Psychopharmacology of binge eating disorder

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I8-69-51 Neuroimaging Studies in Tardive Dyskinesia N. Andreasen, D. Miller, D. O'Leary, T. Cizadlo, S. Arndt. Dept of Psychiatry, The Univ of Iowa Hospital, Iowa City Iowa, U.S.A. Chronic receptor upregulation, potentially leading to receptor proliferation, is presumed to be the mechanism to tardive dyskinesia. Neuroimaging studies offer a potential tool for examining neural substrates of tardive dyskinesia, since they permit direct visualization of brain structure and function in vivo. Although some imaging studies of patients with TD have shown decrease size in the basal ganglia, recent studies using MR have also shown that treated patients suffering from schizophrenia may have enlargement of the basal ganglia. In addition, PET studies using both ftuorodeoxyglucose and 150 water have very recently been used to conduct within subject comparisons of these same patients on neuroleptic medications after medication withdrawal. These studies have consistently shown that patients have increased metabolic activity or cerebral blood flow in the basal ganglia while on medications. This observation may partially explain the finding of increased basal ganglial size in chronically medicated patients. It also provides indirect evidence for receptor overactivity or upregulation. More specific studies examining the effects of typical versus atypical neuroleptics on basal ganglia size (as measured by MR) and blood flow and metabolism (as measured by PET) are now needed.

15.70 I New Trends in the Psychopharmacology of Eating Disorders I

8-70-1 1 The Effects of Lithium and otherMood Stabilisers on BodyWeight in Bipolar Patients

Trevor Silverstone, Jane Elmslie. Departments of Psychological Medicine and Human Nutrition, University of Otago, Dunedin, New Zealand Weight gain is common among patients receiving long-term lithium (Li) prophylaxis of bipolar disorder. To examine whether such weight gain is due to increased food intake or reduced energy expenditure or both we undertook a detailed nutritional survey of 56 patients attending a specialised bipolar clinic. After the body mass index (BMI) and the waistJhip ratio were determined patients completed a 24-houT diet recall, an estimated 5-day diet record, the Stunkard and Messick three-factor eating questionnaire, and the 'Life in New Zealand' activity questionnaire. 35 (54%) were on Li (alone or in combination with another psychotropic drug). 20 were on carbamazepine (alone or in combination) and 15 on an antipsychotic drug. 13 (23%) of the total sample was obese (BMI > 30) with theprevalence being greater in those on a combination of drugs.The detailed findings will be discussed in the light of the detailed nutritional and activity data which we have collected, and compared to the normative values for New Zealand.

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8-70-21 Psychopharmacology of Binge Eating Disorder

5-70 New Trends in the Psychopharmacology of Eating Disorders substantial to dietary treatment and the treatment of obesity even in those with accompanying binge eating, although additional work in this regard is clearly indicated. Also it is unclear how drugs that impact on binge eating in BED may effect weight over time. Put simply - Do treatments that suppress binge-eating result in subsequent weight loss? This is still a largely unanswered question. Recently researchers have begun to investigate novel treatment strategies, such as using combinations of appetite suppressant drugs including phentermine with the SSRIs, or using narcotic antagonists to suppress binge eating in BED. The results of these studies will be reviewed and compared, and suggestions will be offered for further research in the area.

I8-70-31 Fluoxetine PlusNaltrexone in the Treatment of Bulimia Nervosa.

Alessandro Bandecchi. Neurosciences Institute Arezzo Italy At random we divided 94 outpatients fulfilling DSM III R criteria for Bulimia Nervosa into four groups. The preliminary assessment was performed by BITE. ED!, EAT 40, HAMO, Y BOeS, then entered the treatment in double blind conditions. The first group (18 patients) was treated by placebo (PBO). The second one (25) by Fluoxetine (FLX) 60 mg/day. The third (31) was treated by FLX (60 mg/day) plus Naltrexone (NTX) 150 mg/day. The fourth group (20) only by NIX (150 mg/day). After six months the percentage of those who had the BITE scale decreased at least by 50% was: PBO = 8%; FLX = 31%; FLX + NTX = 71%; only NTX = II %. No significant difference was between PBO and NTX groups, whereas it was highly significant (p 0.01) between FLX and PBO and moreover between FLX and FLX + NTX group (p 0.001). After one year the scoring of BITE Severity sub Scale (less than 50%) in each group was: PBO = 5%; FLX = 24%; FLX + NTX = 61%; NIX = 7%. Some psychopatological features of the binge eating could predict a better response to the combined treatment.

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8-70- 4 1 Fluoxetine and Intensive Nutritional Counselling in the Treatment of Bulimia Nervosa

P. Beumont, J. Russell, S. Touyz, G. Johnson. Dept Psychological Medicine, University of Sydney, Sydney, Australia Sixty-seven patients who fulfilled strict criteria for bulimia nervosa were treated with intensive nutritional counselling. The patients were assigned randomly to further treatment with either fluoxetine 60 mg/day or a placebo. After a one-week wash-out, active treatment was given over 8 weeks. This was followed by post-treatment interviews at 4 and at 12 weeks. Both groups of patients improved significantly during treatment. There were some suggestions that the fluoxetine group did slightly better. However, fluoxetine patients decreased their energy intake and lost weight. They went on to regain weight during the follow-up period, and showed a greater tendency to relapse. Our conclusions from the study were that nutritional counselling is an effective means of treating bulimia nervosa, with improvement maintained up to 3 months follow-up. The addition of fluoxetine may confer some benefit during active treatment, but may also contribute to a higher rate of relapse post-treatment. This study, of course, cannot be extrapolated to the efficacy of fluoxetine when used as the only form of treatment in patients for whom intensive counselling is not available.

James E. MitchelL University of Minnesota, Department of Psychiatry Several recent research studied have focused on the development of effective treatment strategies for binge eating disorder (BED). Much of this research interest has developed since the delineation of BED as a separate diagnostic entity although various pharmacological and other treatments have been tried previously for obesity, at times examining response in the subgroup who binge-eat. some of whom may have met criteria for BED. Studies thus far suggest that the treatments which have been shown to be effective for bulimia nervosa, including Cognitive Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT), tricyclic antidepressants such as desipramine and serotonin reuptake inhibitors such as fluvoxamine are also effective in suppressing binge eating behavior in individuals with binge eating disorder. It is less clear that pharmacotherapy adds anything

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8-70- 5 1 Pharmacotherapy and Psychotherapy in Bulimia Nervosa

D. Goldbloom, P. Garfinkel. Department of Psychiatry, University of Toronto and Clarke Institute of Psychiatry, Toronto, Ontario, Canada Cognitive behavioral therapies (CBT) and antidepressant medications have been found to produce symptom reduction, behavioral abstinence and attitudinal change in randomized controlled trials of bulimia nervosa (BN). The efficacy of the drugs is unrelated to intuitively reasonable predictors such as cornorbid depression or a family history of affective illness. Four studies have suggested a higher response rate to CBT alone than to