Biological Treatments for Sz. Flashcards
what is the aim of ECT?
Argues Sz is due to a physical problem. Therefore aims to use a physical treatment to induce a controlled seizure.
When is ECT used?
Patients have acute onset.
Patients show catatonic symptoms.
When ECT has been successful in the past for the patient.
When anti-psychotic medication has been ineffective.
What is the procedure of ECT?
ECT can be performed unilaterally (one hemisphere) or bilaterally (both hemispheres).
Patient given anesthetic and muscle relaxant.
shock of 65-140 volts administered 4-12 times over a 4 week period.
Seizure thought to provide therapeutic benefit - alters levels of neurotransmitters (serotonin, dopamine noradrenaline). These NTs are involved in Sz.
What is the effect of ECT?
improve mood, promote movement. most effective for catatonic symptoms.
Evaluate ECT.
Effectiveness - most effective alongside drugs. Sajatovic and Meltzer - 9 patients for whom drugs were ineffective improved after ECT. Also, when ECT is paired with drugs it is thought to speed up the response to drug treatment.
Appropriateness - does not get to the aetiology, not appropriate to be used in the long term. Tharyan - half of ppts showed short term improvements after ECT compared to a group given a placebo. Therefore shows it can be effective but only in the short term (4-8 weeks after). should only be used as a last resort.
Appropriateness - lack of knowledge on how it works. thought to affect NTs but unsure how.
What is Chlorpromazine.
used to tranquilise surgical patients without sedating them. has therapeutic effect on Sz patients. removed symptoms of delusions, hallucinations.
What are the two forms of antipsychotic medication?
First generation (typical) - chlorpromazine. dopamine antagonists. reduce dopamine levels by binding to dopamine D2 receptors (reducing activity). Reduces the number of positive symptoms.
Second generation (atypical) - dopamine and serotonin antagonists. Clozapine - block dopamine receptor sites (D1, D3, D4. Selectively D2). Also block serotonin receptor sites 2A and 2C. Effective for positive and negative symptoms.
What are the strengths of drugs?
Cheap and effective - work quickly, allow people to live outside of institutions. Reduce symptoms in weeks. Unlike CBT, which can take months to work.
Effectiveness - typical anti-psychotics effective in reducing positive symptoms rather than negative. atypical reduce a wide range of symptoms including negative symptoms such as lack of emotion. also have fewer side effects, and people taking atypical medication went into remission sooner. Shows the effectiveness of medication.
Appropriateness - quick/easy to take. also widely available on the NHS. unlike CBT, which takes longer and requires motivation from the patient, and is more expensive.
What are the limitations of drugs?
Do not get to the root cause of the illness - only deal with symptoms. this can lead to adverse effects when they stop taking the medication such as ‘revolving door phenomenon’ - when they stop taking the medication they relapse and end up back in hospital. suggests they are less effective.
Inappropriate - aetiology fallacy.
Effectiveness - do not work for everyone 30% of all schizophrenics do not respond to drugs. second generation antipsychotics more effective for these individuals.
Inappropriate - ethical issues - chemical straitjacket - drugs are dehumanising, take away control. Also can lead to harmful side effects such as tardive dyskinesia (uncontrollable lip and tongue movements) which affects 24% of people. Unlike CBT, which gives the patient control and does not have side effects.
