All Title Author
Keywords Abstract

Eating Disorders in Schizophrenia: Implications for Research and Management

DOI: 10.1155/2014/791573

Full-Text   Cite this paper   Add to My Lib


Objective. Despite evidence from case series, the comorbidity of eating disorders (EDs) with schizophrenia is poorly understood. This review aimed to assess the epidemiological and clinical characteristics of EDs in schizophrenia patients and to examine whether the management of EDs can be improved. Methods. A qualitative review of the published literature was performed using the following terms: “schizophrenia” in association with “eating disorders,” “anorexia nervosa,” “bulimia nervosa,” “binge eating disorder,” or “night eating syndrome.” Results. According to our literature review, there is a high prevalence of comorbidity between schizophrenia and EDs. EDs may occur together with or independent of psychotic symptoms in these patients. Binge eating disorders and night eating syndromes are frequently found in patients with schizophrenia, with a prevalence of approximately 10%. Anorexia nervosa seems to affect between 1 and 4% of schizophrenia patients. Psychopathological and neurobiological mechanisms, including effects of antipsychotic drugs, should be more extensively explored. Conclusions. The comorbidity of EDs in schizophrenia remains relatively unexplored. The clearest message of this review is the importance of screening for and assessment of comorbid EDs in schizophrenia patients. The management of EDs in schizophrenia requires a multidisciplinary approach to attain maximized health outcomes. For clinical practice, we propose some recommendations regarding patient-centered care. 1. Introduction Schizophrenia is a severe and frequently observed mental illness that affects 1% of the general population. Schizophrenia is characterized by a wide range of symptoms, including positive symptoms (delusions and hallucinations), negative symptoms (social withdrawal, blunted affect), cognitive symptoms (difficulties with memory and attention), and affective dysregulation [1]. Moreover, psychiatric comorbidities are very common among patients with schizophrenia, particularly substance abuse, anxiety, and depressive symptoms [2]. In addition to these psychiatric features, endocrine and cardiometabolic alterations (e.g., type 2 diabetes, obesity, hypertension, and dyslipidemia) are frequently associated with schizophrenia. Indeed, cardiovascular diseases are the leading cause of the high mortality among patients with schizophrenia, which is 2-3 times higher than that of the general population [3, 4]. The etiology of the cardiometabolic disorders in schizophrenia is multifactorial and includes oxidative stress [5], conventional risk factors such as genetic


[1]  J. van Os and S. Kapur, “Schizophrenia,” The Lancet, vol. 374, no. 9690, pp. 635–645, 2009.
[2]  P. F. Buckley, B. J. Miller, D. S. Lehrer, and D. J. Castle, “Psychiatric comorbidities and schizophrenia,” Schizophrenia Bulletin, vol. 35, no. 2, pp. 383–402, 2009.
[3]  S. Saha, D. Chant, and J. McGrath, “A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time?” Archives of General Psychiatry, vol. 64, no. 10, pp. 1123–1131, 2007.
[4]  C. H. Hennekens, A. R. Hennekens, D. Hollar, and D. E. Casey, “Schizophrenia and increased risks of cardiovascular disease,” American Heart Journal, vol. 150, no. 6, pp. 1115–1121, 2005.
[5]  Y. Kouidrat, A. Amad, R. Desailloud et al., “Increased advanced glycation end-products (AGEs) assessed by skin autofluorescence in schizophrenia,” Journal of Psychiatric Research, vol. 47, no. 8, pp. 1044–1048, 2013.
[6]  M. de Hert, C. U. Correll, J. Bobes et al., “Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care,” World Psychiatry, vol. 10, no. 1, pp. 52–77, 2011.
[7]  A. Golay, E. Brock, R. Gabriel et al., “Taking small steps towards targets—perspectives for clinical practice in diabetes, cardiometabolic disorders and beyond,” International Journal of Clinical Practice, vol. 67, no. 4, pp. 322–332, 2013.
[8]  K. L. Klump, C. M. Bulik, W. H. Kaye, J. Treasure, and E. Tyson, “Academy for eating disorders position paper: eating disorders are serious mental illnesses,” International Journal of Eating Disorders, vol. 42, no. 2, pp. 97–103, 2009.
[9]  J. Treasure, A. M. Claudino, and N. Zucker, “Eating disorders,” The Lancet, vol. 375, no. 9714, pp. 583–593, 2010.
[10]  P. Hoff, “Eugen Bleuler's concept of schizophrenia and its relevance to present-day psychiatry,” Neuropsychobiology, vol. 66, no. 1, pp. 6–13, 2012.
[11]  C. Foulon, “Schizophrenia and eating disorders,” Encephale, vol. 29, no. 5, pp. 463–466, 2003.
[12]  M. H. Fawzi and M. M. Fawzi, “Disordered eating attitudes in Egyptian antipsychotic naive patients with schizophrenia,” Comprehensive Psychiatry, vol. 53, no. 3, pp. 259–268, 2012.
[13]  S. Y. Yum, G. Caracci, and M. Y. Hwang, “Schizophrenia and eating disorders,” Psychiatric Clinics of North America, vol. 32, no. 4, pp. 809–819, 2009.
[14]  American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders: DSM-5, American Psychiatric Association, Arlington, Va, USA, 2013.
[15]  C. Call, B. T. Walsh, and E. Attia, “From DSM-IV to DSM-5: changes to eating disorder diagnoses,” Current Opinion in Psychiatry, vol. 26, no. 6, pp. 532–536, 2013.
[16]  F. R. E. Smink, D. Van Hoeken, and H. W. Hoek, “Epidemiology, course, and outcome of eating disorders,” Current Opinion in Psychiatry, vol. 26, no. 6, pp. 543–548, 2013.
[17]  M. K. Heaner and B. T. Walsh, “A history of the identification of the characteristic eating disturbances of Bulimia Nervosa, Binge Eating Disorder and Anorexia Nervosa,” Appetite, vol. 65, pp. 185–188, 2013.
[18]  H. Roux, E. Chapelon, and N. Godart, “épidémiologie de l’anorexie mentale: revue de la littérature,” L’Encéphale, vol. 39, no. 2, pp. 85–93, 2013.
[19]  L. K. G. Hsu, E. S. Meltzer, and A. H. Crisp, “Schizophrenia and anorexia nervosa,” Journal of Nervous and Mental Disease, vol. 169, no. 5, pp. 273–276, 1981.
[20]  J. M. Ferguson and N. F. Damluji, “Anorexia nervosa and schizophrenia,” International Journal of Eating Disorders, vol. 7, no. 3, pp. 343–352, 1988.
[21]  R. H. Striegel-Moore, V. Garvin, F. A. Dohm, and R. A. Rosenheck, “Psychiatric comorbidity of eating disorders in men: a national study of hospitalized veterans,” International Journal of Eating Disorders, vol. 25, no. 4, pp. 399–404, 1999.
[22]  D. Stein, C. Zemishlani, B. Shahal, and Y. Barak, “Disordered eating in elderly female patients diagnosed with chronic schizophrenia,” The Israel Journal of Psychiatry and Related Sciences, vol. 42, no. 3, pp. 191–197, 2005.
[23]  B. Cinemre and B. Kulaksizo?lu, “Case report: comorbid anorexia nervosa and schizophrenia in a male patient,” Turk Psikiyatri Dergisi, vol. 18, no. 1, pp. 87–91, 2007.
[24]  R. B. Khalil, D. Hachem, and S. Richa, “Eating disorders and schizophrenia in male patients: a review,” Eating and Weight Disorders, vol. 16, no. 3, pp. e150–e156, 2011.
[25]  K. G. Gotestam, L. Eriksen, and H. Hagen, “An epidemiological study of eating disorders in Norwegian psychiatric institutions,” International Journal of Eating Disorders, vol. 18, no. 3, pp. 263–268, 1995.
[26]  P. Cheung and E. Wilder-Smith, “Anorexia nervosa and schizophrenia in a male Chinese,” International Journal of Eating Disorders, vol. 18, no. 1, pp. 103–106, 1995.
[27]  B. Kiraly and E. A. Joy, “Case report. Anorexia nervosa and psychosis in a male triathlete,” Current Sports Medicine Reports, vol. 2, no. 6, pp. 317–319, 2003.
[28]  G. T. Wilson and R. Sysko, “Frequency of binge eating episodes in bulimia nervosa and binge eating disorder: diagnostic considerations,” International Journal of Eating Disorders, vol. 42, no. 7, pp. 603–610, 2009.
[29]  M. C. Deckelman, L. B. Dixon, and R. R. Conley, “Comorbid bulimia nervosa and schizophrenia,” International Journal of Eating Disorders, vol. 22, no. 1, pp. 101–105, 1997.
[30]  P. Miotto, B. Pollini, A. Restaneo et al., “Symptoms of psychosis in anorexia and bulimia nervosa,” Psychiatry Research, vol. 175, no. 3, pp. 237–243, 2010.
[31]  Z. Cooper and C. G. Fairburn, “Refining the definition of binge eating disorder and nonpurging bulimia nervosa,” International Journal of Eating Disorders, vol. 34, no. S1, pp. S89–S95, 2003.
[32]  F. M. Theisen, A. Linden, I. R. K?nig, M. Martin, H. Remschmidt, and J. Hebebrand, “Spectrum of binge eating symptomatology in patients treated with clozapine and olanzapine,” Journal of Neural Transmission, vol. 110, no. 1, pp. 111–121, 2003.
[33]  M. Kluge, A. Schuld, H. Himmerich et al., “Clozapine and olanzapine are associated with food craving and binge eating: results from a randomized double-blind study,” Journal of Clinical Psychopharmacology, vol. 27, no. 6, pp. 662–666, 2007.
[34]  J. D. Lundgren, M. V. Rempfer, C. E. Brown, J. Goetz, and E. Hamera, “The prevalence of night eating syndrome and binge eating disorder among overweight and obese individuals with serious mental illness,” Psychiatry Research, vol. 175, no. 3, pp. 233–236, 2010.
[35]  L. B. Palmese, P. C. DeGeorge, J. C. Ratliff et al., “Insomnia is frequent in schizophrenia and associated with night eating and obesity,” Schizophrenia Research, vol. 133, no. 1–3, pp. 238–243, 2011.
[36]  A. Basdevant, M. Pouillon, N. Lahlou, M. Le Barzic, M. Brillant, and B. Guy-Grand, “Prevalence of binge eating disorder in different populations of French women,” International Journal of Eating Disorders, vol. 18, no. 4, pp. 309–315, 1995.
[37]  R. L. Spitzer, S. Yanovski, T. Wadden et al., “Binge eating disorder: its further validation in a multisite study,” International Journal of Eating Disorders, vol. 13, no. 2, pp. 137–153, 1993.
[38]  M. de Zwaan, “Binge eating disorder and obesity,” International Journal of Obesity, vol. 25, supplement 1, pp. S51–S55, 2001.
[39]  C. E. Ramacciotti, R. A. Paoli, M. Catena et al., “Schizophrenia and binge-eating disorders,” Journal of Clinical Psychiatry, vol. 65, no. 7, pp. 1016–1017, 2004.
[40]  A. J. Stunkard, W. J. Grace, and H. G. Wolff, “The night-eating syndrome; a pattern of food intake among certain obese patients,” The American Journal of Medicine, vol. 19, no. 1, pp. 78–86, 1955.
[41]  K. C. Allison, J. D. Lundgren, J. P. O'Reardon et al., “Proposed diagnostic criteria for night eating syndrome,” International Journal of Eating Disorders, vol. 43, no. 3, pp. 241–247, 2010.
[42]  S. Cohrs, “Sleep disturbances in patients with schizophrenia: impact and effect of antipsychotics,” CNS Drugs, vol. 22, no. 11, pp. 939–962, 2008.
[43]  K. Spiegel, E. Tasali, R. Leproult, and E. van Cauter, “Effects of poor and short sleep on glucose metabolism and obesity risk,” Nature Reviews Endocrinology, vol. 5, no. 5, pp. 253–261, 2009.
[44]  C. S. Rand, A. M. Macgregor, and A. J. Stunkard, “The night eating syndrome in the general population and among postoperative obesity surgery patients,” International Journal of Eating Disorders, vol. 22, no. 1, pp. 65–69, 1997.
[45]  L. B. Palmese, J. C. Ratliff, E. L. Reutenauer, K. M. Tonizzo, C. M. Grilo, and C. Tek, “Prevalence of night eating in obese individuals with schizophrenia and schizoaffective disorder,” Comprehensive Psychiatry, vol. 54, no. 3, pp. 276–281, 2013.
[46]  J. D. Lundgren, K. C. Allison, S. Crow et al., “Prevalence of the night eating syndrome in a psychiatric population,” American Journal of Psychiatry, vol. 163, no. 1, pp. 156–158, 2006.
[47]  C. B. Delaney, K. T. Eddy, A. S. Hartmann, A. E. Becker, H. B. Murray, and J. J. Thomas, “Pica and rumination behavior among individuals seeking treatment for eating disorders or obesity,” International Journal of Eating Disorders, 2014.
[48]  A. Domingo-Claros, E. Alonso, and E. de La Banda, “Schizophrenia and refractory anaemia with ring sideroblasts,” British Journal of Haematology, vol. 125, no. 5, p. 543, 2004.
[49]  D. A. Beck and N. R. Frohberg, “Coprophagia in an elderly man: a case report and review of the literature,” International Journal of Psychiatry in Medicine, vol. 35, no. 4, pp. 417–427, 2005.
[50]  E. Mercier-Guidez and G. Loas, “Polydipsia and water intoxication in 353 psychiatric inpatients: an epidemiological and psychopathological study,” European Psychiatry, vol. 15, no. 5, pp. 306–311, 2000.
[51]  A. G. Awad and L. N. P. Voruganti, “The impact of newer atypical antipsychotics on patient-reported outcomes in schizophrenia,” CNS Drugs, vol. 27, no. 8, pp. 625–636, 2013.
[52]  S. Leucht, A. Cipriani, L. Spineli, et al., “Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis,” The Lancet, vol. 382, no. 9896, pp. 951–962, 2013.
[53]  D. B. Allison, J. L. Mentore, M. Heo et al., “Antipsychotic-induced weight gain: a comprehensive research synthesis,” American Journal of Psychiatry, vol. 156, no. 11, pp. 1686–1696, 1999.
[54]  J. W. Newcomer, “Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review,” CNS Drugs, vol. 19, supplement 1, pp. 1–93, 2005.
[55]  T. Lencz, D. G. Robinson, B. Napolitano et al., “DRD2 promoter region variation predicts antipsychotic-induced weight gain in first episode schizophrenia,” Pharmacogenetics and Genomics, vol. 20, no. 9, pp. 569–572, 2010.
[56]  O. Sentissi, A. Viala, M. C. Bourdel et al., “Impact of antipsychotic treatments on the motivation to eat: preliminary results in 153 schizophrenic patients,” International Clinical Psychopharmacology, vol. 24, no. 5, pp. 257–264, 2009.
[57]  F. C. J. Starrenburg and J. P. A. M. Bogers, “How can antipsychotics cause diabetes mellitus? Insights based on receptor-binding profiles, humoral factors and transporter proteins,” European Psychiatry, vol. 24, no. 3, pp. 164–170, 2009.
[58]  K. Weston-Green, X.-F. Huang, M. Han, and C. Deng, “The effects of antipsychotics on the density of cannabinoid receptors in the dorsal vagal complex of rats: implications for olanzapine-induced weight gain,” International Journal of Neuropsychopharmacology, vol. 11, no. 6, pp. 827–835, 2008.
[59]  J.-K. Sharpe, N. M. Byrne, T. J. Stedman, and A. P. Hills, “Resting energy expenditure is lower than predicted in people taking atypical antipsychotic medication,” Journal of the American Dietetic Association, vol. 105, no. 4, pp. 612–615, 2005.
[60]  J.-K. Sharpe, T. J. Stedman, N. M. Byrne, C. Wishart, and A. P. Hills, “Energy expenditure and physical activity in clozapine use: implications for weight management,” Australian & New Zealand Journal of Psychiatry, vol. 40, no. 9, pp. 810–814, 2006.
[61]  G. P. Reynolds and S. L. Kirk, “Metabolic side effects of antipsychotic drug treatment—pharmacological mechanisms,” Pharmacology and Therapeutics, vol. 125, no. 1, pp. 169–179, 2010.
[62]  T. A. P. Lett, T. J. M. Wallace, N. I. Chowdhury, A. K. Tiwari, J. L. Kennedy, and D. J. Müller, “Pharmacogenetics of antipsychotic-induced weight gain: review and clinical implications,” Molecular Psychiatry, vol. 17, no. 3, pp. 242–266, 2012.
[63]  S. F. Kim, A. S. Huang, A. M. Snowman, C. Teuscher, and S. H. Snyder, “Antipsychotic drug-induced weight gain mediated by histamine H1 receptor-linked activation of hypothalamic AMP-kinase,” Proceedings of the National Academy of Sciences of the United States of America, vol. 104, no. 9, pp. 3456–3459, 2007.
[64]  C. U. Correll, T. Lencz, and A. K. Malhotra, “Antipsychotic drugs and obesity,” Trends in Molecular Medicine, vol. 17, no. 2, pp. 97–107, 2011.
[65]  R. Coccurello and A. Moles, “Potential mechanisms of atypical antipsychotic-induced metabolic derangement: clues for understanding obesity and novel drug design,” Pharmacology and Therapeutics, vol. 127, no. 3, pp. 210–251, 2010.
[66]  T. Baptista, J. Zárate, R. Joober et al., “Drug induced weight gain, an impediment to successful pharmacotherapy: focus on antipsychotics,” Current Drug Targets, vol. 5, no. 3, pp. 279–299, 2004.
[67]  A. F. Chintoh, S. W. Mann, L. Lam et al., “Insulin resistance and decreased glucose-stimulated insulin secretion after acute olanzapine administration,” Journal of Clinical Psychopharmacology, vol. 28, no. 5, pp. 494–499, 2008.
[68]  E. Palik, K. D. Birkás, G. Faludi, I. Karádi, and K. Cseh, “Correlation of serum ghrelin levels with body mass index and carbohydrate metabolism in patients treated with atypical antipsychotics,” Diabetes Research and Clinical Practice, vol. 68, supplement 1, pp. S60–S64, 2005.
[69]  H. A. Nasrallah, “Atypical antipsychotic-induced metabolic side effects: insights from receptor-binding profiles,” Molecular Psychiatry, vol. 13, no. 1, pp. 27–35, 2008.
[70]  U. Werneke, D. Taylor, and T. A. B. Sanders, “Behavioral interventions for antipsychotic induced appetite changes,” Current Psychiatry Reports, vol. 15, no. 3, article 347, 2013.
[71]  V. L. Stauffer, I. Lipkovich, V. P. Hoffmann, A. N. Heinloth, H. S. Scott, and B. J. Kinon, “Predictors and correlates for weight changes in patients co-treated with olanzapine and weight mitigating agents; a post-hoc analysis,” BMC Psychiatry, vol. 9, article 12, 2009.
[72]  A. Serretti and L. Mandelli, “Antidepressants and body weight: a comprehensive review and meta-analysis,” Journal of Clinical Psychiatry, vol. 71, no. 10, pp. 1259–1272, 2010.
[73]  J. E. Mitchell, J. Roerig, and K. Steffen, “Biological therapies for eating disorders,” International Journal of Eating Disorders, vol. 46, no. 5, pp. 470–477, 2013.
[74]  D. Le Grange, J. Lock, K. Loeb, and D. Nicholls, “Academy for eating disorders position paper: the role of the family in eating disorders,” International Journal of Eating Disorders, vol. 43, no. 1, pp. 1–5, 2010.
[75]  W. S. Agras and A. H. Robinson, “Forty years of progress in the treatment of the eating disorders,” Nordic Journal of Psychiatry, vol. 62, supplement 47, pp. 19–24, 2008.


comments powered by Disqus