Cases of Patients with Eating Disorder Complicated by Schizophrenia(Symposium/Mental Disorders Coexisting with Eating Disorders)

Abstract

Introduction: The number of patients with an eating disorder complicated by schizophrenia is reportedly small; that is approximately 0.4% of the total patients with an eating disorder. In clinical practice, the complication of schizophrenia is often suspected in patients with severe and intractable symptoms of eating disorder. At Kitasato University East Hospital, we encountered patients who first presented with symptoms of eating disorder and then were definitively diagnosed as having schizophrenia. We report these cases here. Method: The study subjects were 12 patients who were referred to the Department of Psychiatry, Kitasato University East Hospital as outpatients with an eating disorder from April 2004 to December 2009 and were diagnosed as having schizophrenia as a complicating disorder. They first presented typical symptoms of eating disorder and later the symptoms of schizophrenia became evident. Therefore, initially they were not diagnosed as having schizophrenia. The first diagnoses of these patients were anorexia nervosa of the restricting (AN-R) type (five patients), anorexia nervosa of the binge eating/purging (AN-BP) type (four patients), and bulimia nervosa (BN) (three patients). Results and Discussion: Seven patients who were treated at our hospital from the initial stage of onset of AN-R type, AN-BP type, or BN were definitively diagnosed as having schizophrenia one to two years from the onset. The psychological symptoms of these patients were relatively stabilized by pharmacotherapy and their social adjustment was worse than that of the patients with an eating disorder but without schizophrenia. The therapeutic method adopted at a hospital should be determined considering the psychological symptoms of the patients. It is considered that the treatment of eating disorder should precede that of schizophrenia when obsessive persistency such as fat phobia and hyperactivity are involved even though schizophrenia is suspected. The patients were very sensitive to subtle stimulations and environmental changes, and commonly characterized by affective lability. For patients who present typical eating disorder symptoms and tend to have the above-mentioned characteristics, pharmacotherapy should be applied by carefully considering the psychopathic symptoms.