Schizophrenia- Methods of Modification Flashcards
Antipsychotic Drugs
What are the two types of antipsychotics? Conventional (old) & Atypical (new)
How do conventional antipsychotics work?
After the presynaptic neuron releases dopamine into the synapse onto the post-synaptic receptor site, it causes the presynaptic neuron to increase the release of dopamine. The production of dopamine stops after the initial spike. Chlorpromazine blocks the dopamine from getting through, and the reduction of dopamine activity in the mesolimbic pathway declines positive symptoms.
•Chlorpromazine- an antagonist of D2 receptors, whilst also blocking other dopamine receptor subtypes
•What is less dopamine in the mesolimbic pathway thought to reduce? Positive symptoms
•What does chlorpromazine also affect? Serotonin receptors, though mainly a dopamine antagonist.
Atypical
•A new drug, Clozapine, can produce therapeutic gains in schizophrenics who do not respond positively to conventional antipsychotics. (Kane et al, 88)
•These drugs work on the dopamine system, but block serotonin receptors too
•Developed from the 1970s.
•Fewer side effects, and faster working
•One well known atypical antipsychotic is clozapine.
HOW ARE ATYPICALS DIFFERENT FROM TYPICAL/CONVENTIONALS?
Atypical anti-psychs such as clozapine work differently to typical/conventional drugs
•They bind to dopamine receptors but then rapidly dissociate from them
•This means that the drug temporarily occupies the receptor and then ‘drops out’ of the receptor where it goes back into the synapse
•This process means that an excess of dopamine is reduced, but the receptor is not completely blocked so some dopamine can still bind
DIFFERENCES BETWEEN CONVENTIONAL AND ATYPICAL ANTIPSYCHOTICS
- Typical/Conventional antipsychotics reduce +ve symptoms as they reduce the effect of hyperdopaminergia in the mesolimbic system. However, they also reduce the effect of dopamine in other areas of the brain where dopamine levels were balanced before taking the medication.
- But atypical drugs like Aripiprazole can reduce/increase dopamine in the relevant areas thereby reducing both +ve and –ve symptoms , and rapid dissociation means that dopamine receptors aren’t completely blocked so NS levels can be made to be balanced. This means there is a reduced risk of side effects such as tardive dyskinesia
Evaluation
What did Cole et al 1964 find relating to the effectiveness of conventional antipsychotics?
•Cole found that 75% of those given conventional were considered to be ‘much improved’ with only 25% of the control (given a placebo). Also, none of those given conventional were considered to have gotten worse, in comparison to 48% of the controls.
What was Ravanic et al 2009’s study?
•compared effectiveness of clozapine (atypical), chlorpromazine and haloperidol (conventional) in 325 ppts with sz. Found significant differences in psychometric scales favouring clozapine. Also, clozapine had fewer adverse effects (0.9 per patient) with chlorpromazine (3.2) and haloperidol(2.7).
What is the issue of ‘non-compliance’?
•individuals with chronic sz, as many of these individuals lack the correct insight into their conditions, i.e. they don’t believe the severity of their illness and don’t take the medication.
What did Rettenbacher et al 2004 find on non-compliance rates?
•Found full compliance with only 54.2% of individuals with sz, partial compliance in 8.3% and non compliance in 37.5% of those with sz.
Thus, antipsychotics may not be as effective ‘in the real world’
CBT
How many sessions of CBT does a schizophrenic patient usually have? 5 - 20 sessions.
Aim of CBT- Identify and challenge irrational/delusional thoughts.
What happens once the thought has been identified?
Challenge these thoughts, encourage more plausible and less threatening explanation.
What 3 disputing techniques are used to challenge the thoughts?
•Logical disputing - Does it make sense?
Empirical disputing - Where is the evidence?
Pragmatic disputing - Is it helping?
What does disputing do?
•Help patients to make sense of how their delusions/hallucinations impact their feelings/behaviour.
E.g. hearing voices = be afraid.
Offer plausible explanations for these, reduces anxiety.
Realise their beliefs are not based in reality.
What 2 other techniques are used as part of CBT?
- Positive self talk. E.g. saying positive things to challenge auditory hallucinations.
- Diary. Practice disputing and positive self talk daily. Track any hallucinations, assess severity and how they dealt.
Evaluation
What was Kuipers et al 1997 study?
•60 individuals with sz who each had a ‘positive and distressing symptom that was medication resistant’, were randomly allocated to either a CBT plus standard care condition or just a standard care only condition.
What were the findings of Kuipers et al 1997 study?
•Aft. 9 months of therapy- change in CBT plus control, with 50% being improved, with only one being worse. In the standard, care only- 31% were improved with 3 worse and 1 committing suicide. Thus, CBT care is marginally better than standard.
What contradictory evidence did Jauhar et al 2014 find?
•clients reported only a ‘small therapeutic effect’ from using CBT with clients with sz. A month later Morrison et al (2014) reported that CBT significantly reduced psychiatric symptoms.
Why might the evidence be inconsistent?
•results may have varied as Morrisons cohort plan had choice whereas Jauhar’s did not- suggesting choice as an extraneous/cofounding variable, critical to CBT’s success.
What is the issue with short-term effectiveness?
•Success in CBT found in only short-term programmes. Research investigating the longer-term success has not been positive.
Tarrier et al 2004 findings around short term effectiveness
•assessed individuals who received CBT shortly after diagnosis or received standard care, aft. 18 mnths it was found the two had the same relapse rate, suggesting effects of CBT are short lived.
What did Tarrier also note about his short-term effectiveness findings?
•those who received CBT were less negative in their symptoms, suggesting there were some long term benefits
