Weekly Mind Reader: Food for Thought

This week, we explore the latest research on PTSD, alcohol use in anorexia, and alcohol’s impact on transgender patients.

Eating Disorders and Alcohol Misuse

Anorexia nervosa and alcohol use disorder share significant biological and psychological overlaps, posing severe health risks when co-occurring, according to a new case report in The Primary Care Companion for CNS Disorders (PCC).

Anorexia ranks as the second most fatal psychiatric disorder – trailing only substance abuse. And patients with both anorexia and AUD face a tenfold higher mortality risk than those without AUD.

Research suggests that one in five people with an eating disorder will struggle with alcohol abuse at some point in their lives. This data underscores the importance of early detection and integrated treatment approaches.

This particular case study focuses on Ms. D, a 57-year-old with a complex medical history, including major depressive disorder, anxiety, osteoporosis, and AUD. After a referral from neurology, she discussed her disordered eating patterns and long-term alcohol use with psychiatric professionals. She added that she leaned on this behavior at first as an appetite stimulant. And despite a low body mass index, she couldn’t help but see herself as overweight. This highlighted the cognitive dissonance typically found in anorexia patients. Medical evaluations confirmed normal metabolic and hormone levels, even though brain imaging revealed an old ischemic event.

Treatment efforts included antidepressants and the antipsychotic olanzapine, aimed at managing her depressive and eating disorder symptoms. Ms. D found early relief with olanzapine. But she gave it up after an inability to deal with the side effects. Ultimately, caregivers move her to a community mental health center.

Anorexia and AUD share multiple underlying factors, such as cardiac risks, hypokalemia, and cognitive distortions. As a result, patients must manage their medication carefully. 

Critical considerations include biopsychological characteristics such as genetic predispositions, nutrient deficiencies, and emotional defense mechanisms.

Experts typically advise a multimodal treatment approach that  integrates cognitive-behavioral therapy, family support, and motivational techniques. Psychiatric professionals can play a vital part in diagnosing and managing these challenging comorbid conditions, emphasizing individualized care that accounts for each patient’s ability to adapt.

IN OTHER PSYCHIATRY AND NEUROLOGY NEWS

• The Journal of Clinical Psychiatry this week features a commentary on U.S. transgender and gender diverse individuals who wrestle with high rates of substance use disorder.
• PCC this week also includes a narrative review of how to best handle behavioral and psychological symptoms of dementia (BPSD) with nonpharmacologic interventions.
• JCP also has promising news on hyperbaric oxygen therapy, which demonstrated notable improvements on measures of depression in men with combat-associated PTSD.
• Another PCC case study centers on a 68-year-old cancer patient with delirium during the third cycle of treatment with cisplatin-etoposide.
• And, finally, catch up on the most recent studies exploring PTSD.