Reply to The Effects of Newer Antidepressants on Low-Density Lipoprotein Cholesterol Levels

Abstract

Sir: There are many reasons why people with schizophrenia may have problems with food and weight. However, few empirical studies have examined the potential comorbidity between eating disorders and schizophrenia. Recent advances in the pharmacotherapy of schizophrenia have altered the side effect profiles of patients taking the newer generation of atypical antipsychotic drugs compared with older, conventional drugs. The older concerns with motor side effects have been replaced by problems even more relevant than before with overeating, obesity, and type 2 diabetes mellitus and its associated complications.1 Considering that overeating and obesity can be the features of eating disorders, knowledge of an association between schizophrenia and these disorders can lead to earlier identification of the comorbid conditions and prevention of other likely complications.Method. We evaluated a sample of 31 outpatients (25 men with a mean ± SD age of 34.8 ± 9.2 years and 6 women with a mean ± SD age of 41.1 ± 10.1 years) after obtaining informed consent and institutional review board approval. All were diagnosed as having schizophrenia by experienced clinicians using the Structured Clinical Interview for DSM-IV.2 Each of these subjects was administered the semistructured Binge Eating Clinical Interview (BEDCI) 3 to determine the presence or absence of binge-eating disorder. The diagnosis of bulimia nervosa was made by clinicians experienced in treating these conditions, again using the BEDCI. While we have suggested that the differentiation between binge-eating disorder and bulimia nervosa, nonpurging type (BN-NP), may be artificial, 4 for the purposes of this communication, we have relied on the existing classification system (DSM-IV). Additional assessment was performed with the Eating Disorders Inventory (EDI).5 Data were gathered from September through December 2001.Results. Most patients (71%; N = 22) were overweight as defined by a body mass index (BMI) of > 25. Sixty-two percent (N = 19) were obese as defined by a BMI of > 27. Five of the obese subjects (all males), representing 16% of the sample, were diagnosed with binge-eating disorder or BN-NP. Three of these patients developed binge eating after the onset of treatment with atypical antipsychotics. Specific items on the BEDCI and the EDI reflected the subjects' attitudes toward eating and weight. All 5 patients with binge-eating disorder/BN-NP and 5 other patients (32% of the entire sample) had scores indicating that weight and shape affected their self-esteem. The patients with binge-eating disorder displayed low drive for thinness and body dissatisfaction scores on the EDI, reflecting either an attitude of giving up on dieting and concerns with the body or never having been concerned with these issues; this attitude is not unusual for males.