Long-term neuroleptic therapy in chronic anorexia nervosa complicated by tardive dyskinesia. A case report

A patient is described with a 25-year history of disabling, and at times life-threatening, anorexia nervosa alternating with major depression associated with suicidal ideation. Repeated relapse occurred despite a variety of treatments until the institution of high-dose neuroleptic therapy. On this regime, together with supportive psychotherapy, she experienced a sense of emotional well-being, exhibited a good level of functioning and maintained a safe body weight. Multiple attempts to withdraw the medication resulted in relapse. Recently, the patient has exhibited signs of tardive dyskinesia. Possible mechanisms underlying her response to this form of treatment are discussed. The characteristics of the small subgroup of chronic anorexics, in whom the risk/benefit ratio may justify such a regime, are tentatively outlined.