Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-17T05:54:03.316Z Has data issue: false hasContentIssue false
  • English
  • Français

Nature Against Nurture: Calcification in the Right Thalamus in a Young Man with Anorexia Nervosa and Obsessive-Compulsive Personality Disorder

Published online by Cambridge University Press:  07 November 2014

Rupert Conrad ,
Ingo Wegener ,
Franziska Geiser ,
Katrin Imbierowicz  and
Reinhard Liedtke
Get access Rights & Permissions [Opens in a new window]

Abstract

This report describes the case of a young man with a large calcification in the right thalamus that was first diagnosed at 9 years of age. Case history reveals specific eating rituals and other obsessive-compulsive personality traits during the patient's childhood and adolescence, fulfilling diagnostic criteria of obsessive-compulsive personality disorder. After a critical life event the patient develops anorexia nervosa. We suggest that our case and further literature provide evidence for an involvement of specific thalamic structures, such as the dorsomedial nucleus, in the development of anorexia nervosa. Furthermore, the treatment of the patient by a combined psychotherapeutic and pharmacotherapeutic approach is described. We focus on the beneficial effect of the atypical antipsychotic olanzapine, which can induce weight gain by an increase of leptin levels.

Type
Case Report
Information
CNS Spectrums , Volume 13 , Issue 10 , October 2008 , pp. 906 - 910
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Anderluh, MB, Tchanturia, K, Rabe-Hesketh, S, Treasure, J. Childhood obsessive-compulsive personality traits in adult women with eating disorders: defining a broader eating disorder phenotype. Am J Psychiatry. 2003;160:242–247.Google Scholar
2.Cassin, SE, von Ranson, KM. Personality and eating disorders: a decade in review. Clin Psychol Rev. 2005;25:895–916.Google Scholar
3.Srinivasagam, NM, Kaye, WH, Plotnicov, KH, Greeno, C, Weltzin, TE, Rao, R. Persistent perfectionism, symmetry, and exactness after long-term recovery from anorexia nervosa. Am J Psychiatry. 1995;152:1630–1634.Google Scholar
4.Lilenfeld, LR, Kaye, WH, Greeno, CG, et al.A controlled family study of anorexia nervosa and bulimia nervosa: psychiatric disorders in first-degree relatives and effects of proband comorbidity. Arch Gen Psychiatry. 1998;55:603–610.Google Scholar
5.Halmi, KA, Sunday, SR, Klump, KL, et al.Obsessions and compulsions in anorexia nervosa subtypes. Int J Eat Disord. 2003;33:308–319.Google Scholar
6.McGuire, PK, Bench, CJ, Frith, CD, Marks, IM, Frackowiak, RS, Dolan, RJ. Functional anatomy of obsessive-compulsive phenomena. Br J Psychiatry. 1994;164:459–68.CrossRefGoogle ScholarPubMed
7.Graybiel, AM, Rauch, SL. Toward a neurobiology of obsessive compulsive disorder. Neuron. 2000;28:343–347.CrossRefGoogle Scholar
8.Lopez, OL, Berthier, ML, Backer, JT, Boiler, F. Creutzfeldt-Jacob disease with features of obsessive-compulsive disorder and anorexia nervosa: the role of cortical-subcortical systems. Neurospychiatry Neuropsychol Behav Neurol. 1997;10:120–124.Google Scholar
9.Barbarich, N. Is there a common mechanism of serotonin dysregulation in anorexia nervosa and obsessive-compulsive disorder? Eat Weight Disord. 2002;7:221–231.Google Scholar
10.Harel, Z, Hallett, J, Riggs, S, Vaz, R, Kiessling, L. Antibodies against human putamen in adolescents with anorexia nervosa. Int J Eat Disord. 2001;29:463–469.CrossRefGoogle ScholarPubMed
11.Ansari, MO, Chincanchan, CA, Armstrong, DL. Brain calcification in hypoxic-ischemic lesions: an autopsy review. Pediatr Neurol. 1990;6:94–101.Google Scholar
12.Lacerda, AL, Dalgalarrondo, P, Caetano, D, Haas, GL, Camargo, EE, Keshavan, MS. Neuropsychological performance and regional cerebral blood flow in obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2003;27:657–665.Google Scholar
13.Lacerda, AL, Dalgalarrondo, P, Caetano, D, Camargo, EE, Etchebehere, EC, Soares, JC. Elevated thalamic and prefrontal regional cerebral blood flow in obsessive-compulsive disorder: a SPECT study. Psychiatry Res. 2003;123:125–134.Google Scholar
14.Bussato, GF, Buchpiguel, CA, Zamignani, DR, et al.Regional cerebral blood flow abnormalities in early-onset obsessive-compulsive disorder: an exploratory SPECT study. J Am Acad Child Adolesc Psychiatry. 2001;40:347–354.Google Scholar
15.Husain, MM, Black, KJ, Doraiswamy, PM, et al.Subcortical brain anatomy in anorexia and bulimia. Biol Psychiatry. 1992;31:735–738.Google Scholar
16.Chowdhury, U, Gordon, I, Lask, B, Watkins, B, Watt, H, Christie, D. Early-onset anorexia nervosa: Is there evidence of limbic system imbalance? Int J Eat Disord. 2003;33:388–396.CrossRefGoogle ScholarPubMed
17.Takano, A, Shiga, T, Kitagawa, N, et al.Abnormal neuronal network in anorexia nervosa studied with I-123-IMP SPECT. Psychiatry Res. 2001;107:45–50.Google Scholar
18.Rousseaux, M, Muller, P, Gahide, I, Mottin, Y, Romon, M. Disorders of smell, taste, and food intake in a patient with a dorsomedial thalamic infact. Stroke. 1996;27:2328–2330.Google Scholar
19.D'Andrea, F, De Divitiis, E, Megna, G, De Giacomo, P, Pierri, G. Remission of “mental anorexia” following stereotactic thalamolysis (previously resistant to other therapies). Riv Patol Nerv Ment. 1974;95:579–590.Google Scholar
20.Zamboni, R, Larach, V, Poblete, M, et al.Dorsomedial thalamotomy as a treatment for terminal anorexia: a report of two cases. Acta Neurochir Suppl (Wien). 1993;58:34–35.Google Scholar
21.Dusoir, H, Owens, C, Forbes, RB, Morrow, JL, Flynn, PA, McCarron, MO. Anorexia nervosa remission following left thalamic stroke. J Neurol Neurosurg Psychiatry. 2005;76:144–145.Google Scholar
22.Jones, EG. The Thalamus. 2nd ed. Cambridge, UK: Cambridge University Press; 2007.Google Scholar
23.Wolf, K, Konopacki, J. The effect of lesions of the dorsomedial thalamic nucleus on alimentary conditioned reflexes and food intake in dogs. Acta Physiol Pol. 1975;26:341–346.Google Scholar
24.Li, XB, Inoue, T, Nakagawa, S, Koyama, T. Effect of mediodorsal thalamic nucleus lesion on contextual fear conditioning in rats. Brain Res. 2004;1008:261–272.Google Scholar
25.Van Kuyck, K, Casteels, C, Vermaelen, P, Bormans, G, Nuttin, B, Van Laere, K. Motor-and food-related metabolic cerebral changes in the activity based rat model for anorexia nervosa: a voxel-based MicroPET study. Neuroimage. 2007;35:214–221.Google Scholar
26.American Psychiatric Association. Treatment of patients with eating disorders, third edition. Am J Psychiatry. 2006;163:4–54.Google Scholar
27.Dunican, KC, DelDotto, D. The role of olanzapine in the treatment of anorexia nervosa. Ann Pharmacother. 2007;41:111–115.Google Scholar
28.Wang, HC, Chen, PS, Lee, IH, Yang, YK, Yeh, TL, Lu, RB. Rapid leptin elevation after initiation of olanzapine? Neuropsychobiology. 2006;54:182–185.Google Scholar
29.Chan, JL, Mantzoros, CS. Role of leptin in energy deprivation states: normal human physiology and clinical implications for hypothalamic amenorrhoea and anorexia nervosa. Lancet. 2005;366:74–85.Google Scholar
30.Hebebrand, J, Muller, TD, Holtkamp, K, Herpertz-Dahlmann, B. The role of leptin in anorexia nervosa: clinical implications. Mol Psychiatry. 2007;12:23–35.Google Scholar
31.Wang, TS, Chou, YH, Shiah, IS. Combined treatment of olanzapine and mirtazapine in anorexia nervosa associated with major depression. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30:306–309.CrossRefGoogle ScholarPubMed
32.Fountoukalis, KN, Iacovides, A, Siamouli, M, Koumaris, V, Kaprinis, GS. Successful treatment of anorexia with a combination of high-dose olanzapine, fluoxetine and mirtazapine. Int J Clin Pharmacol Ther. 2006;44:452–453.Google Scholar
33.Claudino, AM, Hay, P, Lima, MS, Bacaltchuk, J, Schmidt, U, Treasure, J. Antidepressants for anorexia nervosa. Cochrane Database Syst Rev. 2006;40:11–24.Google Scholar
34.Steinhausen, HC. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2002;159:1284–1293.Google Scholar