Fluvoxamine and graded psychotherapy in the treatment of bulimia nervosa - A randomized, double-blind, placebo-controlled, multicenter study of short-term and long-term pharmacotherapy combined with a stepped care approach to psychotherapy
London Research Institute, Londinium, England, United KingdomJournal of Clinical Psychopharmacology (Impact Factor: 3.76). 11/2004; 24(5):549-52. DOI: 10.1097/01.jcp.0000138776.32891.3e
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Article: Behandlung der Bulimia nervosa[Show abstract] [Hide abstract]
ABSTRACT: Viele junge Frauen, aber auch Männer sind ständig unzufrieden mit ihrem Körper. In einigen Fällen können die Unzufriedenheit mit dem eigenen Körper und das daraus resultierende restriktive Essverhalten den Weg in eine Bulimia nervosa bahnen. Dieser Artikel fasst die Behandlungsmöglichkeiten und deren jeweilige Evidenz bei Bulimia nervosa zusammen. Neben der Wahl des Behandlungssettings werden psychotherapeutische Behandlungsmaßnahmen und die Rolle von Psychopharmaka bei der Behandlung von Bulimia nervosa dargestellt.Der Nervenarzt 09/2011; 82(9). DOI:10.1007/s00115-010-3229-8 · 0.86 Impact Factor
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ABSTRACT: Bulimia nervosa and binge eating disorder are complex eating disorders with a major impact on the life of the patient and that of their family. Over the past two decades, increasing prevalence and incidence rates have confronted primary care and mental health services with high demands for treatment for these disorders that are difficult to meet. Psychotherapeutic interventions are the first-choice treatment. Cognitive–behavioural therapy (CBT) is efficacious in both bulimia nervosa and binge eating disorder, but there is a need to improve outcomes further. Interpersonal psychotherapy (IPT) has also been shown to have benefits, although in bulimia nervosa the response has been slower than with CBT. In general, delivering psychotherapy is costly and is often hampered by limited availability. Self-help versions of CBT may help to overcome these difficulties. Although promising, further exploration is required as to whether self-help strategies are an alternative to or can reduce therapist involvement. Alternatively, pharmacotherapy is a potential treatment option for bulimia nervosa and binge eating disorder, with evidence predominantly on antidepressants. Fluoxetine in a higher dose has been recommended because it is relatively better tolerated than antidepressants of other classes. Overall, combined psychotherapy and pharmacotherapy in patients with bulimia nervosa produces somewhat better outcomes than pharmacotherapy alone, but is not clearly superior to psychotherapy alone. Data on combination treatment in binge eating disorder are less conclusive. Although the therapeutic arsenal for the treatment of bulimia nervosa and binge eating disorder is expanding, several domains required further investigation.Psychiatry 04/2008; 7(4):161-166. DOI:10.1016/j.mppsy.2008.02.001
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ABSTRACT: Background:The extent of psychotropic medication use in patients with eating disorders worldwide is unknown.Objectives:The purposes of this study were to: (1) describe the extent and pattern of psychotropic medication use at a private treatment facility for patients with eating disorders and (2) describe patient characteristics and treatment outcomes at the facility.Methods:This retrospective chart review included data from a private treatment facility (inpatient or outpatient) for patients with eating disorders in the greater Los Angeles area. Data from all patients of any age who attended the facility between January 1, 2004, and January 1, 2005, and who met the criteria for anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (ED NOS) defined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision were included. Two investigators used a consistent chart-review method for recording clinical status, including treatment-related adverse effects and discharge status (improved, no change, or decompensated from admission). Improved was defined as meeting 1 or more of the following criteria: achieved ideal body weight, stabilized mood, decreased eating disorder symptoms (binge-purge, restrictive, or ritualistic behavior), eating disorder remission, or decreased suicidal ideation plus another improvement in this list.Results:Data from 60 patients were included (31 with AN, 28 with 13N, and I with ED NOS). Ages ranged from 12 to 47 years, and the mean duration of treatment was 35 days. Fifty-eight (96.7%) patients received a psychotropic agent; 35 (58.3%) patients were prescribed 2 or more agents concomitantly. Selective serotonin reuptake inhibitors (SSRls) were the most commonly prescribed class of psychotropic medication (86.7%), followed by antipsychotics (38.3%). Fluoxetine, escitalopram, and aripiprazole were the most commonly prescribed agents (41.7%, 28.3%, and 23.3%, respectively). A total of 63.3% of patients had a comorbid diagnosis of major depressive disorder, with 96.7% of these patients prescribed an antidepressant. At discharge, 51.6% of the inpatients and 37.9% of the outpatients had improved (AN, 52.6% and 33.3%, respectively; BN, 54.5% and 41.2%, respectively). Of the patients prescribed an SSRI, 40.4% had improved. In the inpatient setting, 35.5% of patients receiving an antipsychotic had improved, versus 6.9% in the outpatient setting.Conclusions:The results of this retrospective chart review and descriptive analysis of data from patients at a private eating disorders treatment facility in the United States suggest that psychotropics, particularly antidepressants and antipsychotics, were highly utilized, largely to treat comorbid symptoms. Fluoxetine, escitalopram, and aripiprazole were the most commonly prescribed agents. We observed that psychotropic medication selection was based on patient comorbidities and symptom expression and severity.Current Therapeutic Research 11/2005; 66(6-66):572-588. DOI:10.1016/j.curtheres.2005.12.011 · 0.45 Impact Factor
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