Is aripiprazole a key to unlock anorexia nervosa?: A case series

Tahıllıoğlu, Akın; Özcan, Tuğçe; Yüksel, Gamze; Majroh, Noorjahan; Köse, Sezen; Özbaran, Burcu

doi:10.1002/ccr3.3271

Cited by 10 publications

(10 citation statements)

References 28 publications

(62 reference statements)

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“…As a partial D2R agonist, aripiprazole would remediate low basal DA through its agonist properties while the reduced (partial) activation would mitigate super sensitized responses to phasic DA, putatively normalizing the dynamic range of dopamine signaling. Consistent with these ideas, aripiprazole has been shown to promote weight gain in AN (122,123). Interestingly, aripiprazole may have utility in stage 1 as well where its partial agonist properties may counteract escalating increases in dopamine.…”

Section: Discussionmentioning

confidence: 84%

The Rise and Fall of Dopamine: A Two-Stage Model of the Development and Entrenchment of Anorexia Nervosa

Beeler

Burghardt

2022

Front. Psychiatry

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Dopamine has long been implicated as a critical neural substrate mediating anorexia nervosa (AN). Despite nearly 50 years of research, the putative direction of change in dopamine function remains unclear and no consensus on the mechanistic role of dopamine in AN has been achieved. We hypothesize two stages in AN– corresponding to initial development and entrenchment– characterized by opposite changes in dopamine. First, caloric restriction, particularly when combined with exercise, triggers an escalating spiral of increasing dopamine that facilitates the behavioral plasticity necessary to establish and reinforce weight-loss behaviors. Second, chronic self-starvation reverses this escalation to reduce or impair dopamine which, in turn, confers behavioral inflexibility and entrenchment of now established AN behaviors. This pattern of enhanced, followed by impaired dopamine might be a common path to many behavioral disorders characterized by reinforcement learning and subsequent behavioral inflexibility. If correct, our hypothesis has significant clinical and research implications for AN and other disorders, such as addiction and obesity.

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Section: Discussionmentioning

confidence: 84%

The Rise and Fall of Dopamine: A Two-Stage Model of the Development and Entrenchment of Anorexia Nervosa

Beeler

Burghardt

2022

Front. Psychiatry

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“…Tahilioglu et al reported a case series of eleven females with AN treated with aripiprazole. Improvements in obsessive eating attitudes and behaviors were found in all patients: the change in CGIS scores and BMI were statistically significant ( p < 0.001) [ 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…The current review identified scant evidence for the use of aripiprazole in children and adolescents with AN. Two poor-quality studies [ 39 , 40 ] and one small case series with 4 patients [ 38 ] were included. Concerning the considered outcomes, all the studies reported an improvement in body-weight measures, while two studies showed improved psychopathology [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…A good tolerability was described, with only one case of neutropenia [ 38 ]. Despite this evidence, the included studies suffered from a lack of a comparison group [ 40 ] or poor reporting of outcomes [ 39 ], or had a clear case-report nature [ 38 ]. These data suggest a potential role of aripiprazole in improving weight gain in children and adolescents with AN, with an apparent good tolerability profile.…”

Section: Discussionmentioning

confidence: 99%

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Antipsychotics in the Treatment of Children and Adolescents with Anorexia Nervosa: A Systematic Review

et al. 2022

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Evidence about the use of pharmacologic agents in the treatment of Anorexia Nervosa (AN) is lacking, especially in childhood and adolescence. A systematic scoping review was conducted to outline current literature evidence about the use of antipsychotics in this population. A total of 499 studies were identified with the initial search, and 28 of these studies were selected regarding the use of olanzapine (n = 13), risperidone (n = 4), aripiprazole (n = 3), chlorpromazine (n = 3), pimozide (n = 1) clotiapine (n = 1) and multiple antipsychotics (n = 3) in these patients. Overall, major side effects were reported infrequently; improvements in psychopathology and weight measures have been suggested in the majority of the considered studies. Nonetheless, the lack of RCT or good-quality studies strongly limits the generalizability of results in clinical practice.

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“…It is possible that the combined D1 and D2 receptor blockage reduces fear and dread response, although it has limited effect on appetitive food response. While the evidence is still scant, there is now some emerging evidence that the partial D2 receptor agonist aripiprazole could be helpful in targeting illness related preoccupations and supporting insight in AN [ 101 , 102 , 103 , 104 , 105 ]. This may be consistent with animal studies that showed elevated survival of the ABA rodent model in response to stimulating dopamine neurons in the nucleus accumbens [ 106 ].…”

Section: Discussionmentioning

confidence: 99%

From Desire to Dread—A Neurocircuitry Based Model for Food Avoidance in Anorexia Nervosa

Frank

2021

JCM

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Anorexia nervosa is a severe psychiatric illness associated with food avoidance. Animal models from Berridge et al. over the past decade showed that environmental ambience, pleasant or fear inducing, can trigger either appetitive (desire) or avoidance (dread) behaviors in animals via frontal cortex, nucleus accumbens dopamine D1 and D2 receptors, and hypothalamus. Those mechanisms could be relevant for understanding anorexia nervosa. However, models that translate animal research to explain the psychopathology of anorexia nervosa are sparse. This article reviews animal and human research to find evidence for whether this model can explain food avoidance behaviors in anorexia nervosa. Research on anorexia nervosa suggests fear conditioning to food, activation of the corticostriatal brain circuitry, sensitization of ventral striatal dopamine response, and alterations in hypothalamic function. The results support the applicability of the animal neurocircuitry derived model and provide directions to further study the pathophysiology that underlies anorexia nervosa.

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Is aripiprazole a key to unlock anorexia nervosa?: A case series

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 10 publications

References 28 publications

The Rise and Fall of Dopamine: A Two-Stage Model of the Development and Entrenchment of Anorexia Nervosa

The Rise and Fall of Dopamine: A Two-Stage Model of the Development and Entrenchment of Anorexia Nervosa

Antipsychotics in the Treatment of Children and Adolescents with Anorexia Nervosa: A Systematic Review

From Desire to Dread—A Neurocircuitry Based Model for Food Avoidance in Anorexia Nervosa

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