A survey on self-reported psychotropic drug prescribing practices of eating disorder psychiatrists for the treatment of young people with anorexia nervosa

Abstract

Objectives: To survey current prescribing practices of psychotropic drugs by child and adolescent eating disorder (CAED) psychiatrists in the treatment of anorexia nervosa (AN). Design: Cross-sectional self-administered survey. Setting: All child and young people eating disorder services (CYP EDS) in England during a national training program. Participants: 44 child and adolescent eating disorder psychiatrists practicing in CYP EDS in England. Primary and secondary outcome measures: CAED psychiatrists completed a questionnaire regarding the pattern of psychopharmacological care in AN they provide and the medication treatment pattern at their CYP EDS. Secondary outcome measures included the process of continuing pharmacotherapy from secondary care to primary care. Results: Of the 77 CYP EDS representing every team in England, 44 teams represented by a CAED psychiatrist responded, despite 13 having no psychiatrists in post at the time of the study (response rate 69%). Most (40%) respondents estimated <10% of patients with AN were prescribed psychotropic medications. Olanzapine was reported as the most commonly prescribed medication for AN by 38% of respondents, followed by fluoxetine (29%) and sertraline (10%). The most common minimum olanzapine initiation dose in this study was at 2.5mg/day for a duration of 2 to 4 weeks, reaching a maximum dose of 5mg/day. Most (68%) reviewed medications every week (30%) or every two weeks (38%). Over 50% of respondents reported to continue olanzapine prescribing within the CYP EDS teams. Conclusions: This nationally representative survey showed that despite a lack of evidence, psychotropic medications are commonly prescribed to a minority of patients, most frequently olanzapine. Further evidence is needed on which patients may potentially benefit from pharmacotherapy as an adjunct to psychological interventions.