Treatment and Outcome of Anorexia Nervosa

Abstract

Comparison of two similar groups of anorexia nervosa patients admitted to hospital shows the superiority of combined treatment with chlorpromazine and modified insulin regimen over other treatments in rapidly restoring lost weight. It seems likely that chlorpromazine is more important than the insulin, which can sometimes be omitted. After discharge about one-third of patients, whatever treatment they may have received in hospital and after discharge, will lose weight and require readmission. Compulsive overeating, resulting in the patient becoming overweight, may occur during the recovery phase, particularly after treatment with chlorpromazine. These symptoms may also be associated with stealing, usually of food. Menstruation will return only when weight increases to at least 75% standard weight and when underlying psychological causes are resolved. The return of menstruation may be delayed longer in patients treated with chlorpromazine than in the control group. When symptoms of anorexia nervosa persist continuously for more than five years, in spite of adequate treatment, the prognosis is poor. But if weight has never been properly restored, treatment with chlorpromazine and modified insulin may result in recovery. Modified leucotomy may be indicated in carefully selected patients long and continuously disabled by their symptoms. © 1966, British Medical Journal Publishing Group. All rights reserved.