Repeated paranoid-hallucinatory psychosis after beginning of a fasting period in a patient with anorexia nervosa

We report the case of a 37-year old female patient with anorexia nervosa. F or many years, this patient fasted for various periods, from days to weeks, in order to reduce her body weight and to achieve an euphorical effect. In the course of the past four years she developed acute paranoid-hallucinato ry psychosis immediately following one week episodes of fasting, requiring psychiatric in-patient treatment three times. Psychotic prodromal symptoms could not be elicited before nor at the beginning of fasting periods, point ing towards a caustic relationship between the fasting and the psychotic de compensation. Based on this case, we discuss the hypothesis that the fastin g in anorexia nervosa leads to acute hyperactivity of the dopaminergic syst em which could explain the development of paranoid-hallucinatory psychosis. This case examplifies that vulnerable patients with a similar history shou ld strongly be advised to avoid fasting and other dietetic methods. Explana tion of the enhanced risk to develop psychosis could be of therapeutic use for treating the anorexia nervosa in such patients.