Psychotic symptoms in a woman with severe Anorexia Nervosa
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CASE REPORT
Psychotic symptoms in a woman with severe Anorexia Nervosa Psychotic symptoms in Anorexia Nervosa Nadia Delsedime • Barbara Nicotra • Maria Cristina Giovannone Lucrezia Marech • Marta Barosio • Enrica Marzola • Giovanni Abbate-Daga • Secondo Fassino
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Received: 7 November 2011 / Accepted: 24 May 2012 / Published online: 4 April 2013 Ó Springer International Publishing Switzerland 2013
Abstract With this paper we aimed to describe a case of a woman affected by Anorexia Nervosa Restricting subtype (AN-R) with delusional symptoms, visual hallucinations and severe body image distortion. We discussed the main AN diagnosis and whether delusional symptoms could be related to severity of AN describing also the use of olanzapine in such a severe clinical condition. The use of olanzapine was found to be effective to reduce both delusions and body distortions, and to improve compliance to treatments. We found a severe delusional symptomatology with mystic, omnipotence and persecution features. The psychotic structure seemed preceding the eating disorder and was also found to be worsened by emaciation. The use of antipsychotic helped reducing delusional symptoms and improving compliance to treatments. Finally, the dynamically oriented therapeutic relationship helped the patient to gain weight and to achieve a full recovery from psychotic symptoms. Keywords Anorexia Nervosa Delusional symptoms Antipsychotic Olanzapine Psychodynamic relationship
Introduction Anorexia Nervosa (AN) is defined by the DSM-IV-TR as the maintenance of a body weight \85 % of expected, fear of weight gain, disturbance in the experience of body shape
N. Delsedime B. Nicotra M. C. Giovannone L. Marech M. Barosio E. Marzola G. Abbate-Daga S. Fassino (&) Eating Disorders Program, Department of Neuroscience, Psychiatry Section, University of Turin, Via Cherasco 11, 10126 Turin, Italy e-mail: [email protected]
and weight, and amenorrhea [1]. The current management of severe AN typically involves a multidisciplinary approach including a dietary treatment, psychotherapy, parent counselling and pharmacological approaches [2], even if data on the long-term efficacy of pharmacotherapy are scarce [3]. Scientific literature found antidepressants to be scarcely helpful in treating AN. For example, a Cochrane systematic review on the use of antidepressants in AN could not provide evidence about their effectiveness in gaining weight or improving the eating psychopathology [4]. Typical neuroleptics (e.g., chlorpromazine) were also considered in the AN treatment but—given the well-known side effects in the short- and long-term and poorer efficacy in changing eating behavior and body image distortion— their utilization is not recommended. Low doses of haloperidol have been found to be effective in treatment-resistant Anorexia Nervosa Restricting subtype (AN-R) patients in reducing eating psychopathology [5]. Atypical antipsychotics can reduce anxiety, agitation, aggressiveness and obsessive features related to food control and
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