CPG for Eating Disorders

9.10. AntipsychoticsEvidence in AN has been identified for the following Antipsychotics:sulpiride, pimozide and olanzapine.9.10.1. Anorexia nervosa9.10.1.1. What is the efficacy of Antipsychotics in patients with AN?The answer is based on the NICE CPG (2004) 30 and on a high-quality SRSE (1++)(Dunican,2007) 308 . The updated search has not yielded any new evidence.Scientific EvidenceThere is insufficient evidence to determine that ant psychotics (pimozide and sulpiride)have an impact on body weight vs. placebo during multimode treatment of inpatientswith AN (2 crossed studies; N=32; pimozide [Vandereycken, 1982] 309 and sulpiride[Vandereycken, 1984] 310 ).There is insufficient evidence to determine that there is any significant differencebetween antipsychotics and antidepressants in terms of weight gain in cases of AN.RCT1++RCT1++Summary of the EvidenceSRSE 3081++SRSE 3081++In some of the case series and in most of the RCTs, patients with AN gainedweight while receiving treatment with olanzapine, achieving healthy weight inmany cases. Reported cases and RCTs identified additional benefits ofolanzapine, including the reduction of delusional beliefs, improvement of bodyself-image, decrease of agitation and anxiety prior to meals, improvement ofsleep, depressive symptoms and treatment adherence and other symptomsrelated with eating disorders.Preliminary evidence supports the use of olanzapine for the treatment of AN,demonstrating that a 2.5 to 15 daily mg dose promotes weight gain and haspositive effects on related psychological symptoms. The limitations of the dataanalysed are: small sample, high dropout rate in the RCT and the open designof the RCT.Summary of the Evidence(See also recommendations 9.GPH.1. to 9.GPH.6.)150CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS