MOM schizophrenia Flashcards
what is the first MOM schizophrenia
anti-psychotics
2 types of anti-psychotics
anti-psychotics MOM
conventional and atypical
explain conventional anti-psychotics
anti-psychotics MOM
are also known as typical anti-psychotics which were first developed in the 1950s. e.g chlorpromazine work by affecting neurotransmission, by blocking the action of dopamine. Chlorpromazine act as an antagonist of D2 receptors
how does chlorpromazine work
anti-psychotics MOM
after the pre-synaptic neuron releases dopamine into the synapse, the recpetor sites on the post-synaptic neuron are blocked by chlorpromazine, reducing activity in the post-synaptic neuron. this causes the pre-synaptic neuron to increase its release of dopamine into the synapse, rise of dopamine secreted. the production of dopamine will then drop because it’s depleted and the amount of dopamine in the synapse decreases
explain the effects of the reduction in the dopamine activity in the mesolimbic pathway
is thought to be responsible for the decline of positive symptoms (delusions/hallucinations) chlorpromazine is also seen to affect serotonin receptors as well as other receptors in the brain
what are atypical anti-psychotics
anti-psychotics MOM
such as Clozapine are ‘newer’ anti-psychotics. they’ve been developed since the 1990s. they work by acting as a dopamine antagonist (not clear how they work)
differences between 2 types of anti-psychotics
anti-psychotics MOM
- atypical anti-psychotics are received at fewer dopamine D2 receptors and at more D1 and D4 receptor sites
- another is that most atypical anti-psychotics also antagonise the seretonin receptor 5-HT2A, to the same degree as they antagonise the dopamine D2 receptor
- the amount of time they occupy the D2 receptor sites.
what did Phillip Seeman find (in relation to the amount of time they occupy the D2 receptor sites)
anti-psychotics MOM
reports on the ‘fast off’ theory. proposes that atypical anti-psychotics bind more loosely to the D2 receptors than conventional. this means that although they have a therapeutic effect it doesn’t last long enough to produce side affects that are seen in conventional anti-psychotics (tardive diskynsia)
explain the half life of an anti-psychotics
anti-psychotics MOM
also thought to be less than conventional medication- with atypical anti-psychotics the occupancy of D2 receptors fall off within 24 hours, conventional anti-psychotics, the fall off is over 24 hours
explain the dosage of anti-psychotics
anti-psychotics MOM
Largactil (chlorpromazine) can be prescribed as a tablet, oral medication, injection or suppository. the dose is 1000 mg as being the highest daily dose, maximum for a child is between 40-75mg depending on age
dosage of Clozaril, Denzapine and Zanopex (clozapine)
anti-psychotics MOM
are usually in tablet form. the max daily dose is 900mg. patients taking this must be specially monitored as the drug carries a 3% risk of causing agronulocytosis (potentially life threatening drop in WBC) regular blood checks are necessary
what is the second MOM schizophrenia
CBT
when was CBT first developed
CBT MOM
first developed by Beck and Ellis in the 1950s and was first used to treat depression. dince then CBT has successfully been applied to treat psychotic disorders such as schizophrenia and is particularly beneficial to those patients who had persistent symptoms despite taking anti-psychotics
explain irrational thinking
CBT MOM
a major symptom is disordered thinking. the purpose of CBT is to help and individual organise their thoughts. CBT helps to make the individual aware of the connections between their disordered thoughts and their illness. CBT also allows them to challenge their interpretation of events. these techniques help to deal with the positive symptoms but are also effective in making the individual more self-reliant with their illness as they have to challenge their own perceptions
who identified the key components of CBT in treating schizophrenia
CBT MOM
Laura Smith have identified the key components when using CBT for schizophrenia (enagement strategies, psycho-education, cognitive strategies, behavioural skills training, relapse prevention strategies)
explain engagement strategies
CBT MOM
prelimary sessions are used as an opportunity to talk about potential worries or symptoms. therapist will try to develop a rapport with the client. important as clients may have had negative experiences with previous therapists or the client may be experiencing higher levels of paranoia as a result of their illness. the therapist and the client will discuss any ‘natural coping strategies’ the client is using to manage their symptoms
explain psycho-education
CBT MOM
has 3 main funstions. first decatastrophising and normalising the experience of psychotic symptoms. second, the client will increase their own understanding of how their symptoms occur and third, the therapist can further assess the clients understanding of their symptoms and illness
explain cognitive strategies
CBT MOM
are things like disputing or a thought diary
disputing the clients beliefs so they become rational. clients may be asked to keep a thought diary where they record how they felt, what they thought and what they did at a particular event. client will be asked to record possible different views of the event and then discuss this with the therapist
explain behavioural skills training
CBT MOM
a range of effective behavioural strategies can be taught, like relaxation, distraction and problem solving. these are useful in not just coping with residual symptoms that aren’t managed by medication, but also any secondary symptoms of anxiety and depression
what does problem solving involve
CBT MOM
requires the client to work through a series of steps
1. identify a problem
2. generate potential solutions
3. evaluate alternatives
4. decide on a solution
5. evaluate the outcome
explain relapse prevention strategies
the therapist and the client identify early warning indicators of relapse. these include the client identifying thoughts, behaviours and feelings they experienced before becoming unwell. they are also asked to ask someone close to them to say what they may have noticed about them before becoming unwell. the individual and therapist will develop plans so they know what to do if these things happen again, so they are aware of what they can do to help themselves
effectiveness of conventional antipsychotics
evaluation: anti-psychotics MOM schizophrenia
Cole et al. conducted one of the earliest major study into the effectiveness of conventional anto-psychotic drugs. findings suggested that psychiatry could treat mental disorders in the same way that physical disorders are treated (using drugs) he found that 75% of those given a conventional anti-psychotic were considered to be ‘much improves’ compared with only 25% of those given a placebo. none of the pps who were given the drug were considered to have gotten worse, in comparison to 48% of those given a placebo. revolutionary as before many individuals were considered ‘untreatable’
comparing conventional and atypical anti-psychotics
evaluation: anti-psychotics MOM schizophrenia
atypical are generally considered to be more effective than conventional. Ravanic et al compared the effectiveness of clozapine, chlorpromazine and haloperidol in 325 individuals with schizophrenia. found that over a period of five years there were significant differences in psychometric scores measuring schizophrenic symtoms, favouring clozapine. also found clozapine had fewer adverse affects.
what does Ravanic’s research suggest
evaluation: anti-psychotics MOM schizophrenia
atypical antipsychotics are a more effective and preferable option when treating schizophrenia. even though this research suggests conventional anti-psychotics are redundant, must note that some individuals respond better to the older style conventional antipsychotics therefore they still have a role
difficulty assessing the effectiveness of antipsychotics
(weakness)
evaluation: anti-psychotics MOM schizophrenia
one major problem with assessing effectiveness is non-compliance. non-compliance is a particular issue in individuals with chronic schizophrenia because many of these individuals tend to lack the necessary ‘insight’ into their own condition- they don’t believe they have a problem so they don’t take the medication
evidence that goes with the problem of non-compliance
evaluation: anti-psychotics MOM schizophrenia
Rettenbacher found full compliance in only 54.2% of individuals with schizophrenia, partial compliance in 8.3% of individuals with schizophrenia and non-compliance in 37.5%. suggesting in the real world anti-psychotics may not be as effective as they seem to be in the closely controlled ‘clinical studies’ discussed above
ethical : side effects
evaluation: anti-psychotics MOM schizophrenia
both types have side effects. due to the side effects psychiatrists have to consider if the benefits offered to each individual are worth the potential costs of side effects.
ethical-valid consent
evaluation: anti-psychotics MOM schizophrenia
when individuals are first diagnosed with schizophrenia or are experiencing an acute episode of the disorder, anti-psychotics may be administered without their valid consent, meaning side effects are definitely not their choice
chemical straitjacket
evaluation: anti-psychotics MOM schizophrenia
anti-psychotics a simply a means of keeping people quiet and under-control. important ethical dilemma. are antipsychotics administered to alleviate suffering or to increase compliance with society in general. however, if we offer the ‘right to refuse’ antipsychotic medication, we need to be aware of the possible consequences
social implications: asylums or care in the community
evaluation: anti-psychotics MOM schizophrenia
psychiatrist Stephen Lawrie claims that ‘antipsychotic drugs revolutionised the care of schizophrenia changing it from an incurable condition with required institutionalisation to one that could be treated in the community with the potential for recovery. beneficial for both patients as they could lead more normal lives and also society due to the costs of lifelong hospitalisation
social implications: risk of violence
evaluation: anti-psychotics MOM schizophrenia
if an individual doesn’t follow their drug therapy, they may pose a threat to themselves or others Tihonen et al. noted a 37-fold increase in suicide patients who stopped taking their medication. the NCISH reported that 346 homicides had been committed in England by people with history of schizophrenia between 2003 and 2013, also reported that 29% of these individuals had not been adherant to drug treatment in the month before the homicide
what do potential socialimplication suggest
evaluation: anti-psychotics MOM schizophrenia
that despite antipsychotics having clear advantages, the benefits to society may have been outweighed by potential risk
an effective form of treatment
evaluation: CBT as a MOM schizophrenia
Kuipers et al. conducted research into the effectiveness of treating schizophrenia 60 individuals who each had ‘positive and distressing symptoms that were medication resistant’ wil randomly allocated to either a CBT plus standard care condition or a standard care only condition. After nine months of therapy, the research has found there was a change in the psychotic symptoms experience in the CBT plus standard care condition. 50% of the participants were considered to have improved with one individual becoming worse. in the other condition 31% were considered to have improved with three people becoming worse and another committed suicide.
what does Kuipers et al research suggest
evaluation: CBT MOM schizophrenia
this suggests that although improvements offered by CBT plus standard care they only see marginal it is significantly better than standard care only and therefore could improve individuals quality of life.
Contradictory evidence available
evaluation: anti-psychotics MOM schizophrenia
there has been some research that has suggested CBT isn’t effective increasing schizophrenia. Jawhar et al. reported only a “small therapeutic effect” from using CBT with clients with schizophrenia. however, other research by Anthony Morrison reported that CBT significantly reduced psychiatric symptoms in individuals with schizophrenia.
what does the contradictory evidence suggest
evaluation: CBT as MOM schizophrenia
The findings are inconsistent and initially suggest that CBT is ineffective
short term effectiveness
evaluation: CBT as a MOM schizophrenia
The effectiveness increasing schizophrenia seems to be limited to studies that I’ve only looked at short-term programs. Long term effectiveness CBT to treat schizophrenia has not been positive. Tarrier et al. studied individuals who either receive CBT shortly after diagnosis or receive standard care. 18 months later the CBT group had the same relapse as client who adjust standard care. However, Tarrier noted that the individuals in the CBT conditions seem to be less negatively affected by the symptoms and those who hadn’t had CBT.
what does research by TARRIER suggest
evaluation: CBT as a MOM schizophrenia
suggest that treatment of CBT to treat the symptoms are only short-lived and therefore alternative treatment need to be investigated
ethical implications: potential negative experience for clients
evaluation: CBT as a MOM schizophrenia
suggesting
The combination of schizophrenia symptoms being diagnosed and then being prescribed strong sensitive medications are all scary experience. Does CBC negatively added to this? Kuipers et al. Reported clients with generally satisfied with their experience of CBT and that they thought it was an appropriate way to deal with their problems. Reviewing the sustainability of the therapy from the point of view is important, especially it’s ethical impact.
they suggest that although CBT can be effective in treating schizophrenia, it could be causing an individual more harm than good
social implication: is CBT being offered to everyone
evaluation: CBT as a MOM schizophrenia
in the recent national orders of schizophrenia conducted by the royal College of psychiatrist there were significant variations in the amount of people with schizophrenia who would be an offered and taking up CBT in the various trusts.
The audit claim in the different trust the number of people will be offered CBT for schizophrenia range from 67% and 14% with an average of 50% of people reporting that they trusted not offered them CBT . This is a particularly worrying statistics as it clearly contradicts the guidance offered by NICE who recomend that’s every adult is psychosis or schizophrenia be offered CBT for psychosis. weakness because everyone in the nation should have the same access to the best treatment
social implication : CBT is cost effective
evaluation: CBT as a MOM schizophrenia
Kuipers analyse the economic impact of offering CBT to individuals as schizophrenia as well as using antipsychotic medication although the use of CBT may be more costly in the longer in the cost likely to recouped because the individuals schizophrenia are less likely to need emergency psychiatric services this money can then be spent on other health treatments this suggest that using CBT as a treatment for schizophrenia is a strength, positive for society as it’s allowing individuals live with schizophrenia to live a
more normal life.
