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Evaluation of drug therapy for AN - Coggle Diagram
Evaluation of drug therapy for AN
EVIDENCE
Kaye (2001)
- double blind study comparing outcomes for ppts given
fluoxetine
with ppts given a placebo
those on fluoxetine were much more likely to stay on the meds up to a year into their outpatient treatment. They also found those who continued taking fluoxetine had much lower relapse rates (measured by increased body weight & improved symptoms)
Jensen & Mejlhede (2000)
- case study of 3 ppts treated with 5mg of olanzapine each day. positive impact was seen on their body image as it was made more realistic
however, they commented that the first 2 months were difficult as it can take this long for the drug to take effect and reported side effects like hunger & weight gain, which one ppt reported as difficult
Dally & Sargant (1966)
- reported Chlorpromazine led to weight gain but a serious side effect was that some ppts suffered seizures
Vandereycken (1984)
report that antipsychotics that block dopamine also enable ppts to show some weight gain but didnt have any effect on other symptoms
Powers (2002)
- found that olanzapine was used with
18
ppts &
10
gained weight,
4
didnt complete the study &
4
lost weight
shows mixed success - in other research, ppts using olanzapine said they had lower levels of anxiety & less difficulty eating
Ferguson (1999)
- compared 24 ppts taking SSRIs & 16 ppts treated on the same ward without SSRIs. There was no significant difference between them in terms of age, body weight, anxiety or clinical symptoms
this suggests that the use of drugs had no significant impact on treatment outcomes
HOW GOOD IS THE RESEARCH?
uses case studies !
COMPARISONS & LIMITATIONS
practical issues
what if it doesnt work quickly - ppts could die
ppts may not take it if it causes them to gain weight quickly
inpatients could hide drugs & if theyre outpatients theyre even less likely to take them
Mondraty (2005)
- ~1/2 of patients are resistant to psychological, behavioural, pharmaceutical, nutritional and other therapies
the journey back to health is long & trying (physically & mentally) and given that AN has one of the highest mortality rates of any disorder, its important to constantly reassess methods of treatment
side effects
in 0.05% of ppts, antipsychotics can lead to neuroleptic malignant syndrome with symptoms including confusion, high bp & comas
Adityanji & Kaizad (2005)
- up to 10% of ppts taking anti-psychotics can develop long term neurological problems
weight gain can be a positive symptom but can be difficult to deal with mentally
SSRIs - less side effects than first/second gen antipsychotics
Recent improvements
2nd gen drugs are better than 1st gen in terms of side effects & are both better than previous treatments (EG: ECT)
antipsychotics allow people to remain in society rather than institutions
low levels of antipsychotics can be less risky in lower dosages
environmental/social factors
- drugs dont account for the ppts' environmental/social problems, which may contribute to rehospitalisation & relapses
high risk treatment - AN sufferers can have low estrogen so SSRIs may be ineffective
APPLICATION
patients with comorbid symptoms can benefit as it prevents serotonin dysfunction which would cause other disorders to worsen and cause a relapse
Relapse
- antipsychotics can lead to decreased motivation so ppts may prefer not to take them
some ppts would rather relapse than deal with side effects due to impact on their quality of life
ethics
drugs are invasive & already used on vulnerable ppts
symptoms can be contained/stabilized but maintained which may prevent other treatments being used/researched
cure-all
- symptoms arent cured in all cases & may just be maintained so the ppt doesnt get better