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Eating Disorders in Schizophrenia: Implications for Research and Management

DOI: 10.1155/2014/791573

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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

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