The purpose of this article is to review the psychopharmacology treatment literature for patients with eating disorders including bulimia nervosa, anorexia nervosa and binge eating disorder. The best-developed treatment literature concerns bulimia nervosa, which has been studied now in several dozen pharmacological treatment studies. The agents most commonly used are the antidepressants, with particular focus on the selective serotonin reuptake inhibitors including fluoxetine hydrochloride. These agents clearly impact significantly on the frequency of abnormal eating behaviors such as binge eating and purging. However, subjects treated with these drugs rarely achieve remission. Pharmacotherapy of anorexia nervosa has also traditionally focused on the use of antidepressants and there is some evidence that the use of SSRIs may help in preventing relapse in weight restored patients. Recently interest has developed in the use of atypical neuroleptics to help with the obsessionality and resistance to treatment frequently seen in low weight patients, the most commonly employed agent being olanzapine. Pharmacotherapy of binge-eating disorder is now being intensively investigated. In general medication alone seems inferior to psychotherapy in the short term. Antidepressants can increase the amount of weight loss when combined with psychological treatment and also appear to benefit symptoms such as depression. Further data are needed, but a number of drugs appear promising.

Binge Eating Disorder (BED) and Obesity In 1997, binge eating disorder (BED) was included into the DSM-IV as a provisional diagnostic category requiring further study. About 30% of the participants in weight loss programs meet criteria for BED. The prevalence of BED in the general population is 2%; BED is 1.5 times more common in women than men. In treating obese patients with BED there are several potential goals of treatment, including cessation of binge eating and improvement of eating-related psychopathology (e.g. concerns about weight and shape, restraint eating), weight loss or prevention of further weight gain, improvement of physical health, and reduction of psychiatric comorbidity. Contrary to expectations, weight loss programs do not appear to worsen the eating disorder, and successful treatment of binge eating does not automatically promote weight loss. Controlled treatment studies have shown that psychotherapeutic approaches and drug treatment may successfully reduce binge eating episodes in patients with BED. Remission rates are generally high (e.g. 50% and more following cognitive behavioral therapy), and the overall prognosis is better than for patients with bulimia nervosa. Patients who achieve complete abstinence from binge eating lose more weight compared to patients who remain symptomatic.

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By using high-speed cineradiography it is possible to make a detailed description of the swallowing function after extensive surgical treatment of pharyngeal and oral cavity cancer. We think that high-speed cineradiography is a very sensitive diagnostic procedure capable of detecting all functional aspects of swallowing. High-speed cineradiography should be one of the standard diagnostic studies performed surgery of the oral cavity and pharynx.

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