Bulimia nervosa history

Bulimic patients usually have a history of numerous strict or fad diets, punctuated by recurrent episodes of binging and persistent overconcern with body shape and weight (511, 512). MDD, as well as alcohol and drug abuse, often coexist in bulimia nervosa patients. 

A 29-year-old woman with bulimia nervosa and a family history of anxiety was enrolled in a trial of... 

Of 279 patients who presented to a hospital emergency service between 1994 and 1998 with a first tonic-clonic seizure, 17 (6.1%) had seizures that were thought to be drug-related (5). The most common drug-induced causes were cocaine intoxication (6/17) and benzodiazepine withdrawal (5/17) followed by amfebutamone use (4/17). While one amfebutamone-associated seizure occurred in a 26-year-old woman without any other risk factors, the three other patients (all women) had additional risk factors, such as concomitant treatment with antidepressants that also lower seizure threshold and a history of bulimia nervosa. These results suggest that amfebutamone is not an infrequent cause of de novo seizures. However, because of the time frame of the study, many of the patients would have been taking standard-release amfebutamone. It would be of interest to repeat the study now that modified-release amfebutamone is available. 

A 29-year-old woman with bulimia nervosa and a family history of anxiety was enrolled in a trial of naltrexone (100 mg/day). She had no history of opioid use. Within hours of her first dose she experienced alarm, anxiety, chest discomfort, shortness of breath, a fear of dying, sweating, nausea, and derealization. She was unable to remain at home or to go out alone. For 3 days she continued to take naltrexone, with an increasing frequency of panic attacks. On day 4 she was treated with alprazolam (0.5 mg) but relapsed after further naltrexone. Withdrawal of naltrexone led to complete remission of symptoms. 

Fuentes JA, Lauzurica N, Hurtado A et al (2004) Analysis of the -1438 G/A polymorphism of the 5-HT2A serotonin receptor gene in bulimia nervosa patients with or without a history of anorexia nervosa. Psychiatr Genet 14 107-109... 

The occurrence of seizures with bupropion is dose related and may be increased by predisposing factors (e.g., history of head trauma or CNS tumor). At the ceiling dose (450 mg/day), the incidence of seizures is 0.4%. Other side effects include nausea, vomiting, tremor, insomnia, dry mouth, and skin reactions. It is contraindicated in patients with bulimia or anorexia nervosa. 

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