Eating disorders and psychosis: a case report and review of the literature

AimsDespite evidence from case series, the comorbidity of eating disorders (ED) with psychosis is a challenging field to which little attention has been paid. There is no consistent sequence in the co-occurrence of the two conditions-eating disorders sometimes precede, and sometimes follow the onset of psychosis. In this case report, we present a 25-year-old female patient suffering from recurrent episodes of binge eating and inappropriate compensatory purging behaviours with psychotic components to discuss the co-occurrence of these conditions in the light of the literature.MethodOur patient suffered from sleep disturbances, homicidal thoughts, self-induced vomiting worsened in one year. Psychiatric examination revealed psychotic symptoms such as blunted affect, persecutory delusions, and delusions of appeal and justification. In our inpatient psychiatry clinic, she was treated with olanzapine 20 milligrams(mg) and quetiapine 500 mg per day.ResultPsychotic episodes occur in 10–15% of eating disorder patients. The prevalence of primary psychotic diseases like schizophrenia and schizoaffective disorders in eating disorder patients appears to be comparable to that in the general population. An ED can be the early sign of an impending psychosis, or psychotic symptoms can signal the beginning of an ED. The advent of the psychosis, and sometimes the treatment of the psychosis can cure the eating disorder, but it can sometimes aggravate it. The case presented illustrates the difficulties in managing a patient with a comorbid eating disorder and psychosis. To ensure a rigorous assessment of both psychotic and eating disorder symptoms, the focus should be on the pattern of appearance or emergence of symptoms, their phenomenology, clinical and family background of the patient, and clinical status on follow-up.ConclusionThe comorbidity between eating disorders and psychosis is infrequent and raises several conceptual and methodological questions. Epidemiological and family studies show that there is no more significant association between psychosis and ED, although these results are somehow limited by the lack of rigorous data regarding ED.

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Eating disorders and psychosis: a review and case report

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.66.12.1736 ◽

2020 ◽

Vol 66 (12) ◽

pp. 1736-1741

Author(s):

Rita Almeida Leite ◽

Tiago Santos ◽

Patrícia Nunes ◽

Isabel Brandão

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Case Report ◽

Psychotic Disorders ◽

Family Background ◽

Clinical Status ◽

Psychotic Symptoms ◽

Mesh Terms ◽

Pubmed Database

SUMMARY INTRODUCTION: The interplay between eating disorders and psychosis is a challenging field to which little attention has been paid. Its study raises conceptual and methodological questions in both areas, making the diagnosis and management of patients difficult. Such questions are addressed and illustrated with a review and case report. METHODS: The authors present the case of a woman with Anorexia Nervosa and with comorbid Shared Psychotic Disorder, based on a literature review regarding the comorbidity between eating disorders and psychosis. The authors conducted a non-systematic review by searching the PubMed database, using the Mesh Terms “anorexia nervosa”, “bulimia nervosa”, “comorbidity” and “psychotic disorders”. RESULTS: The findings suggest that studies on the subject are limited by issues regarding data on the prevalence of comorbidities, phenomenological aspects of eating disorders, and the interface and integration with psychotic symptoms. CONCLUSIONS: The case presented illustrates the difficulties in managing a patient with a comorbid eating disorder and psychosis. In order to ensure a rigorous assessment of both psychotic and eating disorder symptoms, the focus should be on the pattern of appearance or emergence of symptoms, their phenomenology, clinical and family background of the patient, and clinical status on follow-up.

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Targeting maladaptive overcontrol with radically open dialectical behaviour therapy in a day programme for adolescents with restrictive eating disorders: an uncontrolled case series

Journal of Eating Disorders ◽

10.1186/s40337-020-00338-9 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Julian Baudinet ◽

Mima Simic ◽

Helena Griffiths ◽

Cecily Donnelly ◽

Catherine Stewart ◽

...

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Social Connectedness ◽

Case Series ◽

Self Report ◽

Behaviour Therapy ◽

Treatment Needs ◽

Dialectical Behaviour Therapy ◽

Restrictive Eating ◽

Eating Disorder Symptoms

Abstract Background Radically Open Dialectical Behaviour Therapy (RO-DBT) was developed to target maladaptive overcontrol, a proposed core difficulty of restrictive eating disorders. RO-DBT is now the main group treatment model at the Intensive day Treatment Programme (ITP), Maudsley Hospital. This ITP case series aimed to investigate whether overcontrol is associated with restrictive eating disorder symptoms in adolescents and to evaluate ITP outcomes since RO-DBT skills classes were introduced. Method Self-report measures of eating disorder symptoms and temperament, personality and social characteristics linked to overcontrol were collected at assessment and discharge from ITP for all consecutive adolescents who attended between February 2015 and January 2019 (N = 131). Weight change, global outcomes and treatment needs post-ITP were also recorded. Results Eating disorder symptoms at assessment were significantly correlated with overcontrol factors, including social connectedness (r = −.67), reward responsivity (r = −.54), and cognitive inflexibility (r = .52). Adolescents stayed in ITP on average 13.40 weeks. 70.8% had a Good-Intermediate outcome on Morgan-Russell scale. 4.6% did not respond and were referred to inpatient treatment from ITP. Significant improvements in drive for thinness (d = .33), depressive mood (d = .41), social connectedness (d = .48), and emotional expressiveness (d = .97) were reported at discharge. No changes were observed in perfectionism or negative temperament. Conclusions This study offers preliminary evidence that eating disorder symptoms are associated with overcontrol factors in adolescence and that they can improve with RO-DBT informed day programme treatment. RO-DBT is a promising treatment that offers a new way of conceptualising treatment targets and recovery for adolescent restrictive eating disorders.

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Adolescents newly diagnosed with eating disorders have structural differences in brain regions linked with eating disorder symptoms

Nordic Journal of Psychiatry ◽

10.1080/08039488.2016.1250948 ◽

2016 ◽

Vol 71 (3) ◽

pp. 188-196 ◽

Cited By ~ 5

Author(s):

Linda Solstrand Dahlberg ◽

Lyle Wiemerslage ◽

Ingemar Swenne ◽

Anna Larsen ◽

Julia Stark ◽

...

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Brain Regions ◽

Newly Diagnosed ◽

Eating Disorder Symptoms ◽

Structural Differences

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High-dose olanzapine in treatment resistant schizophrenia. A case report and literature review

BJPsych Open ◽

10.1192/bjo.2021.335 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S115-S115

Author(s):

Ciara Clarke ◽

Clodagh Rushe ◽

Fintan Byrne

Keyword(s):

Case Report ◽

Literature Review ◽

The Body ◽

Psychotic Symptoms ◽

High Dose ◽

Extensive Literature ◽

Treatment Resistant ◽

Persecutory Delusions ◽

Full Resolution ◽

One Year

ObjectiveWe report a case of a 58-year-old gentleman who was hospitalised intermittently for one year due to treatment resistant schizophrenia. Prior to hospitalisation he had been prescribed standard antipsychotics for decades without full resolution of positive psychotic symptoms. During his final admission lasting six months he was guarded, suspicious, irritable, constantly paced the corridor and displayed thought block and paranoid persecutory delusions. He would not enter the assessment room or allow any blood or ECG monitoring, however, he was compliant with oral medication. He was successfully treated with high dose olanzapine (40mg/day) and was discharged to the community. The aim of this study is to bring awareness and add to the body of evidence for the use of high-dose olanzapine in patients with treatment resistant schizophrenia in whom a trial of clozapine is not possible.Case reportThe patient gave written consent for this case report to be written and presented. An extensive literature review was performed and key papers were identified. Discussion focuses on the key areas in the literature.DiscussionThis case demonstrates that high-dose olanzapine can be used effectively as an alternative to clozapine in treatment resistant schizophrenia.ConclusionThis case highlights the need for further evaluation of high-dose olanzapine as an alternative to clozapine in patients with treatment-resistant schizophrenia.

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Perfectionism is associated with higher eating disorder symptoms and lower remission in children and adolescents diagnosed with eating disorders

Eating Behaviors ◽

10.1016/j.eatbeh.2018.05.008 ◽

2018 ◽

Vol 30 ◽

pp. 55-60 ◽

Cited By ~ 16

Author(s):

Jack Johnston ◽

Chloe Y. Shu ◽

Kimberley J. Hoiles ◽

Patrick J.F. Clarke ◽

Hunna J. Watson ◽

...

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Children And Adolescents ◽

Eating Disorder Symptoms

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Association Between Paranoia And Anorexia Nervosa In Adolescents: What Factors Are Involved?

10.21203/rs.2.24625/v1 ◽

2020 ◽

Author(s):

Gennaro Catone ◽

Filomena Salerno ◽

Giulia Muzzo ◽

Valentina Lanzara ◽

Antonella Gritti

Keyword(s):

Eating Disorders ◽

Body Image ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Social Anxiety ◽

Associated Factors ◽

Anxiety Symptoms ◽

Pediatric Care ◽

Eating Disorder Symptoms ◽

Body Image Concerns

Abstract Background: psychiatric comorbidities are of particular interest in Eating disorders. The association between anorexia nervosa and psychotic disorders is less studied than that with affective disorders (anxiety/depression). The aim of this study is to describe a psychotic symptom (paranoia) in adolescents with Eating Disorders looking at several potential explicative associated factors: eating disorder symptoms, body image concerns, depression and social anxiety. Our hypothesis is that paranoia in AN patients is more explained by the concomitant depression and social anxiety symptoms than core symptoms of the disease (eating disorder symptoms or body image concerns). Methods: this is a retrospective cross sectional study and consecutive, help-seeking adolescents admitted to the Eating Disorder service of the Integrated Pediatric Care Department, Luigi Vanvitelli University Hospital constituted the sample. Data was obtained trough retrospective collection of clinical interviews and self – report questionnaires administered by trained and expert child and adolescent psychiatrists. Results: We obtained data from 92 adolescents with Eating Disorders. Paranoia was dimensionally distributed in the sample (mean: 22,17 SD: 17,7; median 18 IQR: 7/36; range: 0-62). Our regression model explained that paranoia in this population was better explained by depression (coefficient= 0,415 SD: 0,210, p=0,052) and social anxiety symptoms (coefficient= 0,253 SD: 0,060; p<0,001) than eating disorder symptoms (coefficient= 0,092 SD: 0,107; p=0,398) and body image concerns (coefficient= 1,916 SD: 2,079; p=0,359) that did not retain their significance when all our predictive factors entered in the model. Conclusion: This study has some theoretical, clinical and treatment implications. It is important to carrying out screening for the presence of psychotic symptoms in patients with Eating Disorders. These symptoms and associated factors (depression and social anxiety) may complicate the clinical picture of the disease with the need, in certain cases, of psychopharmacological drugs and, among these, anti-psychotics. Finally in the psychotherapy context, paranoid idea may be subject of treatment for patient with EDs.

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What Kinds of Psychotherapy Help Eating Disorder Symptoms The Most?

Eating Disorders ◽

10.1093/wentk/9780190926595.003.0012 ◽

2020 ◽

Author(s):

B. Timothy Walsh ◽

Evelyn Attia ◽

Deborah R. Glasofer

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Theory And Practice ◽

Eating Disorder Symptoms

Although the landscape of helpful psychotherapies for eating disorders continues to evolve, several promising interventions are already available. They differ somewhat in theory and practice but share several features. First, these talk therapies focus on the present—on the here and now. They are more...

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Relationships Among Childhood Maltreatment, Limbic System Dysfunction, and Eating Disorders in College Women

Journal of Interpersonal Violence ◽

10.1177/0886260520912590 ◽

2020 ◽

pp. 088626052091259

Author(s):

Andrea E. Mercurio ◽

Fang Hong ◽

Carolyn Amir ◽

Amanda R. Tarullo ◽

Anna Samkavitz ◽

...

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

College Women ◽

Limbic System ◽

Indirect Effect ◽

Childhood Maltreatment ◽

Eating Pathology ◽

Convenience Sample ◽

Eating Disorder Symptoms

The mechanisms linking childhood maltreatment and eating pathology are not fully understood. We examined the mediating role of limbic system dysfunction in the relationships between three forms of childhood maltreatment (parental psychological maltreatment, parental physical maltreatment, and parental emotional neglect) and eating disorder symptoms. A convenience sample of college women ( N = 246, M age = 19.62, SD = 2.41) completed measures of maltreatment (Parent-Child Conflict Tactics Scales and the Parental Bonding Instrument), limbic system dysfunction (Limbic System Questionnaire), and eating pathology (Eating Disorder Examination Questionnaire). We hypothesized that there would be an indirect effect of each type of childhood maltreatment on eating disorder symptoms via limbic system irritability. Results generally supported the hypotheses. Examination of the individual paths that defined the indirect effect indicated that higher reported childhood maltreatment was associated with greater limbic irritability symptoms, and higher limbic irritability symptomatology was related to higher total eating disorder scores. There were no significant direct effects for any of the proposed models. Findings are in line with research supporting the role of limbic system dysfunction as a possible pathway in the maltreatment-eating disorder link. Given that limbic system dysfunction may underlie behavioral symptoms of eating disorders, efforts targeting limbic system dysfunction associated with child maltreatment might best be undertaken at an early developmental stage, although interventions for college women struggling with eating disorders are also crucial.

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