Atypicals, rTMS Weighed for Resistant Anorexia Nervosa

By Wendling, Patrice | Clinical Psychiatry News, January 2011 | Go to article overview

Atypicals, rTMS Weighed for Resistant Anorexia Nervosa


Wendling, Patrice, Clinical Psychiatry News


FT. LAUDERDALE, FLA. - What do atypical antipsychotics, an analeptic, and targeted magnets have in common? They all might play a role in the treatment of anorexia nervosa.

"When you have a disorder that is so treatment resistant, it's like metastatic breast cancer; you have to think outside of the box for new interventions," Dr. Allan S. Kaplan said at a workshop on eating disorders at the meeting.

Current statistics indicate that 20% of patients who are diagnosed with anorexia are resistant to any intervention, and remain chronically ill and disabled. The needs of these patients have been largely neglected by the field, even though their numbers continue to grow because mortality has gradually decreased from 22% in older studies to about 8%-10% today, said Dr. Kaplan, the Loretta Anne Rogers Chair in Eating Disorders and professor of psychiatry at the University of Toronto.

In his experience, many of these patients are now in their 40s and 50s, and have been ill for 20-30 years. Most of them suffer from significant medical complications, including renal failure, cardiac arrhythmias, and osteoporosis with resulting hip fractures that have left them wheelchair bound.

"They are unbelievably disabled," he said. "They are more disabled on quality of life measurements than a comparative group of schizophrenics in the hospital. It's a sobering experience to spend time with these patients."

One novel approach that might be useful is use of repetitive transcranial magnetic stimulation (rTMS), which has been shown to be effective in some patients with depression, schizophrenia, and obsessive-compulsive disorder. Current magnets stimulate superficial cortical areas of the brain, but Dr. Kaplan suggests that a better target might be the insula - a cerebral cortex structure located deep within the lateral fissure that plays a role in interoceptive awareness and motor control.

His group has completed an unpublished meta-analysis of neuroimaging studies in anorexia that provides evidence for over activity in the insula.

The team members have subsequently contracted with an Israeli biotechnology firm to construct a patented magnet for rTMS that will specifically target the insula. They also plan to launch an open-label pilot trial of rTMS for anorexia.

The approach is not without controversy, Dr. Kaplan acknowledged. Although the seizure rate with rTMS is very low in patients with depression, patients with anorexia are at an increased risk for seizures at a rate of about 10% in general. "It's a bit of a shot in the dark, but when you have no other effective treatment, you have to do that," he said.

Atypical antipsychotics have come under increased scrutiny for anorexia, but with limited success in the few small studies and case reports to date. A recent metaanalysis of 43 publications concluded that there is not enough evidence to confirm that these medications increase weight in anorexia (Eur. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • A full archive of books and articles related to this one
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Atypicals, rTMS Weighed for Resistant Anorexia Nervosa
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

    Already a member? Log in now.