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Olanzapine therapy in anorexia nervosa: psychobiological effects

Brambilla, Francescaa h; Garcia, Cristina Segurab; Fassino, Secondoc; Daga, Giovanni Abbatec; Favaro, Angelad; Santonastaso, Paolod; Ramaciotti, Carlae; Bondi, Emiliae; Mellado, Carmena h; Borriello, Renataf; Monteleone, Palmierog

International Clinical Psychopharmacology:
doi: 10.1097/YIC.0b013e328080ca31
Original Articles
Abstract

Dopamine impairments occur in anorexia nervosa. The aim of this study was to see whether treatment with the atypical dopamine antagonist antipsychotic olanzapine improves the disorder. Thirty anorexics, 18 restricted and 12 bingeing–purging, underwent a 3-month course of cognitive behavioral therapy, plus at random and double-blinded oral olanzapine (2.5 mg for 1 month, 5 mg for 2 months) in half and oral placebo in the other half of them. BMI, psychopathological aspects (eating disorder inventory, Hamilton Rating Scale, Buss–Durkee Rating Scale, Yale Brown Cornell for Eating Disorders Rating Scale, temperament–character inventory), and homovanillic acid blood concentrations for dopamine secretion, were monitored at baseline and then monthly during the trial. At the end of the trial BMI, total eating disorder inventory, total Yale Brown Cornell for Eating Disorders Rating Scale, Buss–Durkee Rating Scale, Hamilton Rating Scale scores and in olanzapine-treated patients the subitems of eating disorder inventory ineffectiveness and maturity fear, of Buss–Durkee Rating Scale direct aggressiveness, of temperament–characteristic inventory persistence had improved significantly. When stratified for anorexia nervosa subtype, BMI changes were significant among anorexia nervosa bingeing-purging patient, ‘depression’ (Hamilton Rating Scale) and ‘direct aggressiveness’ (Buss–Durkee Rating Scale) among anorexia nervosa bingeing–purging patients, ‘persistence’ (temprerament–characteristic inventory), among anorexics restricted patients, with a trend toward significance for obsessivity–compulsivity (Yale Brown Cornell for Eating Disorders Rating Scale). homovanilic acid blood levels increased significantly in the cognitive behavioral therapy+olanzapine group. No correlations were observed between homovanilic acid concentrations and psychopathological parameters. The pharmacological treatment can significantly improve specific aspects of anorexia nervosa.

Author Information

aDepartment Mental Health, Sacco Hospital, Milan

bDepartment of Psychiatry, Catanzaro University, Catanzaro

cDepartment of Psychiatry, Turin Uuniversity, Turin

dDepartment of Neuroscience, Padua University, Padua

eDepartment of Psychiatry, Pisa University, Pisa

fChair Phorensic Toxicology

gDepartment of Psychiatry, Naples University SUN, Naples, Italy

hUniversity Deptartment of Psychiatry, SUN, Naples, Italy

Correspondence to Professor Francesca Brambilla, Centro di Psiconeuroendocrinologia, Piazza Grandi 3, Milano 20129, Italy

Tel: +39 02 717350 or +39 368 3017420; fax: +39 02 70122889;

e-mail: francesca.brambilla4@tin.it

Received 30 July 2006 Accepted 2 January 2007

© 2007 Lippincott Williams & Wilkins, Inc.