Bulimia nervosa binge eating

Characteristic Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder... 

Anorexia nervosa, bulimia nervosa, binge-eating disorder... 

Sertraline In a small open study, five patients with bulimia nervosa binged less after being prescribed sertraline (Sloan et al. 2004). In a randomised, placebo-controlled trial of sertraline 100 mg daily for 12 weeks, the patients treated with sertraline had a statistically significant reduction in the number of binge eating crises and purging compared with those who received placebo (Milano et al. 2004). No patients withdrew from the trial because of side effects. 

Millions of people in the United States are affected by eating disorders. More than 90% of those afflicted are adolescents or young adult women. Although all eating disorders share some common manifestations, anorexia nervosa, bulimia nervosa, and binge eating each have distinctive symptoms and risks. 

Bulik, C.M., Sullivan, P.F., and Kendler, K.S. (1998) Heritability and reliability of binge-eating and bulimia nervosa. Biol Psychiatry 44 1210-1218. 

Burnet, P.W., Smith, K.A., Cowen, P.J., Fairburn, C.G., and Harrison, P.J. (1999) Allelic variation of the 5-HT2C receptor (HTR2C) in bulimia nervosa and binge eating disorder. Psychiatr Genet, 9 101-104. 

Although these disorders are more common in adolescent girls or young women, 5% to 15% of anorexia nervosa and bulimia nervosa and approximately 40% of binge-eating disorders occur in boys and men (498). 

Flutamide causes hepatotoxicity in some 0.36% of patients, and for this reason alone it should not be used in the absence of a serious indication. Whether bulimia nervosa in women justifies its use is open to doubt, since non-pharmacological methods of treatment are available. Furthermore, bulimia nervosa in women can be associated with raised serum testosterone concentrations. In a small double-blind study of the use of flutamide, citalo-pram, a combination of the two, or placebo in 31 women over 3 months, all the active treatments reduced the tendency to binge eating (47). However, there was a moderate and reversible increase in serum transaminase activities, leading to withdrawal in two of the 19 subjects who were taking flutamide either alone or in combination. 

Adults with bulimia nervosa may be offered a trial with an antidepressant drug. Patients should be informed that antidepressant drugs can reduce the frequency of binge eating and purging. Selective serotonin reuptake inhibitors (SSRIs), and specifically fluoxetine, are the drugs of first choice for the treatment of bulimia... 

The antidepressant drug fluoxetine Prozac), another compound which promotes serotonergic neurotransmission in the brain, was also shown to reduce appetite and food intake in healthy volunteers (McGuirk and Sil-verstone 1990). It can be effective in the management of binge eating syndrome (see Chapter 6) and bulimia nervosa (see Chapter 5). Its use in uncomplicated obesity is more limited, as any beneficial effect wears off within a few months (Goldstein et al. 1994). 

Although bulimia nervosa was originally described as a variant of anorexia nervosa, the two conditions are classified separately in DSM IV. The distinction between anorexia nervosa of the binge-eating/purging type and bulimia nervosa is based almost exclusively on the patient s body... 

Franklin 1948). Of particular clinical relevance to the pathogenesis of binge eating was the observation that, after all restrictions on food intake had been lifted and the subjects weight had returned to baseline, these previously normal eaters would gorge themselves in the presence of attractive foods. Like patients with bulimia nervosa, at such times they reported that their eating was out of control . 

Methylphenidate Stimulants, such as methylphenidate and amphetamine, are widely used in the management of attention deficit hyperactivity disorder (ADHD). Such drugs have long been known to reduce hunger, but have not been generally recommended for treatment of BN. A few patients who have symptoms of bulimia nervosa plus some co-morbid features of ADHD have noted that the addition of methylphenidate or amphetamine markedly reduced the frequency of binge eating (Drimmer 2003). 

Monteleone, P., V. Martiadis, M. Labrazzo, C. Serritella and M. Maj (2003). Ghrelin and leptin responses to food ingestion in bulimia nervosa implications for binge-eating and compensatory behaviours. Psychol Med 33(8) 1387-94. 

AN anorexia nervosa BE binge eating BMI body mass index BN bulimia nervosa DA dopamine ... 

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