Biological Treatments for AN Flashcards
What are the 2 biological treatments for Anorexia Nervosa? (4 points)
Anti-depressant drugs (SRRI’s) - Prozac (Fluoxetine)
Anti-psychotics - Olanzapine
Normally administered through tablet or syrup form
If a patient forgets or refuses to take them, they can be injected into the bloodstream and physical restraint can be used
What is Prozac and how does it treat AN? (4 points)
A first-generation anti-depressant medication which functions as an SSRI (selective serotonin reuptake inhibitor)
It blocks the reuptake transport protein that normally functions to remove serotonin from the synapse and recycle it back into synaptic vesicles
This causes serotonin to remain in the synapse of the AN patients’ brain, causing increased neurotransmission and improved mood
Fluoxetine was first used to treat depression and other clinical disorders - now used to stabilise AN patients’ serotonin levels
What is Olanzapine and how does it treat AN? (3 points)
Second-generation atypical antipsychotic - functions as a Dopamine D2 receptor antagonist (blocker) and Serotonin 5HT2-A receptor antagonist (blocker)
Unlike Fluoxetine, it has been shown to increase appetite and weight gain because of antagonism at histamine and acetylcholine receptors
Mood-modulating effects seen with Olanzapine were also identified in bipolar patients - has been applied to adjunctive therapy for a range of clinical disorders including OCD
What is the history of Olanzapine? (3 points)
Was first identified as a treatment for Sz patients to address positive symptoms like hallucinations and delusions
However, Sz patients soon refused to take the drug due to its adverse side effect of weight gain
It was then introduced as a biological treatment for anorexic patients, who suffer similar symptoms of delusional thinking concerning distorted body image - they would benefit from gaining weight
How are anti-depressants as a biological treatment for AN? (5 points)
They have been shown to reduce the symptoms of low mood seen in anorexic patients
However, there is inconclusive evidence about their effectiveness in preventing weight loss for AN patients
Side effects:
+ Nausea
+ Fatigue
+ Headaches
Kaye et al., 2001 and Walsh et al. (2006): Found no benefit of Prozac treatment in AN patients, even when combined with CBT
Their use as a biological treatment for AN is limited - does not address critically low levels of BMI which can put AN patients at immediate risk of cardiac arrest
How is Olanzapine as a biological treatment for AN? (5 points)
Suggested to be more suitable for AN patients than anti-depressants
Advantages:
Focuses on the interaction of dopamine and serotonin systems - shown to reduce body dysmorphia and fear of weight gain in AN patients
Increases appetite and weight gain due to anti-histaminergic and anti-muscarinic blockade effects
Decreases anxiety and obsessional thinking (unlike Prozac)
Disadvantages:
Low extrapyramidal effects like Tardive Dyskinesia
What are the 1 supporting and 3 refuting arguments for anti-psychotics as a biological treatment for AN?
Supporting:
Bissada et al (2008)
Refuting:
Mitchell et al
Zhu & Walsh (2002) and Casper (2003)
CBT-E
How does Bissada et al. (2007) support anti-psychotics as a biological treatment for AN? (2 points)
Olanzapine is suggested to significantly increase appetite, slow metabolism and alter all kinds of homeostatic physiological functions
There are empirical research studies like Bissada et al. (2007) which support the use of antipsychotics as a treatment for AN
Describe Bissada et al. (2007), which supports anti-psychotics as a biological treatment for AN. (2 points)
Investigated the use of Olanzapine in 34 AN patients compared to a placebo group over 10 weeks
Patients treated with Olanzapine presented a higher recovery rate of weight gain and improvement in obsessive-compulsive symptoms
How does Mitchell et al. (2013) challenge biological treatments of Sz? (2 points)
No medication has been shown to be effective for the core symptoms of anorexia nervosa in adults or children
Mitchell et al. (2013):
Claims that antidepressants were more effective with bulimia patients than anorexics
How do Zhu & Walsh (2002) and Casper (2003) challenge biological treatments of Sz? (3 points)
Zhu & Walsh (2002) and Casper (2003):
Argue that drug therapy has limited use - not recommended as a first calling point for treatment because of low compliance by AN patients
Anorexic patients may also be prone to further risk from drug therapy, such as cardiac arrest, as they tend to have poor physical health due to malnutrition
Although 2nd generation anti-psychotic drugs like Olanzapine address BMI in anorexic patients, the risk of poor physical health remains
How does CBT-E challenge biological treatments of Sz? (4 points)
Antipsychotic medication is reductionist - only treats the symptoms of anorexia and fails to account for the underlying cause of the eating disorder
An alternative to biological treatment is CBT-E - a cognitive therapy which focuses on maladaptive thinking and how it can be readjusted through counselling
Grave (2014):
+ 96% of patients completed a 20-week CBT-E inpatient treatment programme
+ BMI changes were maintained at the 1-year follow-up
Perhaps a combined approach of antipsychotics with CBT will allow for both physical and mental symptoms of AN to be addressed
