fluvoxamine and Anorexia-Nervosa

The pathological eating behaviour of patients with anorexia nervosa reflects a deficit in planning real-life strategies that can be observed in an experimental setting through the Gambling Task, a tool designed to detect and measure decision-making abilities. We examined the role of Gambling Task performance as a predictor of treatment outcome in anorectic patients, and we evaluated changes in decision-making after clinical improvement. Performance on the Gambling Task was evaluated, and a clinical-nutritional assessment of 38 anorectic patients was carried out before and after a cognitive-behavioural and drug treatment program. Task performance of anorectic patients was compared with that of 30 healthy control participants. Patients who had a better decision-making profile at baseline showed significantly greater improvement in nutritional status. The decision-making deficiency of some anorectic patients is probably linked to those individual features that contribute to the phenomenological expression of the disorder and to its different treatment outcomes.

Topics: Adult; Anorexia Nervosa; Body Mass Index; Cognition Disorders; Cognitive Behavioral Therapy; Combined Modality Therapy; Decision Making; Demography; Female; Fluoxetine; Fluvoxamine; Gambling; Humans; Interview, Psychological; Neuropsychological Tests; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome

To document a case of serotonin syndrome associated with the combined use of fluvoxamine and mirtazapine, and to discuss the pharmacodynamic and pharmacokinetic interactions that were the likely causes of this potentially serious adverse drug reaction (ADR).. A 26-year-old white woman with a 12-year history of anorexia nervosa was being treated with fluvoxamine. After mirtazapine was added to her therapy, she developed tremors,restlessness, twitching, flushing, diaphoresis, and nausea,symptoms that are consistent with serotonin syndrome.. The possible causes of this ADR are discussed, including the effects of fluvoxamine and mirtazapine alone, the possible pharmacodynamic and pharmacokinetic interactions of these two drugs, and the patients underlying anorexia nervosa.. An increasing number of drugs that affect serotonin are available and are indicated for various disorders. Since there is a significant likelihood of these agents being prescribed concomitantly, clinicians must be aware of possible interactions that could lead to serotonin syndrome.

Topics: Adrenergic alpha-Antagonists; Adult; Adverse Drug Reaction Reporting Systems; Anorexia Nervosa; Drug Interactions; Female; Fluvoxamine; Humans; Mianserin; Mirtazapine; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome; Tissue Distribution