A case of anorexia nervosa responding well to paliperidone palmitate

Çıtak S.

8th International Congress on Psychopharmacology & 6th International Symposium on Child and Adolescent Psychopharmacology, Antalya, Turkey, 20 - 24 April 2016, vol.2016, no.26, pp.499

  • Publication Type: Conference Paper / Summary Text
  • Volume: 2016
  • City: Antalya
  • Country: Turkey
  • Page Numbers: pp.499


Anorexia Nervosa (AN) is defined as the maintenance of body weight significantly less than expected, characteristic psychopathology including fear of weight gain and disturbance in the experience of body shape and weight. It’s a chronic disease with a lifetime prevalence of about 0.48–0.6% and long-term relapse rates up to 50%. It has the highest mortality rate of any psychiatric disorder. Current management of severe AN typically involves a multi-disciplinary approach combining refeeding, psychoeducation, cognitive behavioral therapy and family interventions. At present, pharmacotherapy with antipsychotics is not recommended according to treatment guidelines and psychotherapeutic treatment approaches appear to be more promising. However, the number of prescriptions of second generation antipsychotic drugs (SGAs) to anorectic patients has substantially increased over the last years. Unfortunately, treatment is often unsuccessful, with a 40% dropout rate from intensive programs, and only 23% of patients achieving a good outcome at one year. Case: A 45 year-old, female patient, divorced, has one child, lives with her mother, father, brother and daughter. Nearly 1 year ago, she presented to our outpatient department with the complaints of aggression, food refusal and vomiting, she was diagnosed as Anorexia Nervosa with comorbid anxiety. Mirtazapine 15 mg/daily was prescribed and consulted to internal medicine department for medical complications In disease history; at the age of 21, she had feelings of discomfort due to 93 kg of weight (BMI: 43) and began heavy exercise programs, low calorie diets and self-induced vomiting. By the years; she lost weights up to 30 kg (BMI: 13). She had amenorrhea, dental carries, hair loss, constipation, repetitive headaches and dizziness, but she still had thoughts about her overweight. She persisted on frequent eating and spontaneous vomiting attacks. She missed next check-up and was supposed as drop-out, but after 6 months she presented again due to demands of her family. She complained about irritability, social withdrawal, sleeplessness, frequent eating and spontaneous vomiting. In psychiatric evaluation, it was noticed that she got predominant negative psychotic symptoms and reference ideas. She was diagnosed as Anorexia Nervosa; binge-eating type with extreme severity and comorbid atypical psychosis. She refused inpatient psychiatric treatment and we asked for general medical consultation. She was prescribed paliperidone palmitate 50 mg/ monthly/ IM injection, supported socially and motivationally. The response to treatment was satisfactory. In couple of weeks, vomiting stopped and she began to gain weight, psychotic symptoms decreased. After 6 months of follow up,her weight was 60 kg and she told that ‘’I regained the hope of life’’. She is still in complete remission and continuing her treatment. Atypical antipsychotics appear safe and there is some evidence of positive effects on depression, anxiety and core eating disordered psychopathology in patients with anorexia nervosa. The most studied drugs were olanzapine, quetiapine and risperidone. In literature, there is no studies about paliperidone, main opinion about SGAs in AN treatment is negative. So this case is point of rising expectancy about AN treatment. Keywords: anorexia nervosa, psychosis, atypical antipsychotics, paliperidone