Methods of modifying behaviour Flashcards
Drug therapy
majority of Sz have been offered drug therapy at some point during the development of their condition
- antipsychotic drugs were discovered in the 1950s
- they alleviated the positive symptoms by acting on the neurochemical dopamine in the brain
- most modern drugs work by blocking the effects of dopamine
What are the 2 categories of drugs?
Typical antipsychotics
- this is the first generation
Atypical antipsychotics
- the newest form of antipsychotic and seem to be the most effective over a broader range of psychotic symptoms
Typical anti psychotic drug
- lowers dopamine receptors in mesolimbic, mesocortical and nigrostriatal system
- serotonin receptors are not affected
- overall effect on dopamine is lowered in all systems
- reduces positive symptoms, emotional and cognitive problems, motor control problems
Atypical anti psychotic drug
- dopamine is lowered in mesolimbic, mesocortical and nigrostriatal system
- serotonin receptors being blocked raises dopamine in mesocortical and nigrostriatal system
- overall net effect on dopamine is stable in the mesocortical and nigrostriatal system but is lowered in the mesolimbic system
- reduces positive symptoms in mesolimbic system and has no other effects
Conventional antipsychotics (typical)
- used to treat acute episodes of Sz and prevent relapse
- worked by blocking the activity of dopamine within 48 hours
- leads to less dopamine in the mesolimbic system and mesocortical system
Dopamine receptors are seen to be linked with Sz specifically positive symptoms
Side effects of typical antipsychotics
Tardive dyskinesia - grimace/lip smacking
- 20% of patients experience this when taking the drug for over a year
Akathasia - inner restlessness
Parkinsonism - reduced arm swinging, short shuffled gait, slow monotonous slurred speech, rigidity and tremor of extremities and head
- sedation, weight gain, seizures, blurry vision
Atypical antipsychotics
- reduce both positive and negative symptoms
- block receptors for both dopamine and serotonin
Differences between typical and atypical drugs
typical
- reduce positive symptoms as they reduce high levels of dopamine
- however they also lower dopamine in other areas areas of the brain where they were balanced before
- this can lead to cognitive and affective problems and motor problems
atypical
- block dopamine receptors but also serotonin in the mesocortical and nigrostriatal systems
- this can cause an increase in dopamine
- reduction in dopamine is cancelled out by an increase in dopamine in the mesocortical and nigrostriatal system
- so dopamine is balanced
Effectiveness of typical antipsychotics
- older drug
- short term beneficial effect in 75% of patients (Davis et al 1989)
- Long term beneficial effect in 55 - 60 %
- only effective against positive symtpoms
- high risk of side effects
Sample question - Describe the use of antipsychotic drugs as a method of modifying behaviour
1) Role of dopamine
- how drug therapy was seen to work
2) types of antipsychotics — atypical and typical, how are they different?
- what they reduce and in what system and the side effects they caused
Effectiveness of atypical anti - psychotics
Valenstein et al (2004) performed a huge study on over 63,000 Sz taking antipsychotic medication
- in 40% of cases compliance to the regime was poor and the only drug where this was not a problem was clozapine
why?
- side effects could be unbearable
- may feel ‘normal’ and no longer feel they need to take their medication
- may have cognitive deficits that make it difficult for them to plan their own behaviour and remember to take their medication
- may be suffering from paranoid or persecutory delusions and not trust the person issuing the medication
Overall effectiveness of anti - psychotic drugs
- can make a significant difference to some sufferers and their families — removed the need for physical restraint of patient
- drugs only manage symptoms they do not cure
- if non compliance occurs then symptoms will return
- both types of drugs can cause significant side effects
Ethical issues
- Szasz argues that labels such as Schizophrenia exists to exclude non conformists from society
- he is one of the psychologists that is not convinced medication is the best way to treat Sz
However
- he is one of the psychologists that is not convinced medication is the best way to treat Sz
- this may be an idealistic view of mental illness as many Sz suffer greatly because of their illness and refusing treatment to these patients would be unethical as the increased risk of self harm and suicide that goes with Sz suggests that doing something is much more ethical than doing nothing
Social implications
- a serious consequence of non compliance is Sz being a danger the both themselves and other members of society
Tilhonen et al (2006) found an increased rate of suicide amongst those who were non compliant
The NCISH (2015) reported that 346 murders had been committed in England by people with a history of Sz between 2003 - 2013
- chloropromazine sparked a revolution in the treatment of Sz and resulted in far fewer patients being institutionalised
Social implications - COST
-the risk of fatal WBC means that Sz taking clozapine need constant monitoring, which can also be expensive
- the lifetime cost of providing antipsychotics is expensive as many Sz will never be able to stop taking medication
NHS has a limited budget so providing the best value for money in terms of effectiveness vs cost is good for all
- the cheaper a treatment , the more money there will be available for treating others
- in 2015 over 40% of mental health trusts in the UK experienced funding costs
Evaluate antipsychotic drugs in terms of effectiveness and ethical and social implications
3 paras
1 effectiveness
2 social implications
3 ethical implications
4 good conclusion
