# Food for thought: re-emergence of tardive dyskinesia amid nutritional rehabilitation of atypical anorexia nervosa; a case report

## TL;DR

A patient with atypical anorexia nervosa and bipolar disorder developed tardive dyskinesia during nutritional rehabilitation, possibly due to changes in medication metabolism.

## Contribution

This case highlights how refeeding in malnourished patients may affect antipsychotic metabolism and trigger movement disorders.

## Key findings

- A patient on lurasidone developed tardive dyskinesia during nutritional rehabilitation for atypical anorexia nervosa.
- Symptoms improved after reducing the lurasidone dose, suggesting a link between refeeding and medication metabolism.
- The case underscores the need to monitor antipsychotic side effects during eating disorder recovery.

## Abstract

Atypical anorexia nervosa is an eating disorder that involves significant restriction of food intake leading to clinically significant weight loss despite remaining at a normal or above normal weight for age or height. Part of rehabilitation involves increasing calorie intake for nutritional rehabilitation and weight gain to an appropriate percentage of ideal body weight, determined based on patient weight history. This report highlights the importance of considering how increased food intake in a previously malnourished patient can affect the metabolism of medications they are taking for the management of co-occurring psychiatric conditions, including the possibility of the emergence or re-emergence of tardive dyskinesia for a patient on an antipsychotic.

This case presents a 43-year-old female with a history of bipolar disorder type 1, controlled on lurasidone, admitted to an inpatient eating disorder unit for nutritional rehabilitation and weight restoration for atypical anorexia nervosa. Shortly after admission, despite no initial change in medication dosing, the patient began exhibiting symptoms of tardive dyskinesia. These symptoms were reduced once her lurasidone dose was decreased.

Nutritional rehabilitation likely has an impact on the metabolism of certain antipsychotic medications including lurasidone. More research is needed involving patients recovering from a restrictive eating disorder who are on antipsychotic medications and the frequency of increased side effects, including tardive dyskinesia, with refeeding.