Methods Of Modifying SZ Flashcards
What are antipsychotics?
They are drugs used to reduce the severity of symptoms, taken as tablets/syrups/injections. It can be a short cause of medication where the symptoms do not return but sometimes can be long term. It works by altering the process of neurotransmission.
What are typical antipsychotics?
1st generation of antipsychotics, introduced in the 1950s. They were the 1st drug treatment for SZ. They reduce the action of dopamine in the synapse (dopamine antagonists). Blocks transmission.
What are atypical antipsychotics?
2nd generation of drugs developed in 1970s. They were developed to improve the effectiveness of reducing positive symptoms and to reduce side effects. They work on serotonin receptors and other neurotransmitters. They still allow some transmission.
How do typical antipsychotics work?
-They are DA antagonists which mainly tightly bind to the D2 brain receptors.
-Strong affinity to D2 receptors blocks dopamine by binding to receptor sites for a long period of time.
-This reduces activity at the post synaptic neuron.
-It leads to an increase of DA released from the pre-synaptic neuron to begin with until DA levels in the vesicles are depleted, and there’s a reduction in DA in the synapse.
-Reduction in DA in places like the mesolimbic pathway = reduction of positive symptoms.
How do atypical antipsychotics work?
-They also target D2 receptors but with less strength which allows dopamine to slowly bind to the post-synaptic receptors.
-However, they also bind to serotonin receptors which helps reduce negative symptoms through reduction of serotonin activity in the mesocoritical pathway.
-Blockage of the 5-HT2A (2A small letter+number) receptor.
Describe chlorpromazine.
Typical antipsychotic.
Blocks dopamine D2 receptors.
25 mg, 3 times a day.
Side effects - dizziness, restlessness, tremors, movement problems.
It’s still used today but more modern drugs are more often prescribed.
Describe risperidone.
Atypical.
Blocks D2 receptors in the mesolimbic pathway.
Daily dose of 4-8 mg.
Side effects - nausea, increase appetite, vomiting.
Still used commonly.
Evaluate a strength of the effectiveness of antipsychotics (supporting evidence).
Davis et al - 75% of people who took typical antipsychotics improved within 6 months. However, it takes a while for them to work and it doesn’t target negative symptoms so they are not fully useful.
Evaluate a strength of the effectiveness of antipsychotics (clozapine).
Clozapine is an effective antipsychotic drug. It has fewer side effects compared to chlorpromazine but still effectively reduces symptoms. However, it has been found that some patients respond better to atypical antipsychotics. This means it is effective and has minimal side effects.
Evaluate a weakness of the effectiveness of antipsychotics (bio factors).
It focuses on biological factors due to the dopamine hypothesis. It looks at dopamine however ignores other explanations which may have better treatments for SZ. However, if it’s combined with other treatments, this would increase the effectiveness. This means they are not fully effective as other treatments may benefit patients more.
Evaluate a weakness of the ethics of antipsychotics (harm).
It does not protect the patient from harm. Clozapine carries a risk of agranulocytosis which is a drop in white blood cells. To deal with this, blood tests must be done regularly. Although it can help with symptoms, blood tests have to be done and there are severe side effects.
Evaluate a weakness of the ethics of antipsychotics (chemical straitjacket).
Antipsychotics can be seen as chemical straitjackets. They don’t work to improve symptoms but keep the patient under control. Ethical issue as drugs may be used to improve compliance with psychiatric institutions/society instead of a treatment.
Evaluate a strength of the social implications of antipsychotics (cost).
Antipsychotics are cheaper than other treatments. This is good for the NHS as they have a limited budget so more people can be treated. However, the best value for money may not be best for the patient. So this means the treatment is accessible to more people leading to less stress on the NHS.
What is the aim of CBTp?
To help the client make sense of the symptoms through education, then normalising the psychotic experience. After this they help the client accept their symptoms to reduce distress and cope better with their disorder.
What is the 1st phase of CBTp?
Engagement and befriending. Brabben et al emphasise the importance of the therapeutic relationship in CBTp. In this phase, the client will be supported to identify the key issues with which they’re currently struggling in the form of a ‘problem list’ to create goals.
What is the 2nd phase of CBTp?
Assessment of experiences. Collaborative. Therapist drops the assumptions they may hold about these symptoms and being open to other explanations. By this, the therapist is modelling flexibility in thinking and collaboration.
What is the 3rd phase of CBTp?
Formulation development. It helps the client and therapist to gain a better understanding of the links between early experiences, core schemas, unhelpful thinking patterns and maintenance of symptoms. It highlights changes that need to take place.
What is the 4th phase of CBTp?
Application of intervention and skill building. Interventions are developed to address their issues to achieve their goals.
What happens in the 4th phase in relation to the dysfunctional thought diary?
Clients may be asked to keep a record of how they felt, what they did and what they thought about a particular event.
They will write down their automatic negative thoughts to these situations and then challenged to think differently about the event and will be asked to record different views and provide evidence that their way of thinking was appropriate.
The client and therapist will discuss entries.
What happens in the 4th phase in relation to behavioural skills training?
Pleasant activity scheduling, relaxation and problem solving are taught.
These can be employed to cope with the residual symptoms, symptoms that aren’t managed by meditation and possible symptoms that come from SZ
What is the 5th stage of CBTp?
Consolidation of skills. Active participation within sessions. The client actively tests the skills from sessions in the real world.
Evaluate a strength of the effectiveness of CBTp (supporting evidence).
Kuipers et al studied 60 SZ patients who were medication resistant and they were randomly allocated to 1 of 2 conditions. CBT + standard care and standard care only. They found 50% of those with CBT + standard care improved however those with only standard care, only 30% improved. However it only shows the effectiveness of CBT in use with standard care. Shows although it can be useful, it may also not be on its own.
Evaluate a weakness of the effectiveness of CBT (long-term).
It may not be effective in the long-term. Tarrier found that after 18 months, patients who had CBT had the same relapse rates as those who had standard care. Shows it may only be useful in the short term as patients are still just as likely to relapse.
Evaluate a weakness of the effectiveness of CBTp (root cause).
It does not address the root cause of SZ. CBT only teaches the patient to accept their SZ, not prevent the cause. However, it can help the patient cope with their symptoms in day-to-day life and potentially go back to some normality. It may not be able to relieve symptoms, only help them cope.
Evaluate a strength of the ethics of CBTp (compared to antipsychotics).
It’s more ethical compared to antipsychotics. Antipsychotics have very severe side effects whereas CBT has none. For example aguncytosis. Having SZ is unlikely to kill you however if there is a risk of death from the treatment is it worth it? This protects the patient from harm.
Evaluate a weakness of the ethics of CBTp (patient blame).
Can put blame on the patient. They may feel like they are responsible for their SZ due to faulty thinking. However, it may encourage change and empowerment. They may come to psychological harm.
Evaluate a weakness of the social implications of CBTp (expensive).
For around 10-12 sessions, it can be up to more than £100. However the NHS offers around 10 sessions for free. Although you can go through the NHS, the 10 sessions may not be enough, so you will have to start paying.
