Schizophrenia - Methods of modifying Flashcards
1 What are the two types of antipsychotics?
First generation - typical
Second generation - atypical
1 What are typical antipsychotics?
Chlorpromazine - low potency, large amounts have to be administered to achieve desired effect, increased side effects
Haloperidol - higher potency, lower does needed, fewer side effects
Fluphenazine - injection, easier than taking daily tablets
1 How do typical antipsychotics work?
Block D2 receptors - decrease in dopamine in mesolimbic pathway is thought to be responsible for decline of positive symptoms
1 What are atypical antipsychotics?
Clozapine - beneficial for both positive and negative symptoms
1 How do atypical antipsychotics work?
Block fewer dopamine D2 receptors but more D1 and D4
Blocks dopamine and serotonin receptors (5HT2A)
1 What did Seeman report on?
‘fast off’ theory - atypical bind more loosely to D2 receptor sites than typical. does not last long enough to produce side effecs see in typical
1 Supporting research (typical) for antipsychotics?
Cole - 75% given typical considered to be ‘much improved’ compared to 25% given placebo
1 Supporting research (effectiveness) for antipsychotics?
Ravanic - significant differences in psychometric scores measuring symptoms favouring clozapine - atypical more effective and preferable
However, atypical not completely useless as beneficial for some
1 Difficult to assess effectiveness of antipsychotics?
Valenstein - in 40% of cases, adherence was poor - due to side effects, unaware of delusions so dont trust medication
non-compliance is issues as adherence is different in real world than clinical trials
1 Risk of psychological/physical harm from antipsychotics?
side effects - tardive dyskinesia and parkinsonism. Agranulocytosis can also occur which can increase risk of infection or death
1 Lack of valid consent from antipsychotics?
Some antipyshcotics are required to be takrn under mental health act going against ethical principle of valid consent
1 Risk of psychological harm from antipsychotics?
Why some antipsychotics work is unknown. for those that are known, it is unclear why they work for some but not others. - may have to spend years trying to find the appropriate one for them which could cause stress or make their symtpoms worse
1 Economic benefits of antipsychotics?
fewer people are institutionalisedd and people an return to paid employment whcih boosts econmy. Can also peer mentor other SZ to reduce overall suffering
1 Why is non-adherence a social implication?
NCISH - 346 homicides committed in England between 2003 & 2013 we by people with a history of SZ - 29% were non-adherent
1 Financial costs of antipsychotics?
NHS drug tariff & RDTC estimate that the costs can vary from £19.50-£3160.60 per patient per years. average being £1590.55. Not providing treatment will save money in short term but will cost more in long term as unmedicated SZ more likely to be hospitalised
2 What is CBT?
Talking therapy used to treat illnesses like depression and anxiety but also some forms of psychosis
2 What do cogntive approaches see mental illnesses as?
Being caused by problems with internal mental processes - result in disorganised thinking.
2 What did Smith et al identify?
Key components of using CBT
- Engagement strategies - build relationship
- Psychoeducation - patient will learn about illness
- Cognitive strategies - develop more productive thinking styles
- Empirical disputing - find evidence for delusions
- Behavioural skills training - given strategies to cope
- Dysfunctional thought diary
- Behavioural experiments
- Relapse prevention strategies - taught signs of relapse
2 Supporting research (antipsychotics) for CBT?
Kuiper - after 9 months 50% patients given CBT with drugs benefitted in reduction of symptoms while only 31% of control group benefitted
2 Contradictory research (application) for CBT?
Kingdon & Kirschen - CBT is not appropriate for elderly patients as they wouldn’t fully engage. Antipsychotics may havea wider application and therefore are more effective
2 Methodological issues of CBT?
CBT is rarely the only treatment received therefore it is difficult to isolate effectiveness of CBT
2 Why is it difficult to generalise findings to all schizophrenics?
Not suitable for all. if we find that CBT has high levels of effectivenesss , may be because samples hae less severe symtpoms and more willing to overcome illness - more likely to improve regardless of CBT
2 Ethical strength of CBT?
No side effects unlike antipsychotics - could be argued that without medication, CBT is ineffective
2 Valid consent for CBT?
Entered into with patient’s consent - able to withdraw at any point only risk is no further improvement unlike drug therapy which involves coercion
2 How is Kuipers’ study ethical?
reported that clients were generally satisfied and thought it was an appropriate way to deal with illness
2 What does Kingdon & Kirschen’s study suggest?
CBT is under used for SZ - risk of psychological harm because potentially effective therapy is not being offered to elderly patients
2 Why is postcode lottery a social implication for CBT?
In 2014, the number of SZ offered CBT ranged from 67% to 14% in various trusts - people may be denied a helpful treatment
2 Financial implications for CBT?
NICE - cost for CBT is between £1750 and £1800 per patient - additional cost on top of drugs as drug therapy is commonly pffered to all patients with SZ
