Olanzapine therapy in anorexia nervosa: psychobiological effects

Abstract

Dopamine impairments occur in anorexia nervosa. The aim of this study was to see whether treatment with the atypical dopamine antagonist antipsychotic olanzapine improves the disorder. Thirty anorexics, 18 restricted and 12 bingeing-purging, underwent a 3-month course of cognitive behavioral therapy, plus at random and double-blinded oral olanzapine (2.5 mg for 1 month, 5 mg for 2 months) in half and oral placebo in the other half of them. BMI, psychopathological aspects (eating disorder inventory, Hamilton Rating Scale, Buss-Durkee Rating Scale, Yale Brown Cornell for Eating Disorders Rating Scale, temperament-character inventory), and homovanillic acid blood concentrations for dopamine secretion, were monitored at baseline and then monthly during the trial. At the end of the trial BMI, total eating disorder inventory, total Yale Brown Cornell for Eating Disorders Rating Scale, Buss-Durkee Rating Scale, Hamilton Rating Scale scores and in olanzapine-treated patients the subitems of eating disorder inventory ineffectiveness and maturity fear, of Buss-Durkee Rating Scale direct aggressiveness, of temperament-characteristic inventory persistence had improved significantly. When stratified for anorexia nervosa subtype, BMI changes were significant among anorexia nervosa bingeing-purging patient, 'depression' (Hamilton Rating Scale) and 'direct aggressiveness' (Buss-Durkee Rating Scale) among anorexia nervosa bingeing-purging patients, 'persistence' (temprerament-characteristic inventory), among anorexics restricted patients, with a trend toward significance for obsessivity-compulsivity (Yale Brown Cornell for Eating Disorders Rating Scale). homovanilic acid blood levels increased significantly in the cognitive behavioral therapy+olanzapine group. No correlations were observed between homovanilic acid concentrations and psychopathological parameters. The pharmacological treatment can significantly improve specific aspects of anorexia nervosa.

Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings

“…A small number of double-blind trials have evaluated the effects of antipsychotics, with essentially non-significant effects [345-347]. …”

Catechol-O-methyltransferase genotype modifies executive functioning and prefrontal functional connectivity in women with anorexia nervosa

“…S1) was unexpected and, although based on only 4 patients, needs to be replicated. In addition, observations from the field of schizophrenia research 42 indicate that treatment with atypical antipsychotics 43 may have different indications or doses in different COMT genotype groups.…”

Anorexia nervosa, Bulimia nervosa und andere Essstörungen bei Kindern und Jugendlichen

“…Studien zeigen, dass die antidepressive sowie zwangsmindernde und anxiolytische Wirkung der SSRI bei Untergewicht nicht nachgewiesen werden kann [78], so dass auch komorbide Störungen und Begleiterscheinungen im akuten Stadium nur bedingt pharmakologisch behandelt werden können. Einzelfallstudien zeigen eine g ewisse Wirksamkeit von Olanzapin zur Angstreduktion und Gewichtsrestitution [79,80], wobei kontrollierte Studien keine Wirksamkeit in Bezug auf Gewichtsnormalisierung zeigen konnten [81]. Vorsicht ist geboten bei der Interpretation der Resultate pharmakologischer Studien bei A norexia nervosa, da in einer Analyse von Norris et al [82] nur 26% der für Medikamentenstudien angefragten Patientinnen in die Teilnahme an einer kontrollierten Studie einwilligten.…”