Bulimia nervosa, a mental illness 4 times more common than anorexia nervosa, is characterized by binge-eating followed by compensatory purging behaviors, which include self-induced vomiting, diuretic abuse, laxative abuse, and misuse of insulin. Patients with bulimia nervosa are at risk of developing medical complications that affect all body systems, especially the renal and electrolyte systems. Behavior cessation can reverse some, but not all, medical complications. KEY POINTSMost people with bulimia nervosa are young and of normal weight, or even overweight, making detection and diagnosis diffi cult.As a consequence of purging behaviors, pseudo-Bartter syndrome can develop due to chronic dehydration, placing patients at risk for electrolyte abnormalities such as hypokalemia, as well as marked and rapid edema formation when purging is interrupted.Electrolyte and metabolic disturbances are the most common causes of morbidity and mortality in patients with bulimia nervosa. Hypokalemia should be managed aggressively to prevent electrocardiographic changes and arrhythmias such as torsades de pointes.Diabetic patients who purge calories through manipulation of their blood glucose are at high risk for hyperglycemia, ketoacidosis, and premature microvascular complications.Gastrointestinal complaints are common and include gastroesophageal refl ux disease.

Paliperidone extended release (ER) is the most recent atypical antipsychotic to become available for the treatment of schizophrenia. It has a unique extended-release delivery system, allowing once/day dosing with steady plasma concentrations of the medication. Several randomized, double-blinded, placebo-controlled trials have shown paliperidone ER to be efficacious in the management of acute schizophrenia as well as for the prevention of symptom recurrence when compared with placebo. Patients in the treatment groups receiving daily doses ranging from 3 to 12 mg displayed generalized symptom improvement using the Positive and Negative Syndrome Scale (PANSS) and improved functioning on the Personal and Social Performance Scale. Paliperidone ER has been shown to be generally safe and tolerable. At its recommended dose of 6 mg daily, the reported extrapyramidal symptom adverse events are similar to placebo, and weight gain is very modest. However, at higher doses, weight gain and extrapyramidal symptoms are more elevated. Paliperidone ER has the potential to offer advantages over its parent compound and other second generation agents, and may aid in ensuring compliance among persons with schizophrenia. At present, there are no published data from a comparative trial with paliperidone ER versus its parent compound or other second-generation antipsychotic agents.