Anorexia nervosa presenting as a somatic delusional disorder responsive to pharmacotherapy.

A case of somatic delusional disorder with a severe secondary eating disorder is described. The patient's psychotic symptoms and emaciation were markedly improved with separate trials of antipsychotic and antiobsessional medications. Further epidemiologic studies of eating disorders with coexisting psychotic disorders are suggested. Classification of eating disorders to include a subset with psychotic or obsessional features (or both) may prove useful in future diagnoses. Pharmacotherapy may be a beneficial therapeutic modality in treating eating disorders with concurrent psychotic features.

High-dose naltrexone and liver function safety.

Studies have found naltrexone useful in the treatment of diseases other than opiate addiction in which endogenous opioids presumably play a role, such as alcoholism and eating disorders. Some of these studies involve high doses (100-200 mg bid). Because investigational studies with high doses (300 mg/day) reported clinically significant increases in liver enzyme levels, the authors measured a spectrum of liver function parameters in response to high doses of naltrexone in a double-blind, crossover trial (100 mg bid) followed by an open-label period (200 mg bid). They observed no adverse clinical or laboratory changes in liver function in association with high-dose naltrexone therapy in eating disorders.

Endogenous codeine and morphine in anorexia and bulimia nervosa.

The endogenous plasma alkaloids codeine and morphine were shown to be elevated in patients with anorexia nervosa and bulimia nervosa compared to control subjects. The role of these opioids in the pathophysiology of these eating disorders is discussed in relation to an auto-addiction opioid model. This model proposes that endogenous opioids are released during an initial period of dieting and reinforce a state of starvation dependence [1,2].

Naltrexone use in the treatment of anorexia nervosa and bulimia nervosa.

Our auto-addiction model suggests that opiate blockade may be therapeutically useful in anorexia nervosa and bulimia nervosa. Naltrexone was administered to out-patient subjects in double-blind clinical trials with randomized cross-over designs. Reduction in binge-purge symptomatology was evident in the naltrexone period over placebo for 18 out of 19 subjects with either bulimia or anorexia nervosa of the bulimic subtype. In every case, the decoding of drug or placebo double blinding confirmed the assessments of both the investigator and the subjects, based on the blind analysis of the data and on their therapeutic response, respectively. Statistical analysis done on the total population and two diagnostic subgroups found highly significant differences.

A detailed longitudinal analysis on the use of naltrexone in the treatment of bulimia.

In accord with our auto-addiction opioid model, naltrexone was previously reported to be effective in the treatment of bulimia in a controlled double-blind clinical trial with a randomized cross-over design. This is a detailed longitudinal analysis over a 16 month period of one subject from that study. Attenuation in bulimic symptoms in two-drug as compared to no-drug periods was demonstrated. The duration for which the drug was needed was also addressed. The subject is an illustration of a therapeutic response on multiple parameters including binges, purges, urges to perform both behaviors, eating patterns, scaled feelings and Eating Disorder Inventory questionnaire scores. A rare allergic reaction to the drug is reported. It appeared to be heat and photosensitive, even in the presence of sun screen, occurred after a delay and did not appear immediately on skin testing. Use of naltrexone after desensitization is also reported.

Binge eating disorder: response to naltrexone.

Binge eating disorder (BED) is characterized by a bulimic binge eating pattern without the compensatory behaviors of purging or laxative abuse. It is often associated with obesity. The treatment response characteristics are more like bulimia than other forms of obesity. We have shown the opiate antagonist naltrexone to attenuate bulimia nervosa in controlled clinical trials. We report here a response to naltrexone in a subject with BED similar to that previously reported for the larger population of bulimic subjects. Three consecutive periods of drug, placebo and double dose drug were used, with the order of the first two periods double blind until after the data analysis. Symptoms were reduced in the naltrexone compared to placebo period. Statistical significance was demonstrated using time series analysis for this 'n of one' study. Psychotherapy was carried out throughout all periods. Naltrexone plus psychotherapy may be more efficient than psychotherapy alone.

Genital herpes. A pervasive psychosocial disorder.

The reports of patients with genital herpes suggest that it is not an awesome physical disability; the more distressing consequences appear to be psychosocial. The symbolic meaning of the disease and its effects on self-esteem and body image have the greatest destructive impact. Patients move through a sequence of adaptational responses remarkably similar to those described for cancer. Of greatest importance is their growing sense of social isolation and their reluctance to initiate relationships with members of the opposite sex.

Tardive akathisia.

The unusual occurrence of akathisia as a persistent subjective sensation for a prolonged period in two patients following discontinuation of neuroleptic therapy is discussed. The association of akathisia with extrapyramidal dysfunction is questioned.