS Patients with complex clinical presentations inspire a search for research and clinical literature that helps build the neuroscience foundations of advanced practice. PRACTICE IMPLICATIONS Sharing clinical challenges and processes of discovery is a form of scholarship that promotes the evolution of advanced psychiatric nursing practice.
Collapse
|
9
|
McShane KM, Ozbolt L. Neurobiology of Eating Disorders and the Use of Psychotropic Medications. Psychiatr Ann 2018. [DOI: 10.3928/00485713-20180912-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|