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Expert Opinion on Drug Safety Jan 2018Eating disorders represent a set of psychiatric illnesses with lifelong complications and high relapse rates. Individuals with eating disorders are often stigmatized and... (Review)
Review
INTRODUCTION
Eating disorders represent a set of psychiatric illnesses with lifelong complications and high relapse rates. Individuals with eating disorders are often stigmatized and clinicians have a limited set of treatments options. Pharmacotherapy has the potential to improve long term compliance and patient commitment to treatment for eating disorders.
AREAS COVERED
This review will examine the efficacy and safety profile of the FDA-approved medications for the treatment of bulimia nervosa (BN) and binge eating disorder (BED). This will include the evaluation of fluoxetine for BN, and lisdexamfetamine for BED. Safety information will be review from randomized control trials (RCT), open label trials, and case reports.
EXPERT OPINION
Fluoxetine for BN and lisdexamfetamine for BED are relatively safe and well-tolerated. Despite these properties, these two medications represent a limited arsenal for the pharmacological treatment of eating disorders. Thus, more research-based strategies are needed to develop safe, effective, and more targeted therapies for eating disorders.
Topics: Binge-Eating Disorder; Bulimia Nervosa; Fluoxetine; Humans; Lisdexamfetamine Dimesylate; Medication Adherence; Randomized Controlled Trials as Topic
PubMed: 29053927
DOI: 10.1080/14740338.2018.1395854 -
The Cochrane Database of Systematic... Oct 2009A specific manual-based form of cognitive behavioural therapy (CBT) has been developed for the treatment of bulimia nervosa (CBT-BN) and other common related syndromes... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A specific manual-based form of cognitive behavioural therapy (CBT) has been developed for the treatment of bulimia nervosa (CBT-BN) and other common related syndromes such as binge eating disorder. Other psychotherapies and modifications of CBT are also used.
OBJECTIVES
To evaluate the efficacy of CBT, CBT-BN and other psychotherapies in the treatment of adults with bulimia nervosa or related syndromes of recurrent binge eating.
SEARCH STRATEGY
Handsearch of The International Journal of Eating Disorders since first issue; database searches of MEDLINE, EXTRAMED, EMBASE, PsycInfo, CURRENT CONTENTS, LILACS, SCISEARCH, CENTRAL and the The Cochrane Collaboration Depression, Anxiety & Neurosis Controlled Trials Register; citation list searching and personal approaches to authors were used. Search date June 2007.
SELECTION CRITERIA
Randomised controlled trials of psychotherapy for adults with bulimia nervosa, binge eating disorder and/or eating disorder not otherwise specified (EDNOS) of a bulimic type which applied a standardised outcome methodology and had less than 50% drop-out rate.
DATA COLLECTION AND ANALYSIS
Data were analysed using the Review Manager software program. Relative risks were calculated for binary outcome data. Standardised mean differences were calculated for continuous variable outcome data. A random effects model was applied.
MAIN RESULTS
48 studies (n = 3054 participants) were included. The review supported the efficacy of CBT and particularly CBT-BN in the treatment of people with bulimia nervosa and also (but less strongly due to the small number of trials) related eating disorder syndromes.Other psychotherapies were also efficacious, particularly interpersonal psychotherapy in the longer-term. Self-help approaches that used highly structured CBT treatment manuals were promising. Exposure and Response Prevention did not enhance the efficacy of CBT.Psychotherapy alone is unlikely to reduce or change body weight in people with bulimia nervosa or similar eating disorders.
AUTHORS' CONCLUSIONS
There is a small body of evidence for the efficacy of CBT in bulimia nervosa and similar syndromes, but the quality of trials is very variable and sample sizes are often small. More and larger trials are needed, particularly for binge eating disorder and other EDNOS syndromes. There is a need to develop more efficacious therapies for those with both a weight and an eating disorder.
Topics: Adult; Binge-Eating Disorder; Bulimia Nervosa; Cognitive Behavioral Therapy; Female; Humans; Male; Psychotherapy; Randomized Controlled Trials as Topic
PubMed: 19821271
DOI: 10.1002/14651858.CD000562.pub3 -
Psychological Medicine Jan 2021Anorexia nervosa and bulimia nervosa are two severe eating disorders associated with high premature mortality, suicidal risk and serious medical complications....
BACKGROUND
Anorexia nervosa and bulimia nervosa are two severe eating disorders associated with high premature mortality, suicidal risk and serious medical complications. Transition between anorexia nervosa and bulimia nervosa over the illness course and familial co-aggregation of the two eating disorders imply aetiological overlap. However, genetic and environmental liabilities to the overlap are poorly understood. Quantitative genetic research using clinical diagnosis is needed.
METHODS
We acquired a clinical diagnosis of anorexia nervosa (prevalence = 0.90%) and bulimia nervosa (prevalence = 0.48%) in a large population-based sample (N = 782 938) of randomly selected full-sisters and maternal half-sisters born in Sweden between 1970 and 2005. Structural equation modelling was applied to quantify heritability of clinically diagnosed anorexia nervosa and bulimia nervosa and the contributions of genetic and environmental effects on their overlap.
RESULTS
The heritability of clinically diagnosed anorexia nervosa and bulimia nervosa was estimated at 43% [95% confidence interval (CI) (36-50%)] and 41% (31-52%), respectively, in the study population, with the remaining variance explained by variance in unique environmental effects. We found statistically significant genetic [0.66, 95% CI (0.49-0.82)] and unique environmental correlations [0.55 (0.43-0.66)] between the two clinically diagnosed eating disorders; and their overlap was about equally explained by genetic and unique environmental effects [co-heritability 47% (35-58%)].
CONCLUSIONS
Our study supports shared mechanisms for anorexia nervosa and bulimia nervosa and extends the literature from self-reported behavioural measures to clinical diagnosis. The findings encourage future molecular genetic research on both eating disorders and emphasize clinical vigilance for symptom fluctuation between them.
Topics: Adolescent; Adult; Anorexia Nervosa; Bulimia Nervosa; Child; Environment; Female; Humans; Registries; Risk Factors; Siblings; Sweden; Young Adult
PubMed: 31658910
DOI: 10.1017/S0033291719002976 -
Trends in Molecular Medicine Apr 2024Eating disorders (EDs) are common mental health conditions that carry exceedingly high morbidity and mortality rates. Evidence-based treatment options include a range of... (Review)
Review
Eating disorders (EDs) are common mental health conditions that carry exceedingly high morbidity and mortality rates. Evidence-based treatment options include a range of psychotherapies and some, mainly adjunctive, pharmacological interventions. However, around 20-30% of people fail to respond to the best available treatments and develop a persistent treatment-refractory illness. Novel treatments for these disorders are emerging, but their efficacy and clinical relevance need further investigation. In this review article, we first outline the evidence-base for the established treatments of the three 'classical' EDs [anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)]. We then review research on some of the most promising emerging treatment modalities, discussing the questions and challenges that remain.
Topics: Humans; Feeding and Eating Disorders; Bulimia Nervosa; Binge-Eating Disorder; Psychotherapy
PubMed: 38503683
DOI: 10.1016/j.molmed.2024.02.009 -
The International Journal of Eating... Jun 2019Food insecurity occurs when access to food is limited by financial hardship. Yet, paradoxically, food insecurity is associated with overeating, with emerging evidence...
BACKGROUND
Food insecurity occurs when access to food is limited by financial hardship. Yet, paradoxically, food insecurity is associated with overeating, with emerging evidence that it may be related to disordered eating. A recent report found that food insecurity was associated with binge-eating disorder (BED), but it is not yet known whether food insecurity is also associated with bulimia nervosa (BN).
METHODS
Participants were 873 respondents recruited online who completed a battery of established measures and were categorized into three study groups: healthy-weight (HW), BED, and BN. Hierarchical logistic regressions evaluated the extent to which low and very low food security were associated with BN compared with HW and BED study groups.
RESULTS
Low and very low food security were both associated with increased likelihood of BN group membership compared with HW but not BED.
CONCLUSIONS
Our findings suggest that food insecurity is associated with BN and also suggest that food insecurity's association with BN is similar to that for BED. These findings highlight the need for greater clinical and research attention to associations between food insecurity and eating disorders that include binge eating to inform eating-disorder prevention and treatment.
Topics: Adult; Bulimia Nervosa; Female; Food Supply; Humans; Male; United States
PubMed: 30920683
DOI: 10.1002/eat.23074 -
Clinical Therapeutics Jan 2021Bulimia nervosa (BN) is an eating disorder characterized by binge eating, inappropriate compensatory behaviors, and body image concerns in persons at or above a healthy... (Review)
Review
PURPOSE
Bulimia nervosa (BN) is an eating disorder characterized by binge eating, inappropriate compensatory behaviors, and body image concerns in persons at or above a healthy weight. BN is a serious disorder with medical sequelae and marked psychosocial impairment. To reduce and eliminate symptoms of BN, psychological and pharmacologic treatments for BN have been developed. We review the current state-of-the-art treatments for BN.
METHODS
We conducted a narrative review of the BN treatment literature to synthesize the current evidence base, provide recommendations, and propose future directions for BN treatment research.
FINDINGS
Currently, the first-line, state-of-the-art treatment for adults with BN is cognitive-behavioral therapy (CBT). Interpersonal therapy is a second-line evidence-based treatment for adults with BN, and dialectical behavior therapy and integrative cognitive-affective therapy are also promising. For BN in adolescents, family-based treatment for BN or CBT are evidence-based approaches. Pharmacotherapy is best considered adjunctive to psychotherapy in adults with BN but may be helpful, depending on the type of psychotherapy and whether psychotherapy is ineffective or unavailable. Fluoxetine 60 mg/d is the medication of choice for adults with BN. Little is known with respect to pharmacologic treatment of BN in adolescents, although fluoxetine 60 mg/d holds promise.
IMPLICATIONS
Despite decades of treatment-development research in BN, there is room for improvement because nearly 60% of those with BN do not achieve remission with specialty treatment and strikingly few randomized controlled trials for BN in adolescents exist. Moreover, the field should address issues related to treatment dissemination, access, and cost.
Topics: Bulimia Nervosa; Humans; Psychotherapy
PubMed: 33358256
DOI: 10.1016/j.clinthera.2020.10.012 -
Neuroscience Jun 2012Feeding is a fundamental process for basic survival and is influenced by genetics and environmental stressors. Recent advances in our understanding of behavioral... (Review)
Review
Feeding is a fundamental process for basic survival and is influenced by genetics and environmental stressors. Recent advances in our understanding of behavioral genetics have provided a profound insight on several components regulating eating patterns. However, our understanding of eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating, is still poor. The animal model is an essential tool in the investigation of eating behaviors and their pathological forms, yet development of an appropriate animal model for eating disorders still remains challenging due to our limited knowledge and some of the more ambiguous clinical diagnostic measures. Therefore, this review will serve to focus on the basic clinical features of eating disorders and the current advances in animal models of eating disorders.
Topics: Animals; Anorexia Nervosa; Binge-Eating Disorder; Bulimia Nervosa; Disease Models, Animal; Humans
PubMed: 22465439
DOI: 10.1016/j.neuroscience.2012.03.024 -
Journal of Psychiatry & Neuroscience :... Nov 2000Pharmacotherapy for anorexia nervosa is considered to be of limited efficacy. However, many studies suffer methodological limitations, and the utility of newer drugs in... (Review)
Review
Pharmacotherapy for anorexia nervosa is considered to be of limited efficacy. However, many studies suffer methodological limitations, and the utility of newer drugs in the treatment of anorexia has not been examined yet. Although there have been more fruitful investigations on the efficacy of medication in the management of bulimia nervosa, there are still many unresolved issues regarding the optimal management of partial remission during the acute treatment phase and the intensity and duration of pharmacotherapy to achieve optimal prophylaxis. Selective serotonin reuptake inhibitors (SSRIs) control the binge urges in binge-eating disorder, but more trials are required to investigate the utility of SSRIs and other agents in maintenance treatment. We review the current status of psychopharmacotherapy for anorexia nervosa, bulimia nervosa and binge-eating disorder and evaluate the merits of newer agents in the treatment of these disorders.
Topics: Affect; Anorexia Nervosa; Anti-Anxiety Agents; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Bulimia Nervosa; Humans; Psychotropic Drugs; Selective Serotonin Reuptake Inhibitors
PubMed: 11109300
DOI: No ID Found -
Journal of Psychiatric Research Nov 2017The objective of our study was to examine the neurobiological support for an interoceptive sensory processing model of bulimia nervosa (BN). To do so, we conducted a... (Review)
Review
The objective of our study was to examine the neurobiological support for an interoceptive sensory processing model of bulimia nervosa (BN). To do so, we conducted a systematic review of interoceptive sensory processing in BN, using the PRISMA guidelines. We searched PsychInfo, Pubmed, and Web of Knowledge databases to identify biological and behavioral studies that examine interoceptive detection in BN. After screening 390 articles for inclusion and conducting a quality assessment of articles that met inclusion criteria, we reviewed 41 articles. We found that global interoceptive sensory processing deficits may be present in BN. Specifically there is evidence of abnormal brain function, structure and connectivity in the interoceptive neural network, in addition to gastric and pain processing disturbances. These results suggest that there may be a neurobiological basis for global interoceptive sensory processing deficits in BN that remain after recovery. Data from taste and heart beat detection studies were inconclusive; some studies suggest interoceptive disturbances in these sensory domains. Discrepancies in findings appear to be due to methodological differences. In conclusion, interoceptive sensory processing deficits may directly contribute to and explain a variety of symptoms present in those with BN. Further examination of interoceptive sensory processing deficits could inform the development of treatments for those with BN.
Topics: Bulimia Nervosa; Humans; Interoception; Models, Theoretical
PubMed: 28651098
DOI: 10.1016/j.jpsychires.2017.06.009 -
Biological Psychiatry. Cognitive... Dec 2019Bulimia nervosa (BN) is associated with functional abnormalities in frontostriatal and frontolimbic circuits. Although structural alterations in the frontal portions of...
BACKGROUND
Bulimia nervosa (BN) is associated with functional abnormalities in frontostriatal and frontolimbic circuits. Although structural alterations in the frontal portions of these circuits have been observed, this is the first study of subcortical surface morphometry and the largest study of subcortical volume in BN.
METHODS
Anatomical magnetic resonance scans were acquired from 62 female participants with full and subthreshold BN (mean age ± SD, 18.7 ± 4.0 years) and 65 group-matched healthy control participants (mean age ± SD, 19.3 ± 5.7 years). General linear models were used to compare groups and assess the significance of group-by-age interactions on the shape and total volume of 15 subcortical structures (p < .05, familywise error corrected). Associations with illness severity and duration were assessed in the BN group.
RESULTS
Subcortical volumes did not differ across groups, but vertexwise analyses revealed inward shape deformations on the anterior surface of the pallidum in BN relative to control participants that were associated with binge-eating frequency and illness duration. Inward deformations on the ventrolateral thalamus and dorsal amygdala were more pronounced with advancing age in the BN group, and inward deformations on the caudate, putamen, and amygdala were associated with self-induced vomiting frequency.
CONCLUSIONS
Our findings point to localized deformations on the surface of subcortical structures in areas that comprise both reward and cognitive control circuits. These deformations were more pronounced among older BN participants and among those with the most severe symptoms. Such precise localization of alterations in subcortical morphometry may ultimately aid in efforts to identify markers of risk and BN persistence.
Topics: Adolescent; Adult; Amygdala; Basal Ganglia; Binge-Eating Disorder; Bulimia Nervosa; Female; Humans; Magnetic Resonance Imaging; Thalamus; Young Adult
PubMed: 30846367
DOI: 10.1016/j.bpsc.2018.12.011