Severe anorexia nervosa, co-occurring major depressive disorder and electroconvulsive therapy as maintenance treatment: a case report

Poutanen, Outi; Huuhka, Kaija; Perko, Kaisa

doi:10.1186/1757-1626-2-9362

Cited by 9 publications

(8 citation statements)

References 14 publications

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“…Future tDCS studies in patients with AN could leverage more personalized protocols according to the predominant symptoms (19). A similar practice was used in electroconvulsive therapy (ECT) for treating AN [e.g., (64,65)] or in deep brain stimulation studies (66). In the future, also individual placement guided by MRI (67) and a combination of tDCS and cognitive remediation or psychotherapy are another potential options for clinical research in AN.…”

Section: Discussionmentioning

confidence: 99%

Effects of Transcranial Direct Current Stimulation Treatment for Anorexia Nervosa

et al. 2021

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Background: Anorexia nervosa (AN) is a life-threatening illness with poor treatment outcomes. Although transcranial direct current stimulation (tDCS) is a promising non-invasive brain stimulation method, its effect in patients with AN remains unclear.Objective: This study investigated changes in maladaptive eating behavior, body mass index (BMI), and depression after 10 sessions of anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC).Methods: In this double-blind, randomized controlled trial, 43 inpatients with AN were divided to receive either active (n = 22) or sham (n = 21) tDCS over the left DLPFC (anode F3/cathode Fp2, 2 mA for 30 min). All patients filled the Eating Disorder Examination Questionnaire (EDE-Q) and Zung Self-Rating Depression Scale (ZUNG), and their BMI was measured. These values were obtained repeatedly in four stages: (1) before tDCS treatment, (2) after tDCS treatment, (3) in the follow-up after 2 weeks, and (4) in the follow-up after 4 weeks.Results: Primary outcomes (EDE-Q) based on the ANOVA results do not show any between-group differences either after the active part of the study or in the follow-up. Secondary analysis reveals a reduction in some items of EDE-Q. Compared with sham tDCS, active tDCS significantly improved self-evaluation based on body shape (p < 0.05) and significantly decreased the need of excessive control over calorie intake (p < 0.05) in the 4-week follow-up. However, the results do not survive multiple comparison correction. In both sham and active groups, the BMI values improved, albeit not significantly.Conclusion: We did not observe a significant effect of tDCS over the left DLPFC on complex psychopathology and weight recovery in patients with AN. tDCS reduced the need to follow specific dietary rules and improved body image evaluation in patients with AN. Tests with a larger sample and different positions of electrodes are needed.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03273205.

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Section: Discussionmentioning

confidence: 99%

Effects of Transcranial Direct Current Stimulation Treatment for Anorexia Nervosa

et al. 2021

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“…There is no consensus on treatment guidelines for AN [53]. Furthermore, the role of psychopharmaceuticals is not clear, except in the case of major depressive disorder [59]. Hence, there is a need for effective therapy resulting in rapid improvement, particularly for patients with severe and life-threatening AN.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, while ECT use among adults is more common than adolescents, the literature about adults with AN treated with ECT is meager. For example, a 21-year old female experienced AN symptomology for several years [59]. At her lowest BMI (12.6 kg/m2), the diagnosis of both severe AN and major depressive disorder was made.…”

Section: Electroconvulsive Therapymentioning

confidence: 99%

Neurostimulation Approaches in the Treatment of Severe Anorexia Nervosa

Baker¹

2020

Neurobiology

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Psychiatry is seeking interventions that could reliably sustain weight gain and psychosomatic recovery of patients with severe anorexia nervosa (AN). Currently, patients with AN, even after receiving individually-tailored therapeutic interventions, often relapse following marginal weight restoration. Also, the evidence regarding the effectiveness of psychotropic medications in relieving and treating AN symptomology is limited. The research in the field is aiming to mitigate shortcomings associated with common practices and build on strategies including enhanced-CBT. An eminent discordance with conventional treatment modalities gives reason to explore alternative standards of care. This review explores 21st-century studies adopting neurostimulation therapies as an alternative approach for severe AN. The most widely used neurostimulation treatment in psychiatry is electroconvulsive therapy (ECT), but modern transcranial magnetic stimulation (TMS) due to its non-invasive technology has also garnered the attention of practitioners. Deep brain stimulation (DBS) is rapidly emerging as a potential (invasive) treatment. These three treatment options are further explored, and future research directions are discussed.

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“…With support of ICU care and medical treatment, including antiplatelet therapy, the patient underwent ECT, uneventfully. Poutanen et al (2009) gave maintenance ECT for a patient with anorexia nervosa with low BMI (ranging from 14.8 to 15.3) that had comorbidity of MDD. No complication were observed during throughout the ECT.…”

Section: Discussionmentioning

confidence: 99%

Is Electroconvulsive Therapy Safe for Patient with Very Low BMI? A Case Report

Jl¹,

As²,

Sidi³

et al. 2016

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ABSTRAK Laporan kes ini mengetengahkan kaedah penstablian terapi elektrokonvulsif (ECT) yang cepat bagi pesakit kemurungan major (MDD) yang mempunyai indeks jisim berat badan (BMI ABSTRACTA case of rapid stabilization using electroconvulsive therapy (ECT) for a major depressive disordered (MDD) patient with life-threatening low body mass index (BMI) is reported. This case report focuses on a 55-year-old Malay housewife with underlying hyperthyroidism in a euthyroid state who presented with MDD with mood congruent psychotic features, which were precipitated by the death of her husband. Her BMI was only 11 kg/m 2 due to severe anorexia, and she was highly suicidal. Peripheral total parenteral nutrition was started and ECT was commenced for rapid stabilization on top of tablet escitalopram 15 mg nocte. Full remission was 84 Med & Health 2016;11(1): 83-86 Loo J.L. et al. thinking that her internal organs ceased to function and she no longer existed in this world. To add to it, she had second person auditory hallucination commanding her to kill herself. There were persistent thoughts of ending her life, but she was too weak to attempt suicide. She was admitted for one month and treated with oral fluoxetine, which was optimized until 40 mg daily. In view of poor response to pharmacotherapy and the need of rapid stabilization due to deteriorating physical health, she was transferred to another hospital with psychiatry service and ECT facility. Upon transfer, the patient's depressive symptoms and psychotic symptoms persisted. Examination revealed an alert, dehydrated cachexic Malay lady who appeared older than her age. Her BMI was only 11 (weight 25kg, height 152.5cm) with no hypothermia, hypotension or bradycardia. She was guarded and not fully cooperative. Prominent psychomotor retardation was noticed. Her speech was not spontaneous but relevant and coherent with reduced in tone, volume, rate, and amount. She was depressed and her affect was appropriate, non-reactive and restricted. She had active suicidal idea, nihilistic delusion, and second person auditory hallucination that commanding her to commit suicide. achieved after nine ECTs and steady healthy weight gain was achieved throughout admission. The patient was discharged at BMI of 13 kg/m 2 with good appetite. ECT was safe for very low BMI MDD patient.

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Severe anorexia nervosa, co-occurring major depressive disorder and electroconvulsive therapy as maintenance treatment: a case report

Cited by 9 publications

References 14 publications

Effects of Transcranial Direct Current Stimulation Treatment for Anorexia Nervosa

Effects of Transcranial Direct Current Stimulation Treatment for Anorexia Nervosa

Neurostimulation Approaches in the Treatment of Severe Anorexia Nervosa

Is Electroconvulsive Therapy Safe for Patient with Very Low BMI? A Case Report

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