5.1.4 AN- Treatment (Drug Therapy)

Question 1

Why would drug therapy be suggested as a biological treatment for anorexia?

Answer 1

If it is assumed that disorders occur biologically, then treatment should also originate biologically.

Question 2

Who publish guidelines for treating mental illness?

Answer 2

National Institute for Health and Care Excellence (NICE).

Question 3

What did NICE suggest about treatments for anorexia?

Answer 3

That drug therapy should be a last resort and to use other methods such as family therapy first.

Question 4

What is the rationale of using drugs for anorexia?

Answer 4

Low levels of neurotransmitters are found in anorexics
Serotonin is associated with suppression of appetite and and mood
Disruption to this leads to increased anxiety which can trigger anorexia

Question 5

What is a co-morbid symptom

Answer 5

A disorder that may result from the main diagnosis.

Question 6

List 3 example of co-morbid symptoms.

Answer 6

1) Depression
2) Anxiety
3) OCD

Question 7

What 2 types of drugs are used to treat anorexia and co-morbid symptoms?

Answer 7

1) Selective serotonin reuptake inhibitors (SSRIs)

2) Antipsychotics

Question 8

Briefly explain how SSRIs work, using an example

Answer 8

Antidepressants that use natural neurotransmitters
They block reuptake of serotonin in the presynaptic neurons
This means more serotonin is available in the synapse for stimulation which increases levels
They can help with co-morbid symptoms of anxiety and depression
Citalopram is an example of an SSRI

Question 9

SSRI- Supporting Studies

Answer 9

P - Fassino et al (2002) supports SSRIs treating co-morbid symptoms
E - He found that Citalopram didn’t help with weight gain but did help with depression and OCD
E - Therefore demonstrating that they can be used to treat co-morbid symptoms that may then lead to recovery

Question 10

Briefly explain how antipsychotics work, using an example.

Answer 10

Focus on dopamine due to the assumption that unusual dopamine functioning in the striatum may contribute to anorexia
The striatum is associated with the reward pathway that corrects functioning of feeling satisfied after eating
They bind to D2 receptors and block them to inhibit stimulation of dopamine receptors
It also helps to reduce co-morbid symptoms such as anxiety due to dopamine being responsible for regulating emotional responses and so normal levels will allow normal emotional responses
Olanzapine is an atypical antipsychotic drug

Question 11

Antipsychs- Supporting Studies

Answer 11

P - Powers et al (2002) supports antipsychotics as a treatment for anorexia
E - Found that 10/18 patients gained weight when using Olanzapine, 4 didn’t complete the study and 4 lost weight
E - Whilst this study has mixed success it shows that overall there is a gain in weight and so treats anorexia

Question 12

DESSERT-Diff treatment

Answer 12

P - Token economy as an alternative treatment
E - It uses principles from operant conditioning to reinforce desirable behaviour of gaining weight for anorexics and rewarding them with tokens that can be exchanged for money or family time
E - This is a long-term patient-centred process that allows the individual to find independence in their own improvement and so is better than the short-term improvement of drug treatment

Question 13

DESSERT-Expense

Answer 13

P - Highly expensive
E - It can be very costly to buy the medication for this treatment especially if the patient would need to try different SSRIs or antipsychotics in order to see improvements
E - Therefore this renders the treatment ineffective as people may be deterred to complete treatment due to the price

Question 14

DESSERT-Supporting & Rejecting studies

Answer 14

P - Kaye et al (2001) supports SSRIs treating anorexia
E - Used a double blind study to compare the outcomes of Fluoxetine and a placebo and found that those taking the SSRI were more likely to stay on medication and had much lower relapse rates, measure by body weight
E - Therefore demonstrating that SSRIs reduce relapses and increase time spent taking medication so improves anorexia
P - Ferguson et al (1999) rejects the use of SSRIs to treat anorexia
E - Compared 24 patients taking SSRIs to 16 patients who weren’t and found no significant difference between their body weight or anxiety levels
E - This therefore suggests that the use of drugs had no significant impact on treatment outcomes for AN

Question 15

DESSERT-Side effects

Answer 15

P - Antipsychotics have severe side effects
E - Dally and Sargant (1966) reported seizures in patients who were treated with Chlorpromazine with other side effects including insomnia and nausea
E - These may cause a patient to stop taking medication due to not wanting to experience the side effects and so may cause their disorder to worsen giving them a relapse

Question 16

DESSERT-Ethics

Answer 16

P - Weight gain can be unethical
E - The side effect of weight gain due to medication can cause psychological distress in patients who are considered a vulnerable group (due to their poor health, such as heart problems from low blood pressure)
E - This reduces the effectiveness of drug treatments as they may cause a patient to stop medicating which would lead to a relapse but may also worsen co-morbid symptoms such as anxiety through gaining unwanted weight