Anorexia: Biological Treatment - Drug Treatments Flashcards
Why would drug therapy be suggested as a biological treatment for anorexia?
If it is assumed that disorders occur biologically, then treatment should also originate biologically.
Who publish guidelines for treating mental illness?
National Institute for Health and Care Excellence (NICE).
What did NICE suggest about treatments for anorexia?
That drug therapy should be a last resort and to use other methods such as family therapy first.
What is the rationale of using drugs for anorexia?
- 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
What is a co-morbid symptom?
A disorder that may result from the main diagnosis.
List 3 example of co-morbid symptoms.
1) Depression
2) Anxiety
3) OCD
What 2 types of drugs are used to treat anorexia and co-morbid symptoms?
1) Selective serotonin reuptake inhibitors (SSRIs)
2) Antipsychotics
Briefly explain how SSRIs work, using an example.
- 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
Evaluate a supporting piece of evidence for SSRIs treating anorexia.
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
Briefly explain how antipsychotics work, using an example.
- 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
Evaluate a supporting piece of evidence for antipsychotics treating anorexia.
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
Using the acronym ‘DESSERT’, evaluate a ‘different treatment’ point.
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
Using the acronym ‘DESSERT’, evaluate an ‘expense’ point.
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
Using the acronym ‘DESSERT’, evaluate a supporting and rejecting ‘studies’ point.
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 anorexia
Using the acronym ‘DESSERT’, evaluate a ‘side effects’ point.
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
Using the acronym ‘DESSERT’, evaluate an ‘ethics’ point.
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
Using the acronym ‘DESSERT’, evaluate a ‘reason or mask’ point.
P - Drugs mask the problem
E - Drugs mainly treat co-morbid symptoms such as depression and anxiety that can worsen the disorder and different types of anorexia (restricting and binging) will require different ways of being treated
E - Therefore does not get to the root of the problem that caused the disorder, only masks symptoms, and so is not effective
Using the acronym ‘DESSERT’, evaluate a ‘time commitment’ point.
P - Patients must commit to taking the drugs regularly
E - For some the treatment plan may be short-term however some are placed on it for life and so taking medication takes up a lot of time
E - Therefore this may result in demotivation and result in a relapse
Any other evaluation points?
P - Reductionist
E - It only focuses on treating symptoms caused by biological reasons such as a chemical imbalance of the neurotransmitters serotonin and dopamine
E - Therefore it doesn’t account for environmental factors that may be influencing relapse of a patient or cause of the disorder
P - There have been recent improvements in drug threatments
E - Court et al (2012) found that low doses of the antipsychotic Quetiapine showed improvements with very few side effects due to its low dosage
E - Therefore patients may be more likely to seek help due to the reduced consequences, however there is still a way to go
