schizophrenia - topic 3 - therapies for schizophrenia

Question 1

typical antipsychotics

Answer 1

example: Chlorpromazine (low potency), Haloperidol (high potency)
U:Reduce positive symptoms.
R: Based on the idea schizophrenia is caused by excess dopamine activity at certain synaptic sites.
A:Chlorpromazine reduces dopamine activity at receptor sites.
P: Blocking D2 dopamine receptors, reduces ability of dopamine to bind to postsynaptic receptor, lessening the response.

Question 2

atypical antipsychotics

Answer 2

example: clozapine
U: Reduce both positive and negative symptoms with fewer side-effects.
R: Based on the idea schizophrenia is caused by excess dopamine activity at certain synaptic sites. Also re-balance other neurotransmitters associated with schizophrenia i.e. serotonin. Target serotonin and dopamine receptors in the brain.
A: Target serotonin and dopamine receptors in the brain. Precise biochemical mechanisms are unknown but they appear to impact serotonin receptors by blocking them.
P: Precise biochemical mechanisms are unknown but they appear to impact serotonin receptors by blocking them.

Question 3

arguments for/against

Answer 3

positive
patients do not have to spend long in psychiatric wards
reduction in positive (and negative symptoms)

negative
Do not cure, simply put off symptoms
Little effect on negative symptoms
30% of patients do not respond to medication
40% relapse rate
Minor and extreme side effects
About ½ of patients taking anti psychotics stop after a year as side effects are too severe.
Clozapine can reduce white blood count, this weakens immune system.

Question 4

appropriateness of drug therapy

Answer 4

Side Effects:
Clozapine reduces white blood cell count which weakens the immune system, rarely, but can result in death.
Dry mouth, dizziness, blurred vision, low blood pressure.
Dysfunction of nerve tracts = side effects that mimic symptoms of parkinson’s disease i.e. involuntary muscle contraction.
Compliance:
Some patients have trouble remembering to take medication .This can be helped with depot injections every few weeks. This creates a depot that slowly releases medication into the body.
Ethics:
People may not want their lives dominated by drugs.
They are able to chose whether or not they wish to continue with their course of medication if side effects have too much of a negative impact.

Question 5

effectiveness of drug therapy

Answer 5

Cochrane Review 1: Effectiveness of chlorpromazine is short to medium term. Improves symptoms.
Cochrane Review 2: Lower relapse rate with clozapine than typical antipsychotics. Fewer motor effects with clozapine. Better long term.

Question 6

ECT

Answer 6

electro-convulsive therapy
U: To treat schizophrenia but now more common in treating depression.
R: Schizophrenia is caused by abnormal activity of neurotransmitters/hormones.
A: The applied shock corrects abnormal activity of neurotransmitters/hormones.
P: Anaesthetic/muscle relaxants are administered.
Electric current applied through electrodes placed on either 1 or both sides of the head for 0.5 - 5 seconds
Takes place over several sessions across a number of weeks.

Question 7

research evidence for ECT

Answer 7

Tharyan and Adams - Cochrane Review:
Method: Meta-analysis of 26 studies.
Results:
ECT compared with sham ECT - more patients improved with real ECT (therefore not placebo effect)
ECT resulted in less relapse in short term than sham ECT
No evidence for medium/long term advantage
When compared with drug treatment results favoured drugs
Limited evidence showing ECT combined with drug therapy was more effective than drugs alone.
Conclusions:
For some schizophrenic patients ECT can act as a short term treatment.
When rapid reduction in symptoms is needed ECT combined with drug therapy may be beneficial to some.

Question 8

effectiveness of ECT

Answer 8

Use of sham ECT in studies shows its effectiveness. Real ECT resulted in decreased symptoms and reduced relapse rate.
The benefits are not long term
Drug treatment tends to be more effective
Can be effective for those who do not respond to drugs
A quick way to reduce severe symptoms i.e. psychotic episode

Question 9

appropriateness of ECT

Answer 9

Side Effects
Cognitive deficits
Memory loss that can last up to 6 months
Ethical Issues
Memory loss can be upsetting, confusing and disruptive to patients lives
Can be given without consent - on agreement of 2 doctors and a social worker when patient is at serious risk to their own health.

Question 10

CBT

Answer 10

U: Treat schizophrenia.
R: Based on the idea schizophrenia is caused, or maintained by the patient’s irrational thoughts.
A: Address and change the patient’s beliefs and thoughts that contribute to symptoms.
P: 12-20 sessions with patient and therapist.
COGNITIVE ELEMENT- make patient aware of cognitions and how they impact functioning. Trying to challenge and question irrational beliefs.
BEHAVIOURAL ELEMENT - reality testing, role-play, homework. This may be done using Ellis’ ABC model
-A: activating event .i.e voices
-B: beliefs i.e. voices are controlling my life
-C: consequenecs i.e. loneliness and isolation

goals setting
normalisation techniques