A Placebo-Controlled Pilot Study of Adjunctive Olanzapine for Adolescents with Anorexia Nervosa

Kafantaris, Vivian; Leigh, Ellen; Hertz, Stanley; Berest, Alison; Schebendach, Janet; Sterling, Wendy Meyer; Saito, Ema; Sunday, Suzanne R.; Higdon, Claudine; Golden, Neville H.; Malhotra, Anil K.

doi:10.1089/cap.2010.0139

Cited by 114 publications

(122 citation statements)

References 15 publications

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“…There is no evidence to suggest that pharmacotherapy in AN should be first line, but it may play a role in individual patients resistant to treatment or with premorbid psychiatric conditions. 107,[128][129][130] In BN, several RCTs in adults have found that antidepressants are effective in decreasing binge eating and purging symptoms. Specifically, fluoxetine has a strong evidence base and is approved by the Food and Drug Administration for use in adults with BN; thus far there is some evidence that the effects are similar in adolescents.…”

Section: Pharmacotherapymentioning

confidence: 99%

Eating Disorders in Children and Adolescents: State of the Art Review

2014

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This is the 3rd in our series on Adolescent Health. abstract Despite their high prevalence, associated morbidity and mortality, and available treatment options, eating disorders (EDs) continue to be underdiagnosed by pediatric professionals. Many adolescents go untreated, do not recover, or reach only partial recovery. Higher rates of EDs are seen now in younger children, boys, and minority groups; EDs are increasingly recognized in patients with previous histories of obesity. Medical complications are common in both full and subthreshold EDs and affect every organ system. No single cause of EDs has emerged, although neurobiological and genetic predispositions are emerging as important. Recent treatment paradigms acknowledge that they are not caused by families or chosen by patients. EDs present differently in pediatric populations, and providers should have a high index of suspicion using new Diagnostic and Statistical Manual, 5th edition diagnostic criteria because early intervention can affect prognosis. Outpatient family-based treatment focused on weight restoration, reducing blame, and empowering caregivers has emerged as particularly effective; cognitive behavioral therapy, individual therapy, and higher levels of care may also be appropriate. Pharmacotherapy is useful in specific contexts. Full weight restoration is critical, often involves high-calorie diets, and must allow for continued growth and development; weight maintenance is typically inappropriate in pediatric populations. Physical, nutritional, behavioral, and psychological health are all metrics of a full recovery, and pediatric EDs have a good prognosis with appropriate care. ED prevention efforts should work toward aligning with families and understanding the impact of antiobesity efforts. Primary care providers can be key players in treatment success.

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Section: Pharmacotherapymentioning

confidence: 99%

Eating Disorders in Children and Adolescents: State of the Art Review

2014

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“…The updated literature search yielded 698 citations in the initial search step and finally, six citations on four trials were incorporated [31,32,33,34]. Online supplementary figure 1 (see www.karger.com/doi/10.1159/000369978 for all online suppl.…”

Section: Resultsmentioning

confidence: 99%

“…In those studies indicating the subtype of anorexia nervosa 64.2% suffered from the restricting subtype and the remaining ones from the binge-purging subtype. Four trials examined an antipsychotic medication with olanzapine (n = 112) [28,29,31,33], two with quetiapine (n = 48) [30,34], and one with risperidone (n = 41) [32]. All studies were characterized by a parallel-group design.…”

Section: Resultsmentioning

confidence: 99%

Second-Generation Antipsychotic Drugs in Anorexia Nervosa: A Meta-Analysis of Randomized Controlled Trials

Dold

Anders

Klabunde

et al. 2015

Psychother Psychosom

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Background: Second-generation antipsychotic drugs (SGAs) are increasingly administered to achieve weight gain in anorexia nervosa. In this meta-analysis, we aimed to determine if any evidence for this treatment option can be derived from randomized controlled trials (RCTs). Methods: Based on the ‘World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Eating Disorders', a systematic update literature search was applied to identify all RCTs investigating the efficacy, acceptability, and tolerability of SGAs in anorexia nervosa in comparison to placebo/no treatment. The primary outcome was weight gain measured by mean change in body mass index (BMI). Secondary outcomes were mean changes in Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS) total score and Eating Disorders Inventory (EDI) total score and premature discontinuation of treatment. Employing a random-effects model standardized mean differences based on Hedges's g and Mantel-Haenszel risk ratios were calculated. Results: Seven RCTs (n = 201) investigating olanzapine (N = 4), quetiapine (N = 2), and risperidone (N = 1) were included. We found no statistically significant between-group differences for mean BMI change when pooling the SGAs (N = 7, n = 161; Hedges's g = 0.13, 95% CI: -0.17 to 0.43; p = 0.4) and when examining the individual drugs. Furthermore, the SGAs failed to differentiate statistically significantly from placebo/no treatment for all secondary outcomes. Conclusions: Based on the current evidence, pharmacological treatment of anorexia nervosa with SGAs cannot be generally recommended although some individuals or subgroups of patients might benefit from an antipsychotic medication. Further research is required to identify which patients will likely benefit from such a treatment option.

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“…Two (Kafantaris 2011;Norris 2011) showed no greater benefit of olanzapine over placebo. Similarly, a randomised trial of risperidone v. placebo found no effect on eating disorder rating scales or weight (Hagman 2011).…”

Section: Treatment Of Anorexia Nervosamentioning

confidence: 92%

Atypical early-onset eating disorders

Nicholls¹,

Barrett²,

Huline-Dickens³

2014

Adv. psychiatr. treat

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SUMMARYThis article reviews the recent changes to the DSM diagnostic classification of feeding and eating disorders with particular reference to children and adolescents. The common clinical presentations of the 'at ypical' feeding and eating problems of middle childhood and early adolescence are reviewed using clinical case vignettes, and the limited evidence base regarding management is summarised. There are many gaps in the evidence base and this is likely to be an area of rapid development for the field subsequent on the new terminology outlined in DSM-5. LEARNING OBJECTIVES• Be able to describe the recent changes in terminology of DSM-5 for eating disorders in children and adolescents.

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A Placebo-Controlled Pilot Study of Adjunctive Olanzapine for Adolescents with Anorexia Nervosa

Abstract: These preliminary findings do not support a role for adjunctive olanzapine for underweight adolescent females with anorexia nervosa-restricting type who are receiving standard care in an eating disorder treatment program (clinical trials.gov; no. NCT00592930).

Cited by 114 publications

References 15 publications

Eating Disorders in Children and Adolescents: State of the Art Review

Eating Disorders in Children and Adolescents: State of the Art Review

Second-Generation Antipsychotic Drugs in Anorexia Nervosa: A Meta-Analysis of Randomized Controlled Trials

Atypical early-onset eating disorders

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