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This case report emphasizes that increased food intake in previously malnourished patients can alter metabolism of medications used for co-occurring psychiatric conditions, including the potential re-emergence of tardive dyskinesia in patients taking an 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Journal of Eating Disorders (2026) 14:7  \n[https://doi.org/10.1186/s40337-025-01466-w](https://doi.org/10.1186/s40337-025-01466-w)  \nJournal of Eating Disorders  \nCASE REPORT Open Access  \nFood for thought: re-emergence of tardive dyskinesia amid nutritional rehabilitation of atypical anorexia nervosa; a case report  \nNicole Gulino 1,2*, Ally Reardon 1,2 and Matthew J. Johnson 1,2,3  \nAbstract  \nBackground 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.  \nCase presentation 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 foratypical 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. Conclusions 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. Keywords Case report, Tardive dyskinesia, Lurasidone, Anorexia, Nutritional rehabilitation  \n*Correspondence:  \nNicole Gulino  \n[nmh112@rwjms.rutgers.edu](nmh112@rwjms.rutgers.edu)  \n1Rutgers Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick, NJ 08901, USA  \n2Department of Psychiatry, Robert Wood Johnson University HospitalSomerset, 110 Rehill Ave, Somerville 08876, NJ, USA  \n3Encompass Psychiatry, Morristown, NJ, USA  \nBackground  \nAtypical anorexia nervosa (AAN) is an eating disorder characterized by significant energy restriction leading to clinically significant weight loss despite remaining ata normal or above normal weight for age or height [1]. Anorexia nervosa (AN) presents similarly, but with a reduction in body weight leading to low body weight and body mass index (BMI) for age or height [2]. In both conditions, current management strategies focus on nutritional rehabilitation and weight gain to an appropriate percentage of ideal body weight, determined by the patient’s weight history. Pharmacologic agents, such as antidepressants, antipsychotics, anti-anxiety  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://creativecommons.org/l)","cbCaioibvAhIz61h","https://ap.wps.com/l/cbCaioibvAhIz61h","pdf",960099,"English","# Abstract\n## Background\n## Case presentation\n## Conclusions\n# Background\n## Tardive dyskinesia and medication metabolism\n# Case presentation\n## Patient history and presentation","[{\"question\":\"What is the clinical concern addressed by this case report?\",\"answer\":\"The report highlights that nutritional rehabilitation and increased food intake in a previously malnourished patient may affect the metabolism of antipsychotic medications, potentially leading to the emergence or re-emergence of tardive dyskinesia.\"},{\"question\":\"What patient characteristics and treatment context are described?\",\"answer\":\"A 43-year-old woman with bipolar disorder type 1, controlled on lurasidone, was admitted to an inpatient eating disorder unit for nutritional rehabilitation and weight restoration for atypical anorexia nervosa.\"},{\"question\":\"How did the tardive dyskinesia symptoms respond during treatment?\",\"answer\":\"Shortly after admission, the patient developed tardive dyskinesia symptoms despite no initial medication dosing change, and the symptoms were reduced after her lurasidone dose was decreased.\"}]","Food for thought - re-emergence of tardive dyskinesia amid nutritional rehabilitation of atypical anorexia nervosa - a case report | PDF"]