Methods of Modifying SZ

Question 1

Typical/conventional antipsychotics

Answer 1

Dopamine antagonists - reduce activation of dopamine in the synapse, so only reduce positive symptoms

Question 2

How do typical antipsychotics work?

Answer 2

They tightly bind (strong affinity) to mainly D2 receptors which blocks dopamine. Reduces activity of postsynaptic neuron. DA levels in vesicles are depleted, and reduction of DA in synapse results in reduction in the mesolimbic pathway.

Question 3

Why were atypical antipsychotics developed?

Answer 3

Mainly to reduce the negative side effects of typical antipsychotics (mostly related to movement), but to also target negative symptoms

Question 4

How do atypical antipsychotics work?

Answer 4

Weaker affinity to D2 receptors than typical antipsychotics, which allow DA to bind at a slower rate. BUT they also bind to serotonin receptors (S-HT2a) to reduce negative symptoms by reducing activity of serotonin in the mesocortical pathway.

Question 5

Chlor-pro-za-mine

Answer 5

A typical antipsychotic developed in the 1950s.
Taken orally beginning at 25mg, or anally at 100mg every 6-8hrs.
Balances levels of DA as well as some antiserotonergic properties.

Question 6

Side effects of Chlorprozamine

Answer 6

Neuroleptic malignant syndrome.
Agitation.
Tremors.
Seizures.
Dizziness.

Question 7

Ris-per-id-one

Answer 7

Atypical antipsychotic. More pronounced serotonin antagonist than dopamine. Strong affinity targeting D1 + D2.
Consumption:
Deep intramuscular injection starting at 75mg every 28 days

Question 8

Side effects of Risperidone

Answer 8

Catatonia
Depression/anxiety
Abnormal appetite
Sleep apnoea
Water intoxication

Question 9

Extrapyrodimal side effects

Answer 9

Affect motor abilities, like tremors, stiffness, restlessness, etc. (mostly in typical antipsychotics)

Question 10

Metabolic side effects

Answer 10

Affect metabolism, like weight gain, high cholesteral or blood sugar, mostly in typical antipsychotics

Question 11

Anticholinergic side effects

Answer 11

Dry mouth, feeling hot, constipation, urinary difficulties, etc. (atypical)

Question 12

Prolactin side effects

Answer 12

Affects fertility - delayed menstrual cycle, difficulty conceiving, lactation in both sexes, breast enlargement (atypical, mostly in Risperidone)

Question 13

Family therapy

Answer 13

Aims to improve the environment of the family home and reduce relapse in SZ

Question 14

Components of family therapy

Answer 14

Focus on stress reduction, education, emotional processing, regulating, as well as structured problem solving to promote empathy and support. Reduces EE and double bind family dynamics.

Question 15

CBT for Psychosis

Answer 15

Aims to promote coping mechanisms for those with SZ with similar methods to CBT, but isn’t curative.

Question 16

ABC Model component of CBTp

Answer 16

Client explains to therapist the (A) activating event that causes irrational (B) beliefs and the (C) consequences of them. Beliefs are challenged, and client is asked for evidence.

Question 17

Dysfunctional thoughts diary

Answer 17

Similar to regular CBT, recording their thoughts, feelings, and behaviours. Irrationalities are challenged, and client is asked to provide evidence to support them.

Question 18

Behavioural experiment

Answer 18

Aimed to challenge hallucinations by identifying situations/actions they can engage in to reduce hallucinations, e.g listening to music.
Severity of hallucinations are rated, and allows clients to recognise the control they have

Question 19

Behavioural skills training

Answer 19

Similar to pleasant activity scheduling. Relaxation techniques are taught and employed to cope with symptoms not managed with medication.
Problem solving refers to systematically working through several steps: 1) identify problem, 2) generate solutions, 3) evaluate alternatives, 4) decide, 5) evaluate outcome

Question 20

Relapse prevention

Answer 20

Identifying early warning signs of relapse, assessing how well they get along with others, and developing plans to avoid relapse

Question 21

Phase 1

Answer 21

Engagement and Befriending - building trust between therapist and client to avoid paranoia and form a ‘problem list’ via ABC model

Question 22

Phase 2

Answer 22

Assessment of Experiences - providing expert role and assumptions of symptoms

Question 23

Phase 3

Answer 23

Formulation Development - links between early childhood experiences and symptoms, core schema, thinking patterns, maintenance of symptoms

Event -> interpretation -> emotions and behaviour

Question 24

Phase 4

Answer 24

Application of intervention and skill building

Question 25

Phase 5

Answer 25

Consolidation of skills - aim to have client apply skills externally from therapy sessions