Treatments for anorexia

• National Institute for Health and Care Excellence (NICE); drugs shouldn't be used primarily or only treatment for patients with anorexia nervosa
• Little evidence that drugs are effective treatment to cure anorexia 
• Patients with anorxia suffer from comorbid conditions e.g. depression or anxieties; thus drug therapy is highly effective
• SSRIs and olanzpine are used 
• SSSIs; selective serotonin reuptake inhibitors; antidepressnt; block reuptake of serotonin in presynaptic nuron; thus more serotonin is available in synapse; more can be passed to the postsynaptic neuron; increasing levels of serotonin 
• Olanzapine; antipsychotic drug; treatmet for anxiety; blocks absorbtion of dopamine and serotonin in certain pathways in brain 
• Patients with comorbid conditions use mediciation treat these symtoms to enble them to be more psychologally ready for psychlogical treatments/therapies that are effective in treating anorexia 
• e.g. a patient who's anxious about their weight gain, which is ncessary to treat their eating disorder is less likely to drop out of a therapy programme if their anxiety can be treated with drugs

• Anorexics often have a poor health due to manutrition; e.g. heart problems and poor cardiac functionning
• therefore, prescribing them with medication; too risky as some have cardiac side-effects
• Potential risks need to be considered; potential gains e.g. treatment need to outweigh these risks 
• SSRI and olanzapine cause weightgain; patients might find this a diffifult side effect
• little evidence that drug tretments are effective in treating AN
• Ferguson et al; compared 24 ppts taking SSRIs and 16 patients treated on the same ward not on SSRIs- no sig. difference with age and weight; as well as impact on patient's treatment outcomes 
• Kaye et al; double-blind study comparing patients on fluoxetine vs. placaebo; former were more likely to stay on treatment up to a year in outpatient treatment and lower replapse rates; measured by increased body weight and improvement in symptoms 

• Form of CBT for eating disorders
• Enhanced cognitive behaviour theparpy CBT-E used for treating AN and other eating disorders; aimed specifically at tackling the thoughts and behaviours accosiated with disordered eating beh
• Advantage of CBT-E; e.g. CBT-BED, is that the mechanism in CBT-E are comprehensive enough to treat the chnaging patterns of disordered eaating that are common for patients over time 
• CBT; conductd on one-to-one basis ; client and therapist; 20 courses initially, some 40 if severly underweight
• Detailed interview to asses patient's suitability for treatment using CBT-E
• explains the treatment process for potential questions
• For therapy to be effective; possibl barriers must be removed; factors in patient's life are dealt with before treatment starts

Stage 1; 4 weeks long, 2 sessions p/w to encourage rapid change in client's beh

Two vital stages; 'weekly weighing' and 'regular eating'

Important that patient is positive about treatment and motivated to progress; therapy only effective if they're willing to make a change. 

Stage 2; 2 sessions 1p/w. Discuss progress made in S1, 'taking stock' how the patient is coping

Good progress is praised to boost motivation, poor progress is discussed to uncover possible reesons for this

Stage 3; 8 sessions p/w to tackle the factors involved in the maintenance of eating disorder; body image, dietary rules and event changes in eating 

Dealing with body image; look at certain beh. that lead to body dissatisfaction e.g. constand body checking and triggers that mak them 'feel fat'.

Dietary rules are explored to consider the impact that ragid and restrictive rules are having on client's quality of life and any foods they avoid are gradually introduced to the diet. Also importance that external events that impact major changes in eating are considered and tackled at this stage in treatment

Stage 4; clients encouraged to look to the future and consider factors that need to be managed to prevent relapse. 3 sessions 2 weeks apart. 

therapist and patient draw up an agreed plan that's personalised for their specific crcumstances 

Clients encouraged to consider own mindset; to avoid seeing relapse as failure- instead think that's a lapse they can address

A post-treatment review appointment will be made 5 months later; discuss setbacks and issues

• Motivation is needed for treatment to be effective; so won't help everyone 
• However, initial stage asseses whether client is mentally ready for treatment 
• Benefit; any form of CBT is flexible so is adaptable to suit th needs of the patient e.g. version of CBT-E that's designed specifically for patients with extremely low body weight 
• Most common form of CBT-E; only effective for patients with AN whose eating disorder isn't maintained by clinical perfectionism, low self-esteem and interpersonal problems 
• However, there are other forms of CBT that can b used for these patient groups - identifiable early on treatment process
• Pike et al; compared effectiveness of CBT and nutritional counselling as outpatient treatments given to patietns with AN following hospitalisation; 
• 33 patients; relapse rates of those receiving CBT was 22% lower than those receiving nutritional counsellling 73%
• Stratergies taught in CBT-E; more suited to treating older patients with AN who have more opoortunity to acesss treatment independantly and have a family; these stratergies are designed to enable the patient to take control and montor their own thinking and beh. 
• Patients that live at home can reeive fmily therapy- more effectve as it deals with the effects that anorexia can have on the family- not just the indiv.