Y2: Psychology: Clinical Anorexia: Biological Treatment - Drug Treatments

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

National Institute for Health and Care Excellence (NICE).

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

• 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

A disorder that may result from the main diagnosis.

1) Depression
2) Anxiety
3) OCD

1) Selective serotonin reuptake inhibitors (SSRIs)

2) Antipsychotics

• 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

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

• 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

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

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

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

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

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

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

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

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

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