Discuss biological therapies for schizophrenia. (8+16)

Question 1

Drug treatment types

Answer 1

Conventional/typical antipsychotics (chlorpromazine) and Clozapine/atypical antipsychotics

Question 2

Conventional/typical antipsychotics

Answer 2

Use - reduces the positive symptoms of schizophrenia, Rationale - based on the theory that schizophrenia results from an excess of dopamine activity at certain synaptic sites, Aim - to reduce dopamine activity at receptor sites, Process - works by blocking the D2 dopamine receptors, reducing the ability of dopamine to bind on the post-synaptic receptor, lessening the response

Question 3

Clozapine/atypical antipsychotics

Answer 3

Use - to treat schizophrenia without the previous problems of side effects, Rationale - based on the theory that schizophrenia results from an excess of dopamine activity at certain synaptic sites, also based on the idea that an imbalance in other neurotransmitters, such as serotonin, are linked to schizophrenia, Aim - to target serotonin and dopamine receptors in the brain, Process - the precise biochemical mechanisms are unknown. They do appear to have a major impact on serotonin receptors, blocking these receptors

Question 4

Taking antipsychotics

Answer 4

Usually taken orally, absorbed from the digestive tract, pass the blood/brain barrier and then make their way to synapses where they bind to post-synaptic receptors. However, they can also be injected. High potency typical antipsychotics and some atypical antipsychotics are available as depot injections. The interval between injections is usually between 2 and 4 weeks.

Question 5

Appropriateness

Answer 5

side effects, compliance, ethics

Question 6

Effectiveness

Answer 6

research findings, methodological evaluation, reduction of symptoms, relapse

Question 7

Frude

Answer 7

before the 1950s, over half of those admitted to a mental hospital and diagnosed with schizophrenia remained in hospital for the rest of their days. For most patients, ‘treatment’ considered of little more than long-term care and custody - the management of such patients was revolutionised by these drugs; rapidly reduced many of the most disturbing symptoms and sharply decreased the average length of stay in hospital

Question 8

Gross and Rolls

Answer 8

traditional drugs have little effect on negative symptoms, about 30% of patients with schizophrenia don’t respond favourably to these antipsychotics - even those on maintenance does may make only marginal adjustment to the community

Question 9

Herz

Answer 9

tested the effectiveness of a new treatment which involved; education patients about relapse and recognising signs of relapse, monitoring early signs of relapse by staff, weekly supportive group sessions or individual therapy, family educational sessions, quick intervention, involving both increased doses of medication and crisis-orientated problem-solving therapy - over an 18-month period, the new treatment cut relapse rates in half and reduced hospitalisation rates by 44%

Question 10

Bennett

Answer 10

antipsychotic drugs may be an important protective factor against relapse, relapse rates of 40% in the first year following the start of treatment, and 15% in successive years, are typical; overall, they appear to delay relapse rather than prevent it

Question 11

Side effects of typical antipsychotics

Answer 11

Dry mouth, dizziness, blurred vision, restlessness, constipation, glaucoma and sexual dysfunction. Theres a group of particularly disturbing side effects, which stem from dysfunctions of the nerve tracts which resembles the symptoms of Parkinsons disease

Question 12

Benefits of newer drug therapies

Answer 12

Clozapine can produce therapeutic gains in schizophrenic patients who don’t respond well to traditional antipsychotics and it has proven more effective in reducing positive symptoms than traditional antipsychotics. Also has the advantage of reducing negative symptoms

Question 13

Side effects of clozapine

Answer 13

produces fewer motor side effects, those it does produce are serious. Agrancilocytosis involved an impairment to the functioning of the immune system in 1-2% of patients by lowering the number of white blood cells, making patients susceptible to infection and even death. Other side effects include seizures, fatigue, drooling and weight gain.

Question 14

Cochrane review - chlorpromazine

Answer 14

meta-analysis of 302 studies of the effectiveness of chlorpromazine, all used placebo effect, all used random allocation to conditions. chlorpromazine reduces relapse rates in the short and medium term, though less so in the long term, it improves symptoms, functioning and the probability of leaving treatment. It leads to various side effects, movement disorders, sedation and lower blood pressure

Question 15

Cochrane review - chlorpromazine evaluation

Answer 15

meta-analyses are more reliable than individual studies as results are much less likely to be a fluke. the only studies chosen for analyses were well-designed with appropriate control groups. they all involved use of placebos, so effects are not a result of participant reactivity. these also involve random allocation, so effects are not just due to patients who are likely to better choosing to undergo treatment

Question 16

Cochrane review - clozapine

Answer 16

meta-analysis of 52 randomised controlled trials, 44 less than 13 weeks duration. no significant difference in the effects of clozapine and typical antipsychotics in terms of broad outcomes, including ability to work and suitability for discharge at the end of the study. clinical improvements (symptom reduction) were seen more frequently for those taking clozapine and fewer relapses. clozapine was more acceptable in long term treatment than conventional antipsychotic medication

Question 17

ECT

Answer 17

Use - originally developed to treat schizophrenia but now more commonly used to treat depression, Rationale - there is an abnormal activity of neurotransmitters and/or hormones, Aim - the shock disrupts/corrects the abnormal neurotransmitter activity in the brain, Process - anaesthetic and muscle relaxants are administered before, electrical current is applied via electrodes positioned on the head, current is either given bilaterally or unilaterally. When given unilaterally it is usually to the non-dominant cerebral hemisphere, small electric current (70-130mv) for 0.5 to 5 seconds, induces a mini-seizure by producing electrical convulsions in brain. Usually given 3 times a week from 3-4 to 12-15 treatments

Question 18

Tharayan and Adams

Answer 18

meta-analysis of 26 studies, inclusion of all randomised controlled clinical trials comparing ECT with ‘sham ECT, non-pharmacological interventions and antipsychotics’ - results - ECT compared with sham ECT - more patients improved in real ECT groups, ECT seemed to result in less relapses in the short term than sham ECT - when ECT was compared with antipsychotic drug treatment, drug treatment was favoured

Question 19

Side effects of ECT

Answer 19

‘adverse cognitive effects’ - global cognitive deficits, and memory loss, that persist for up to six months after treatment

Question 20

Ethical issues of ECT

Answer 20

possible that because we don’t know the precise mechanisms there may be some effects we are unaware of - minor side effects of memory loss may outweigh the side effects of schizophrenia

Question 21

When to get ECT treatment

Answer 21

possible to give treatment under mental health act - if they are a threat tot heir own or other’s health