Schizophrenia- Methods of modifying Flashcards
What is the first method of modifying for SZ?
Antipsychotics
What are the 2 types of antipsychotics?
1- Typical
2- Atypical
What are typical (conventional) antipsychotics?
First generation 1950s
- dopamine antagonist
- block action of NT dopamine
What do Chlorplazmines do?
Block dopamine receptors in the synapses of the brain
- reduce the action of dopamine
- normalise transmission in key areas of brain
- reduce positive symptoms- hallucinations
- mesolimbic pathway, not commonly used
What are some negatives to typical antipsychotics?
Serious effects with movement
X Tardive dyskinesia
X agitated, weight gain, itchy skin
What are atypical antipsychotics?
Second generation 1970s
- maintain/improve effectiveness
What does atypical antipsychotic clozapine do?
Binds to dopamine receptors in the same way and acts on dopamine, serotonin and glutamate receptors
- improve mood, reduce depression
- improve cognitive functioning
What are the negative of clozapine- atypical antipsychotic?
X Discontinued for a period of time
X die from weak immune system, low white blood cell count
- can still be used if use regular blood tests
What does atypical antipsychotic risperidone do?
The same as Clozapine without serious side effects
- binds more strongly to dopamine receptor sites
- lower dosage
- 1990s
What are the negatives of atypical antipsychotic risperidone?
- Fewest side effects
X breastmilk production - still used, very common
What do both typical and atypical antipsychotics do?
Both affect the process of neurotransmission
Atypical - symptoms affected
Positive and negative symptoms- more NTs
Typical- symptoms affected
Positive symptoms- just dopamine
Evaluation: Antipsychotic drugs
Effectiveness of Conventional
Cole et al- 75% much improved, 25% placebo
- none worse, 48% placebo
X Noll, 1/3 of patients do not respond to conventional antipsychotics
- revolutionary and highly useful research
Evaluation: Antipsychotic drugs
Atypical are more effective than 1st generation
Ravanic et al- over 5 years, significant differences in psychometric scores measuring SZ symptoms
- more effective and preferable
X one fits all approach, not all find them to be more effective in reducing
X although typical are P and ME, conventional drugs still play an important role and their effectiveness should not be ignored
Evaluation: Antipsychotic drugs
Effectiveness
X What is non-compliance?
Particular issues in individuals with chronic SZ, many tend to lack the necessary insight into their own condition
X don’t believe they have a problem, therefore don’t take the medication
Evaluation: Antipsychotic drugs
X non-compliance Rettenbacher
Found full compliance in only 54.2% of individuals with SZ, partial compliance in 8.3% and non-compliance in 37.5%
X in the real world anti-psychotics may not be as effective as they seem to be in closely controlled clinical studies
X Q validity
Evaluation: Antipsychotic drugs
Ethics X serious side effects
Tardive Dyskinesia and Parkinsonianism
- uncontrollable, irregular movements
P- A group of conditions that cause slow, stiff, shakey and unsteady movements
X acute episode, not given valid consent
X do benefits outweigh side effects to protect from harm especially when valid consent has not been given
Evaluation: Antipsychotic drugs
Ethics X Control ‘chemical straightjacket’
Rather than having a therapeutic value and curing symptoms, reduce patient to a calm zombie like state
X Szasz- method of social control to keep individuals conformist
- are necessary to keep SZ patient from harming themselves and others
X unethical, what is their purpose to alleviate suffering or as a form social control
Evaluation: Antipsychotic drugs
Social- New revolution
‘care of the community’
Lawrie- incurable, treated with the potential for independent living and recovery
- social revolution, beneficial for patients (can lead more normal lives) and society (costs of lifetime hospitalisation)
- several benefits
Conclusion for antipsychotics drugs
Overall, there is a general consensus amongst scientists that antipsychotics as a method of modifying SZ behaviour has revolutionised treatments for SZ patients. This in turn has resulted in positive social implications. Although there are some questions surrounding ethics the positive outweighs his as the individuals do have a choice the majority of the time
What is the second method of modifying SZ?
Cognitive Behavioural therapy for psychosis
Intro to CBTp
Alter disorganised thinking, manage and organise
-can’t prevent SZ but help them deal and cope with it
CBTp
Aims to alter the way in which the patient thinks, manage their disordered thinking
- cannot prevent but helps them understand and cope with the episodes
- correctly attribute the source of the voices
- challenge false beliefs that underpin delusions
- empower to be more independent and increase confidence
Assessment
Client and therapist meet for the first time
-client explains their experiences and symptoms to therapist
- goals and expectations of therapy are established
What are the 3 components of CBTp?
1- Engagement
2- Psychoeducation/normalisation
3- Coping strategies
1- Engagement
Provides client opportunity to talk at length about worries and symptoms
- therapist develops rapport with the client
- therapist empathises with the patients perspective and feelings of distress
- C & T discuss coping strategies, client can appreciate their role in this
2- Psychoeducation/normalisation
- therapist normalises experience of psychotic symptoms after alternative explanations for symptoms, client feels less stigmatised
- increase clients understanding of the context in which their symptoms occur
- helps the therapist to assess the SZs understanding of their symptoms
3- Coping strategies (5)
1- Relapse prevention
2- Dysfunctional thought diary
3- The ABC model
4- Skills training
5- Behavioural experiments
What is relapse prevention?
> T n C identify warning indicators of relapse
- thoughts, feelings behaviours before
SZ assesses how well they got on with others, what others may have noticed before becoming unwell
T n C develop plans when they notice indicators
- say to family and friends, support options and strategies
What is dysfunctional thought diary?
Record feelings due to particular event
- write automatic negative thoughts associated with events
- client challenged to think differently and record differEnt views, more rational
- C n T discuss their entries
What is the ABC model?
- patient describes Activating event that causes irrational Beliefs/Behaviour as well as Consequences
- beliefs can be challenged, disputed, changed
- asked for evidence of belief
‘won’t like me’- voices
‘some may find it interesting’
What is skills training?
Behavioural strategies- relaxation, pleasant activity scheduling, problem solving taught
- cope with residual symptoms (not managed by medication, anxiety/depression caused by SZ)
1- identify problem
2- potential solution
3- evaluate alternatives
4- decide on solution
5- evaluate outcomes
What are behavioural experiments?
Challenge hallucinations
- identify situation/action that lessens voices
- listen to music, gardening, conversation
- Client rates severity of voices, allows them to realise they can control the voices they hear
Evaluation: CBTp
- Research support
Kuipers- CBT and standard care- 50% improve, 1 worse
SC only- 31% improve, 3 worse, committed suicide
- although improvements seem marginal, they are significantly better
- CBT is more effective at modifying SZ and helping treat patients in comparison to SC only
Evaluation: CBTp
X Not all R suggests CBTp is an effective method
Jouhar- only a small therapeutic effect
Morrison- CBT significantly reduced psychiatric symptoms in individuals with SZ
X lacks consistent findings result of ‘exercising choice’
X M- choice of treatment plan, J not less success
X no research consensus, lowers validity and usefulness
Evaluation: CBTp
X Long term effectiveness
Tarrier- 18m later, received some relapse rates, effects of CNT are short-lived
T- CBT condition, less negatively affected, depends on how benefits are assessed
( relapse rate X, reduction of symptoms yes)
X not useful if it does not last
Evaluation: CBTp
Ethics
- C has more control, input and ownership over improvement, boosts self-esteem
- no side effects in comparison with antipsychotics
X patient blame, the way they think is wrong
X psychiatric prejudice, judge the person isn’t suitable for CBT without giving them a chance- just prescribe antipsychotics
Evaluation: CBTp
Social implications
- coping strategies to live a ‘normal’ life
- less intrusive on daily life
- return to work, contribute to tax, less reliant on the state
X attending is more intrusive, not suit daily routine
X in conjunction with APs, more costly as a whole
X not all NHS trusts offer CBT 67-14% across the country, long waiting times
