Anorexia Nervosa: Olanzapine (Zyprexa)-Veganism

Girl in a Chemise circa 1905 Pablo Picasso (1881-1973) Tate Collection

Mental Nurse Zarathustra recently had two important posts on Anorexia Nervosa: One on the use of Olanzapine (Zyprexa) and the other on Veganism.

Mental Nurse: Anorexia and Olanzapine

……..Here’s the thing though. As we know, Olanzapine has a fair few side effects. Two of these are:
1. It makes you sleep until doomsday.
2. It makes you so hungry you eat the contents of the fridge.
Could these side effects be the reason for the improvement in these anorexic patients, rather than any antipsychotic effect? God no, says our consultant. The Olanzapine is being used to reduce the levels of intrusive anorexic thoughts that are causing distress to the patient. It’s being used as an antipsychotic, not simply to make people drowsy and hungry.
Though the burning question is, if that’s the case, why isn’t he keen to try, say, Aripiprazole? You know, the antipsychotic that isn’t supposed to make you fat and sleepy. Admittedly Aripiprazole is also a bloody awful antipsychotic that rarely seems to reduce psychosis, but that hasn’t stopped him prescribing it en masse to his psychotic patients.

Read the full post here.

In the opening chapter of The Cockroach Catcher:

“’It is our view that clinically it was wrong for Candy to be transferred at this stage. It was wrong for the NHS to accept her back and in our view Candy is in serious risk of – quite frankly – dying.’

“Those were more or less the words said at the transfer meeting by the nurse from the private hospital where Candy had been for the past eighteen months. She had been compulsorily detained twice and she had been put on Olanzapine. Olanzapine is one of a new group of drugs licensed for Schizophrenia and has been found to induce a voracious appetite especially the bingeing of carbohydrates. Some psychiatrists have started using it for this specific effect. In Candy’s case she managed to fight the biochemical effect of Olanzapine.”

You can read the complete chapter here.

At least in my days there was still honesty and most Child Psychiatrists who used to prescribe Olanzapine (Zyprexa) to Anorectics did not pretend to be using its main effect.

Now that there is EBM, it is well known that the major Pharmaceuticals ghost write articles in pushing for off-label use by doctors. Because of medical confidentiality issues, it is difficult to find out if the so called patients were genuine.

I am amazed that given Olanzapine (Zyprexa) has been in so much trouble in the US, UK and Europe still have not done much to curb its off-label use.

Perhaps one should not forget Lena Zavaroni, former child singing prodigy who died aged 35, following a 22-year battle with anorexia. She had various drug treatments and ECT, and eventually a neuro-surgical procedure that was not a lobotomy according to the hospital but was meant as a “cure” for her depression. She died shortly after of unrelated pneumonia. That was in 1999. It was before Dr Crippen, Jobbing Doctor, Angus Dei and other blogs. Otherwise the neurosurgeon Brian Simpson might have a lot more explaining to do. Anyway, neurosurgery was not part of NICE Guideline on Treatment of Depression.

Have we really learned anything about the treatment of Anorexia in the ten years since her death? Why are we going the same way, only the drug is different!

Mental Nurse: Case Study Vignette - Anorexia and Veganism

“…….Kate has announced that she’s becoming a vegan. She now insists that she won’t eat any meat, fish, dairy or poultry products, and has taken out a membership to PETA. She states that this is because vegan diets are “healthier” and because she is ethically opposed to the use of animal products.

The multidisciplinary team, on the other hand, believe that she is doing this because she wants to restrict her intake of carbohydrates, fat and protein, and also because of anorexic thinking patterns that involve the demonisation of certain food groups.

The dietitian states that a vegan diet will make it much more difficult for the ward to refeed Kate and bring her BMI back up to a safer level. We could get around this by giving Kate nutritional supplements. However, while this would help her to gain weight, it wouldn’t do anything to treat the anorexic thinking patterns. Indeed, arguably we’d be running a risk of reinforcing them by colluding in the avoidance of these food groups.

So, is it ethical to compel Kate to eat animal products?”

Zarathustra talked about the role of the multidisciplinary team and of course its collective view. In my opinion, contrary to widely held views, a good Adolescent In-patient Unit dealing with Anorexia Nervosa patients needs to be able to accommodate and hold opposing views in its team, just like a well functioning family. These patients themselves more often than not come from families that try to avoid conflicts at all costs.

Conflict containment that is more or less non-existent in the families these patients come from.

As to the vegan diet, it is not impossible to have a vegan diet that has high calorific value. That, the dietician should know. I have seen many vegans in the Caribbean becoming quite obese from the high yam and sweet potato diet. (There you go: these are two food items that can be part of a vegan diet!)

The trick with Anorexia Nervosa is you need to be inventive and inventive every single day. Think Jay Haley, think Hobson’s choice. The patient can still be a vegan. She does not need any drugs. She does not need any ECT or neurosurgical procedure.

In the end, Anorexia Nervosa could be a rewarding condition to deal with:

“If our work is to be therapeutic then a sort of therapeutic alliance is important, even if tentative. Some people do not realise that you can fight with your patient and still have a sort of therapeutic alliance.” The Cockroach Catcher

Have a good fight!!!

Anorexia Nervosa: What If!

A Brief History of Time: Anorexia Nervosa

Anorexia Nervosa: a cult?