NEDA TOOLKIT for Parents
It is recommended that clinicians inquire about a
patient’s or family’s use of Internet-based support and
other alternative and complementary approaches and
be prepared to openly and sympathetically discuss the
information and ideas gathered from these sources [I].
iii. Chronic Anorexia Nervosa
Patients with chronic anorexia nervosa generally show
a lack of substantial clinical response to formal
psychotherapy. Nevertheless, many clinicians report
seeing patients with chronic anorexia nervosa who,
after many years of struggling with their disorder,
experience substantial remission, so clinicians are
justified in maintaining and extending some degree
of hope to patients and families [II]. More extensive
psychotherapeutic measures may be undertaken to
engage and help motivate patients whose illness is
resistant to treatment [II] or, failing that, as
compassionate care [I]. For patients who have
difficulty talking about their problems, clinicians have
reported that a variety of nonverbal therapeutic
methods, such as the creative arts, movement therapy
programs, and occupational therapy, can be useful
[III]. Psychosocial programs designed for patients with
chronic eating disorders are being implemented at
several treatment sites and may prove useful [II].
c. i.
For example, these medications may be considered for
those with persistent depressive, anxiety, or obsessive-
compulsive symptoms and for bulimic symptoms in
weight-restored patients [II]. A U.S. Food and Drug
Administration (FDA) black box warning concerning
the use of bupropion in patients with eating disorders
has been issued because of the increased seizure risk
in these patients. Adverse reactions to tricyclic
antidepressants and monoamine oxidase inhibitors
(MAOIs) are more pronounced in malnourished
individuals, and these medications should generally be
avoided in this patient population [I]. Second-
generation antipsychotics, particularly olanzapine,
risperidone, and quetiapine, have been used in small
series and individual cases for patients, but controlled
studies of these medications are lacking. Clinical
impressions suggest that they may be useful in
patients with severe, unremitting resistance to gaining
weight; severe obsessional thinking; and denial that
assumes delusional proportions [III]. Small doses of
older antipsychotics such as chlorpromazine may be
helpful prior to meals in very disturbed patients [III].
Although the risks of extrapyramidal side effects are
less with second-generation antipsychotics than with
first-generation antipsychotics, debilitated anorexia
nervosa patients may be at a higher risk for these than
expected. Medications and Other Somatic Treatments
Weight Restoration
The decision about whether to use psychotropic
medications and, if so, which medications to choose
will be based on the patient’s clinical presentation [I].
The limited empirical data on malnourished patients
indicate that selective serotonin reuptake inhibitors
(SSRIs) do not appear to confer advantage regarding
weight gain in patients who are concurrently receiving
inpatient treatment in an organized eating disorder
program [I]. However, SSRIs in combination with
psychotherapy are widely used in treating patients
with anorexia nervosa.
Therefore, if these medications are used, it is
recommended that patients be carefully monitored for
extrapyramidal symptoms and akathisia [I]. It is also
important to routinely monitor patients for potential
side effects of these medications, which can result in
insulin resistance, abnormal lipid metabolism, and
prolongation of the QTc interval [I]. Because
ziprasidone has not been studied in individuals with
anorexia nervosa and can prolong QTc intervals,
careful monitoring of serial electrocardiograms and
serum potassium measurements is needed if anorexic
patients are treated with ziprasidone [I].
Page | 51