[Manic psychosis as a complication of coercive treatment in severe anorexia nervosa]

Anorexia nervosa is a severe psychiatric disorder, with a mortality rate of 15%. Comorbid disorders are common, however there are no clinical guidelines for the treatment of anorexia nervosa and comorbid bipolar disorder. We describe the casus of a 27-year-old female patient, with a history of anorexia nervosa, depressive disorder, and ADHD, who was admitted to our medical psychiatric unit because of severe underweight (BMI 13.6 kg/m2, weight 36.8 kg). The coercive treatment was complicated by a manic psychosis. Treatment with olanzapine and lorazepam was ineffective, the manic psychosis posed a somatic threat. Zuclopentixol quickly resolved the manic symptoms. However, within months after discontinuation, a relapse into manic psychosis occurred. This case report highlights the importance of research into the acute and prophylactic treatment of anorexia nervosa and comorbid bipolar disorder.