RT Book, Section
A1 Stoner, Steven C.
A1 Ruehter, Valerie L.
A1 Palmer, Melissa C.
A2 DiPiro, Joseph T.
A2 Yee, Gary C.
A2 Posey, L. Michael
A2 Haines, Stuart T.
A2 Nolin, Thomas D.
A2 Ellingrod, Vicki
SR Print(0)
ID 1182456813
T1 Eating Disorders
T2 Pharmacotherapy: A Pathophysiologic Approach, 11e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260116816
LK accesspharmacy.mhmedical.com/content.aspx?aid=1182456813
RD 2024/04/18
AB KEY  CONCEPTS  Historically,  the  categorization  of  eating  disorders  as  a  psychiatric  illness  has  faced  significant  scrutiny,  while  no  longer  the  case  the  treatments  of  these  disorders  continue  to  be  challenging  with  limited  evidence-based  medicine–supported  treatments.  Despite  strong  genetic  associations  for  the  development  of  eating  disorders  as  established  in  monozygotic  and  dizygotic  twin  studies,  a  clear  association  with  a  specific  genetic  linkage  or  mutation  has  not  been  identified.  Shifting  between  eating  disorder  diagnostic  categories  is  possible,  especially  when  symptom  remission  is  not  achieved  with  treatment.  Psychiatric  comorbidities  are  common  with  all  forms  of  eating  disorders,  and  the  differential  diagnosis  should  generally  include  evaluation  for  depression,  schizophrenia,  generalized  anxiety,  obsessive–compulsive  disorder  (OCD),  and  personality  disorders.  During  the  process  of  caloric  restoration,  calories  must  be  gradually  introduced  to  prevent  the  potentially  fatal  complication  known  as  refeeding  syndrome.  Failure  to  restore  calories  quickly  enough  may  result  in  an  unfeeding  syndrome.  Mortality  resulting  from  suicide  in  individuals  with  eating  disorders  is  not  uncommon,  and  clinicians  must  monitor  closely  for  suicidality  and  educate  appropriately  as  they  would  during  the  treatment  of  patients  with  major  depressive  disorder  taking  antidepressants.  The  current  preferred  treatment  approach  for  anorexia  nervosa  (AN)  includes  a  minimum  of  6  months  of  psychotherapy,  preferably  cognitive  behavioral  therapy  (CBT),  in  adults  and  family-based  therapy  in  children.  Despite  limited  data,  antidepressants  are  the  preferred  pharmacologic  intervention  for  the  acute  and  maintenance  phases  of  bulimia  nervosa  (BN)  in  combination  with  nonpharmacologic  treatments.  A  growing  body  of  evidence  supports  the  use  of  selective  serotonin  reuptake  inhibitors  (SSRIs)  for  the  treatment  of  binge-eating  disorder  (BED)  along  with  CBT  and  interpersonal  psychotherapy  (IPT).  Lisdexamfetamine  is  the  sole  FDA-approved  agent  for  BED  treatment.  There  is  growing  sentiment  that  severe  and  enduring  AN  exists  and  that  the  focus  should  be  on  the  impact  of  the  disorder  and  improving  quality  of  life  instead  of  on  treating  medical  symptoms.