Drug treatments of AN Flashcards
Drugs AN
Seretonin
AN = Low lvls of Seretonin metabolitesbin cerebrospinal fluid than not AN
Body Synthesises Seretonin from food we eat, so Stsrvation = low lvls Sere
• Kaye, Fudge and Paulus 2009
Hypothesise that when sere decresses in starvation
– brain responds by increasing lvl of Sere receptord to utalise the remanding seretonin more effectivley
– to feel better as this seretonin is used, the person continues to starve themselfs
• researchers show when AN eats, Seretonin lvls spike Rapidly, causing Xtreem anxiety
– known as Seretonin Syndrome
– as sere is primarily produced in the Gastrointedtinal tract, a sudden increase in it resultd in:
– Nausea, Agitation and Anxiety
– this is why AN have a restrictive diet as dont want this
– also y they develop a fear of eating
Drugs AN
Dopamine
• hypothesised that AN is associated with a over-production of Dopamine
– causes anxiety and harm avoidence
– And the ability to go w/o food, which would bring healthy people satisfaction
• Dieting + high lvls exeesise also triggers a stress response in the brain
– Stress increases Dopamine in the Reward pathway in AN ppl
– Elevated Dopamine is then beleived to aid rewarding behaviours such as Self-Starvation and Excessive exersise to become Habits (Like a drug addiction)
Drugs AN
Drug Treatments
• Drug treatments are commonly used to treat the co-morbid symptoms of AN such as: depression and anxiety
• In the UK, the NICE Guidelines (2004)
– do not suggest that drug therapy is used as the first choice of treatment
– due to them not helping with the core symptoms of the disorder
• The New Zealand Guidelines (2011)
– recommend that family therapy, CBT and dietary advise should be the first choice theraples
– but acknowledge drug treatments can be used alongside these help with co-morbid symptoms.
Drugs AN
SELECTIVE SERETONIN REUPTAKE INHIBITORS
SSRIs
• Cuz of the link between low Sere and AN, SSRIs (Selective Seretonin Reuptake Inhibitors) are oft Perscribed
• Fluoxetine = an SSRI drug
– Workes by increasing Sere lvls
– assumed this will improve the depression and Anxiert behavioural symptoms of AN
– Kaye et al [2001]
– Suggests in higher doses, Fluoxetune helps prevent relapse when individual has finished therapy and is receiving their ‘maintenance dose’
• SSRIs work bt Blocking the Reuptake of Seretonin
– so that all Seretonin thats released cant be reuptaked and recycled and has to bind to a receptor
– Increasing the Levels of Seretonin
Drugs AN
FGAnti-Psychotics
• fga’s work by binding to all D2 dopamine receptors to stop them taking in dopamine
– reducing the levels of Dopamine for our brain
– As AN is thought to be connected to High Dopamime levels as stressing in AN leads to Dopamine overproduction in the reward pathways known as the nucleus accumbens
– which may lead to self starvation and excess exercise
– used to reduce the stressing in AN being rewarded by dopamine
– it therefore becomes a habit like addiction
• so decreasing dopamine levels will decreased AN symptoms
• Chlopromazine has been used and has led to increase weight gain
– however for some patience it also causes severe seizures (Dally and sargant 1966)
– Silverstone (2005)
– Identified that while Anti-psychotics enable patients to achieve weight gain
– they do not treat any of the co-morbid symptoms
– Comorbidity means you have more than one illness at once
– in this case e.g.: Anxiety and Clinical depression or even Obsessive compullsive dissorder (OCD)
Drugs AN
SGAnti-psychotics
• second generation on psychotics otherwise known as atypical Anti-psychotics, have also been used to treat AN
– patients who have prescribed Olanzapine not only gained weight
– but also reported less difficulty with eating as well as lower levels of anxiety (Silverstone 2005)
• in sga’s not all of the D2 sectors are blocked
– They also block seretonin and glutamate receptors (NMDA) which may also combat negative symptoms of anorexia such as Anxiety
– only Sertain Receptors are blocked allowing for some if the NT to still carry out its basic function, reducing some side effects.
Drugs AN
SSRIs Side effects
• taking too many SSRIs can result in serotonin syndrome which is when there is too much serotonin
• this results in anxiety nausea, agitation, muscle twitching, shivering, sweating and diarrhea
• some individuals also Express increased suicidal thoughts when taking SSRIs
– research has shown the chances suicidal thoughts can double when taking antidepressants including SSRIs when compared to a placebo
• whilst gaining weight is a desired outcomes for patients being treated for anorexia
– the initial weight gain associated with taking the medication can be difficult for the patient to come to terms with
– this often means patients to struggle with taking their medication regularly
– possibly decreasing their willingness to take it
Drugs AN
Wheight gain (goal) +
Drug therapy aids with the weight gain that is the main goal of therapy in anorexia
therefore suggesting it is a useful treatment of the disorder
Drugs AN
SGA also aids with Co-morbid Symptoms +
2nd generation anti psychotics such as olanzapine
Not only aid would wait to go but also helps reduce co-morbid symptoms such as anxiety and depression
Therefore they tackle a large range of the symptoms of anorexia
This is done by blocking some dopamine, serotonin and glutamate receptors, reduce the overall level of dopamine
Which also reduces self-starvation excessive exercise becoming habits
as this also treats other symptoms of anorexia, also comorbid symptoms such as anxiety
this is another strength of drug therapy use to treat an anorexia
Drugs AN
Drug Therapy is validly researched for AN (valid +)
• studies showing the usefulness of drug therapy such as for weight gain in the treatment of anorexia
– tend to be in controlled trials such as (crisp et al 1987)
• this means they are credible and reliable findings
– as they are tested objectively in a scientific controlled space without the influence of extraneous variables such as the influence of other people (an extraneous variable)
– (which could effect the establishment of cause and effect between drugs and the success of treatment)
– making these results and the research itself valid to support the use of drug therapy, to treat and in the treatment of anorexia
Drugs AN
Cheap, mass produced and readily avalable, effects quick to show +
Drugs are often cheapyly produced and mass produced
– therefore are cheap and readily available and accessible to be used in treatment
– furthermore the effects of such drugs in treatment are usually faster to show in patients therapies such as a token economy program
• such as the SSRI Fluoxetine
which is a strength of drug therapy for annorexia
Drugs AN
lots of evidence against its usefullness,
likley as it doesnt Resolve AN just treats symptoms –
• there is lots of evidence to suggesting that drug treatment is not directly useful in anorexia
even though it helps with the comorbid symptoms such as anxiety, depression, obsession and compulsions
It may not be considered useful as it’s only deals with some of these symptoms and helps with weight gain an appetite
– but may not help the anorexic patients, no longer be anorexic in the long term (cure) as this may require therapy
meaning that drug therapy is not the treatment of choice
even the NICE guidelines don’t recommend it as the first Choice
This is there for a weakness against the use of drug therapy in anorexia treatment
Drugs AN
not effective alone/ not focused on treating AN only symptoms and oft being used in an innapropriate setting for it to be effective/successfull
(-)
• drug therapy is carried out in a certain setting
– and the NICE guidelines in 2004 suggest a successful treatment depends on it’s being carried out in an appropriate setting
• an example of an appropriate setting would be being treated as an out-patient, for the treatment to be a more natural development of the individual
– such as in family based therapy
• compared to being in-patient in a hospital
– and being given drugs
– this only Focuses on the need of weight gain rather than the need to treat anorexia
– it also to suggests that family-based therapies are essential, meaning that drug therapy alone is never going to be enough
– They also said drug therapy could be used to support psychological treatments for the management of comorbid conditions such as depression
– but not to treat anorexia by itself, only symptoms
Therefore due to not being Focused enough on the treatment of anorexia to be effective alone
– without the implementation of family therapies or psychological treatments
– and often being administered in a inappropriate setting such as being an in-patient in a hospital
– rather than an out-patient in a more naturaly developing treatment in e.g. family therapy
– means that this is a weakness of drug therapy as a treatment of anorexia
Drugs AN
studies dont consider how nutrition of patienets effect drug action -
– studies don’t often consider how problems with nutrition in those with anorexia may affect drug action
• E.g. Halbreich and Kahj 2000
– showed that Anti-depressants like SSRIs may not work as well if oestrogen levels are low
Therefore this is a weakness of research into drug therapy for the treatment of anorexia, And DT as a treatment of AN itself
– as often studies don’t consider how problems with nutrition in anorexia would affect the drugs Action, showing a weakness of DT and the Studies about it
Drugs AN
side effects, willingness and indeffinet cuz only treat symoptoms not AN itself –
The drugs often have side effects such as blurry vision, dizziness, sleepiness and light-headedness for second generation antipsychotics
With first generation antipsychotics also having major motor side effects such as the slow, lack of or random movement of musscle or even musscle stiffness
• as well as an overdose of ssri’s leads to serotonin syndrome with effects such as anxiety, nausea and agitation and muscle twitching and shivers
Due to these side effects patients may be less willing to take these drugs
Furthermore if not used alongside therapy or tolken economy to treat anorexia itself
due to the facts it only reduces the symptoms of anorexia
– not treating AN itself
the drug would need to be taken indefinitely
until either the drug is no longer taken
or the patient naturally resolves their anorexia by themselves
These also weaknesses of drug therapy to treat anorexia
