ABSTRACT
Title
Olanzapine in the treatment of anorexia nervosa: a case report
Authors
W. Milano, G. Nolfe, L. Milano, C. Petrella, A. Capasso*
Mental Health Unit-District 44 - ASL Napoli 1 and *Departiment of Pharmaceutical and Biomedical Science, University of Salerno, Italy
Mental Health Unit-District 44 - ASL Napoli 1 and *Departiment of Pharmaceutical and Biomedical Science, University of Salerno, Italy
Abstract
Anorexia Nervosa (AN) is a complex and severe psychiatric disease, whose etiopathogenesis is still little-known, it involves mainly young women between 15 and 20 years old (Santonastaso et al. 2009). The AN, according to the criteria of DSM IV, is characterized by marked symptoms such as the weight loss due to the drastic reduction of the food intake, intense fear of increasing weight and to accumulate fat even though it is underweight, with or without compensating phenomena as self-induced vomiting, the use of laxatives and diuretics (APA, 2000). At today, the treatment of the AN is quite uncertain (APA, 2004). Many drugs have been used recently with encouraging results (RA, 2004).
The use of atypical antipsychotics, particularly the olanzapine, although in clinical trials on a small number of patients, showed an improvement in weight and in eating behavior and some psychopathological aspects such as anxiety, the obsessive and compulsive behavior, the perfectionism, the idea of thinness, the delusions about body image, hostility and loss of perception of reality. Here we report a clinical case of a young patient suffering from AN-treated with olanzapine.
The anorexic patient named A.R. was a young woman (19 years old) followed by our MHU (Mental Health Unit) starting by November 2008. A.R. showed a diagnosis of AN with a marked weight loss (15 kg in two years) because of an incongruous and spontaneous calorie diet. Her clinical history showed that her anorexic symptoms were previously treated with an individual and family psychotherapy as well as with nutritional supplements and multivitamins, prescribed by family doctor without any significant clinical improvement. At the first our clinical examination, she weighed 44 kg for a height of 162 cm (BMI 17.5), with frequent episodes of self-induced vomiting and excessive physical exercise: she walked for 2/3 hours per day. Along with a simple and balanced program of nutritional rehabilitation, our anorexic patient was treated with olanzapine 2.5 mg/day for the first month and 5 mg/day for three months. At the beginning and the end of observation period, our anorexic patient has completed a psychometric test for self-eating disorders (DCA), the Eating Disorder Inventory (EDI), to evaluate the size of certain psychological traits or groups of symptoms typical of the DCA, as the drive for thinness, bulimia ideas, dissatisfaction with their body, inadequacy, perfectionism, interpersonal conflict, fear of maturity. The control of the body weight occurred every two weeks and no side effects were observed during olanzapine treatment.
Afterfour months of olanzapine treatment both the weight and BMI of our anorexic patient were slightly increased. In addition, the EDI scores are generally improved, especially in sub-scale for perfectionism, the drive for thinness and a sense of inadequacy
Given the above evidences, it is reasonable to assume the use of olanzapine in the treatment of AN.
Santonastaso P, Favaro A. “Epidemiologia e fattori di rischio in AN e BN” Noos 2009 1: 15-20
American Psychiatric Association “Diagnostic and Statistical Manual of Mental Disorders” TR 4th revised ed. Washinton DC 2000
American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders 2004 “Practice Guidelines for Eating Disordes” APA 2004
Royal Australian and New Zeland College of Psychiatrists “Australian and New Zeland clinical practice guidelines for treatment of AN” Australian and New Zeland Journal of Psichiatry 2004 38:659-670
The use of atypical antipsychotics, particularly the olanzapine, although in clinical trials on a small number of patients, showed an improvement in weight and in eating behavior and some psychopathological aspects such as anxiety, the obsessive and compulsive behavior, the perfectionism, the idea of thinness, the delusions about body image, hostility and loss of perception of reality. Here we report a clinical case of a young patient suffering from AN-treated with olanzapine.
The anorexic patient named A.R. was a young woman (19 years old) followed by our MHU (Mental Health Unit) starting by November 2008. A.R. showed a diagnosis of AN with a marked weight loss (15 kg in two years) because of an incongruous and spontaneous calorie diet. Her clinical history showed that her anorexic symptoms were previously treated with an individual and family psychotherapy as well as with nutritional supplements and multivitamins, prescribed by family doctor without any significant clinical improvement. At the first our clinical examination, she weighed 44 kg for a height of 162 cm (BMI 17.5), with frequent episodes of self-induced vomiting and excessive physical exercise: she walked for 2/3 hours per day. Along with a simple and balanced program of nutritional rehabilitation, our anorexic patient was treated with olanzapine 2.5 mg/day for the first month and 5 mg/day for three months. At the beginning and the end of observation period, our anorexic patient has completed a psychometric test for self-eating disorders (DCA), the Eating Disorder Inventory (EDI), to evaluate the size of certain psychological traits or groups of symptoms typical of the DCA, as the drive for thinness, bulimia ideas, dissatisfaction with their body, inadequacy, perfectionism, interpersonal conflict, fear of maturity. The control of the body weight occurred every two weeks and no side effects were observed during olanzapine treatment.
Afterfour months of olanzapine treatment both the weight and BMI of our anorexic patient were slightly increased. In addition, the EDI scores are generally improved, especially in sub-scale for perfectionism, the drive for thinness and a sense of inadequacy
Given the above evidences, it is reasonable to assume the use of olanzapine in the treatment of AN.
Santonastaso P, Favaro A. “Epidemiologia e fattori di rischio in AN e BN” Noos 2009 1: 15-20
American Psychiatric Association “Diagnostic and Statistical Manual of Mental Disorders” TR 4th revised ed. Washinton DC 2000
American Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders 2004 “Practice Guidelines for Eating Disordes” APA 2004
Royal Australian and New Zeland College of Psychiatrists “Australian and New Zeland clinical practice guidelines for treatment of AN” Australian and New Zeland Journal of Psichiatry 2004 38:659-670