Jeremias Daniela, Santana Leonor, Braga Francisca, Mesquita Bárbara, Santos Catarina
Psychiatry Department, Hospital de Egas Moniz - Unidade Local de Saúde de Lisboa Ocidental, Lisbon, PRT.
Psychiatry Department, Hospital de Cascais, Lisbon, PRT.
Cureus. 2024 Sep 10;16(9):e69076. doi: 10.7759/cureus.69076. eCollection 2024 Sep.
A 32-year-old woman with no prior medical conditions, but a history of anorexia nervosa (AN) diagnosed in adolescence, was referred for evaluation by an eating disorders (ED) specialist due to worsening bingeing and purging behaviors. Her clinical presentation was characterized by a body mass index (BMI) approaching the underweight range and frequent bingeing and purging episodes occurring twice daily, consistent with a diagnosis of BN. No other medical or psychiatric comorbidities were diagnosed, including mood, anxiety, and substance use disorders, which are often comorbid with ED. However, the patient reported significant difficulties in managing both personal and professional activities, attributing these challenges to impaired concentration. She had difficulty staying focused on tasks and was easily distracted by unrelated thoughts or stimuli. As a result, she often procrastinated on household and self-care tasks. She also reported problems with time management, frequently arriving late to work, struggling to complete assignments on time, and underestimating how long tasks would take. Initial treatment with fluoxetine and cognitive behavioral therapy (CBT) yielded no substantial improvement. Given the presence of symptoms suggestive of attention deficit hyperactivity disorder (ADHD), a one-month trial of lisdexamfetamine (LDX) was initiated. This intervention resulted in a marked reduction in bingeing and purging episodes and a notable improvement in the patient's concentration, thereby enhancing her overall quality of life. The importance of ADHD screening is underscored, particularly for high-functioning adult women who may not present typical symptoms. In this case, a thorough clinical assessment and detailed anamnesis raised suspicion of previously unrecognized ADHD, that may have been present since childhood. Although the literature on the comorbidity of ADHD and BN is limited, this case highlights a potential link between the two conditions. The significant improvement observed following the introduction of psychostimulants supports the hypothesis that untreated ADHD may contribute to the exacerbation of BN symptoms. Further research is essential to clarify the underlying mechanisms and establish a solid scientific basis for future clinical interventions and therapeutic strategies.
一名32岁女性，既往无其他疾病史，但在青春期被诊断为神经性厌食症（AN），因暴饮暴食和催吐行为恶化，被转介给进食障碍（ED）专家进行评估。她的临床表现为体重指数（BMI）接近体重过轻范围，且每天频繁出现两次暴饮暴食和催吐发作，符合神经性贪食症（BN）的诊断。未诊断出其他医学或精神科合并症，包括通常与进食障碍合并存在的情绪、焦虑和物质使用障碍。然而，患者报告在处理个人和职业活动方面存在重大困难，将这些挑战归因于注意力不集中。她难以专注于任务，容易被无关的想法或刺激分散注意力。因此，她经常拖延家务和自我护理任务。她还报告了时间管理方面的问题，经常上班迟到，难以按时完成任务，并且低估了任务所需的时间。最初使用氟西汀和认知行为疗法（CBT）治疗未取得实质性改善。鉴于存在提示注意力缺陷多动障碍（ADHD）的症状，开始了为期一个月的赖右苯丙胺（LDX）试验。这种干预措施使暴饮暴食和催吐发作显著减少，患者的注意力有了明显改善，从而提高了她的整体生活质量。强调了ADHD筛查的重要性，特别是对于可能未表现出典型症状的高功能成年女性。在这个案例中，全面的临床评估和详细的病史引发了对先前未被认识到的ADHD的怀疑，这种怀疑可能自童年就已存在。尽管关于ADHD和BN合并症的文献有限，但这个案例突出了这两种情况之间的潜在联系。引入精神兴奋剂后观察到的显著改善支持了这样一种假设，即未经治疗的ADHD可能导致BN症状加重。进一步的研究对于阐明潜在机制并为未来的临床干预和治疗策略建立坚实的科学基础至关重要。
