methods of modifying Flashcards
outline antipsychotic drugs
explain
- based on the biological explanation of schizophrenia (the dopamine hypothesis, which suggests schizophrenics have more dopamine receptors than other people)
- aim to address the associated chemical imbalance in the brain and regulate dopamine levels, and as a result, reduce symptoms of schizophrenia
- first generation or typical antipsychotics (e.g. chlorpromazine) first appeared in the 1950s and focus on blocking D2 receptors - primarily used to reduce positive symptoms such as delusions and hallucinations, achieving this through a “blanket approach” and block receptors in the neocortical (overactive in schizophrenics) and mesolimbic (underactive in schizophrenics) pathways in the brain
- although this reduces positive symptoms, the negative symptoms often worsen as it reduces dopamine everywhere
- Carlsson and Lindqvist (1963) demonstrated that these drugs increase the turnover of dopamine when administered to animals
- second generation or atypical antipsychotics (e.g. clozapine) were introduced in the 1970s and block 5-HT2 serotonin receptors as well as D2 receptors
- used to reduce negative symptoms such as withdrawal and disorganised speech but also relieve positive symptoms
- can also be used as a sedative because they have a tranquilising effect and are used for very disturbed or aggressive patients
outline antipsychotic drugs
research
- Carlsson and Lindqvist (1963)
evaluate antipsychotic drugs
explain
effectiveness
+ research
Lobos (2010) compared clozapine to other atypical antipsychotics and it reduced positive symptoms but the risk of serious side effects (agranulocytosis, a life threatening blood disorder) caused people to drop out of the study. clozapine was the most effective for participants who accepted treatment and paired clozapine with another drug (CBT)
- medical schedule
due to the nature of psychosis, many schizophrenics find it difficult to adhere to a routine and remember to take their medication and once dismissed from hospital, they are responsible for their own recovery and there is a high risk of relapse (revolving door syndrome)
ethics
+ widespread use
millions of people have used antipsychotics, proving that they work and can improve someone’s lifestyle. their aim is well natured and wants to improve the wellbeing of the patient (to reduce symptoms, which can be consuming and scary, is always a positive)
- research
Szasz (1960) antipsychotic medication is not the best method, used as a “chemical straightjacket” in institutions to control and calm them, seems like a good short term plan but is damaging. how can schizophrenics give consent for medicine? they control symptoms and integrating them into society may be harmful
social implications
+ reduces cases of hospitalisation (cost)
society benefits from this because it is cheaper. schizophrenics are given independence and freedom and can positively contribute to the community by getting a job
- economic inequality
clinicians often choose the cheapest option and the welfare of the patient is sadly not always at the centre of these decisions.
the cheapest (chlorpromazine) phased out in the West but still used in developing countries due to funds . the NHS often have to choose cost effective treatment and many are not receiving the treatment that they deserve
evaluate antipsychotic drugs
research
- Lobos (2010)
- Szasz (1960)
outline cbt
explain
- mental illnesses is as a result of faulty internal mental processes
explains the symptoms through cognitive concepts such as:
Hearing voices (Frith)
Cognitive triad (Beck)
Lack of preconscious filters
Compromised ToM
- Smith (2003) identified key components of using CBT for schizophrenia:
Engagement strategies
The patient must be invested in their treatment and recovery for full effectiveness
Behavioural skills training
Alters the way that they think by training them with skills to manage and organise their disorganised thinking, therefore reducing symptoms. Equips them with the skills to rationalise their thinking and replace maladaptive thoughts with constructive ones
Socratic questioning
An example of a cognitive strategy.
Guided discovery allows them to unroot their delusions and identify errors in their thinking
Psychoeducation
Schizophrenics are not aware of their condition due to the illness being a severe psychosis (loss of touch with reality)
- CBT aims to alter the way that schizophrenics think by training them with skills to manage and organise their disorganised thinking, therefore reducing symptoms.
- the aim is not to make the patient symptom-free, but to make them more confident and independent. CBT gives them control over their disorder, meaning that they feel empowered and allows them to cope with their symptoms
outline cbt
research
- Smith (2003)
- engagement strategies, behavioural skills training, socratic questioning, psychoeducation
evaluate cbt
explain
effectiveness
+ research
Morrison (2014)
CBT significantly reduces psychotic symptoms
- difficult to assess
often used in conjunction with antipsychotics (as suggested by NICE) meaning that it is difficult to conclude effectiveness of CBT as an independent therapy
ethics
+ no side effects
patients are not ingesting any chemicals (unlike antipsychotic treatment). however, it is rarely used alone…
- research
Bentall et al (1994) emphasises on controlling thought process rather than understanding the cause, may cause harm (unconscious thoughts and reasons behind them), too reductionist
+ consent
more ethical than drug treatment because it ensures proper consent and clear right to withdraw
social implications
+ independence
CBT leads to personal empowerment, can positively contribute to society e.g. by getting a job
- economic inequality
very expensive (relatively long term commitment, up to 1 year)
“Postcode lottery” determines access to treatment
NICE recommend a combination of CBT and antipsychotics but only 50% of patients are referred for CBT
+ cost effective
skills reduces reliance on medicine and patients are less likely to be hospitalised
evaluate cbt
research
- Morrison (2014)
- Bentall et al (1994)
