Schizophrenia - Treatment comparisons Flashcards
Effectiveness - evidence: Antipsychotics
-Typical antipsychotics (e.g., Chlorpromazine): Reduce dopamine activity; research shows effectiveness in reducing positive symptoms like hallucinations and delusions.
-Atypical antipsychotics (e.g., Clozapine, Risperidone): More effective for treatment-resistant patients, also target serotonin, improving mood and cognitive functioning.
-Meltzer (2012) found Clozapine effective in 30–50% of patients where other drugs failed.
Effectiveness: Family therapy
-Pharoah et al. (2010) found family therapy reduces relapse rates and hospital readmission by improving family communication and reducing expressed emotion (EE).
-Lower EE environments decrease stress and prevent relapse. Also improves medication compliance.
-Leff et al. (1985): Found that after two years, relapse rates were 50% lower in patients who received family therapy compared to control groups
Effectiveness: CBTp
-NICE recommends CBTp for all schizophrenia patients, showing that it reduces symptom severity, especially for delusions and hallucinations.
-Tarrier et al. (2004): Found that patients who received CBTp alongside medication showed lower symptom severity and relapse rates compared to those receiving medication alone.
-Helps patients develop coping strategies, challenge irrational beliefs, and manage stress.
Effectiveness: Interactionist approach
-Combines biological (antipsychotic medication) and psychological (CBTp, family therapy) treatments. -Tarrier et al. (2004): Found patients receiving combined treatment had lower symptom severity and relapse rates than those receiving medication alone.
-Suggests the most effective approach targets both biological vulnerabilities and environmental stressors (diathesis-stress model).
Effectiveness: Token economies
-Used in institutional settings to manage behavior, encouraging positive actions like hygiene, taking medication, and social interaction.
-Azrin(1968): Found that token economies improved behavior in patients with schizophrenia in hospital settings.
-However, generalization to outside environments is limited.
Side effects: Antipsychotics
-Typical: Tardive dyskinesia (involuntary movements), drowsiness, weight gain.
-Atypical: Fewer extrapyramidal side effects, but can cause agranulocytosis (especially with Clozapine), weight gain, and diabetes.
-Long-term dependency concerns.
Side effects: Family therapy
-Sessions may provoke tension as sensitive topics are discussed. -Emotional distress can occur if family dynamics are problematic. -Time commitment may also be a barrier.
Side effects: CBTp
-No physical side effects. -Psychological risks include distress when confronting delusions or hallucinations.
-Some patients may find discussing their experiences challenging, especially if insight into their condition is limited.
Side effects: Interactionist approach
-Incorporates side effects of medication (e.g., weight gain, diabetes) alongside the psychological challenges of therapy. -However, combining treatments can reduce reliance on high medication doses, minimizing physical side effects.
Side effects: Token economies
-Ethical concerns arise as it may restrict access to activities seen as basic rights if tokens are not earned. -May lead to dependency on institutional settings, making reintegration into society difficult.
Perceptions of treatment: Antipsychotics
-Seen as essential for managing acute episodes.
-However, side effects, especially with typical antipsychotics, lead to negative perceptions.
-Patients may feel disempowered due to chemical control.
Perceptions of treatment: Family therapy
-Generally positive perception as it improves family understanding and support.
-However, can be perceived as invasive by some families.
-Success depends on family willingness to engage.
Perceptions of treatment: CBTp
-Perceived as empowering as it gives patients tools to manage symptoms. -However, effectiveness depends on patient engagement and insight into their condition.
-Some may prefer quicker, medication-based solutions.
Perceptions of treatment: Interactionist approach
-Highly regarded for its comprehensive approach.
-Patients benefit from symptom management via medication and skill development through therapy. -However, resource-intensive and requires patient motivation for therapy.
Perceptions of treatment: Token economies
-Positively viewed in institutions as it encourages routine and positive behavior.
-However, criticized for being superficial and not addressing underlying symptoms.
-Can be perceived as manipulative.
Passive or Active: Antipsychotics
Passive – patients do not actively engage in the treatment process; medication works biologically.
Passive or Active: Family therapy
Active – requires participation from both patients and family members in sessions.
Passive or Active: CBTp
Active – requires patients to engage in discussions, homework, and self-reflection.
Passive or Active: Interactionist approach
Both: Medication is passive, but psychological therapies are active, requiring participation.
Passive or Active: Token economies
Active – patients must engage in desired behaviors to earn tokens, promoting self-regulation.
Where is it done?: Antipsychotics
Hospitals (acute episodes), outpatient clinics, and community mental health centers for maintenance doses.
Where is it done?: Family therapy
Outpatient settings, community centers, or even in patients’ homes. Flexible in delivery (face-to-face or online).
Where is it done?: CBTp
Outpatient therapy sessions, hospitals, community mental health services. Can be done individually or in groups.
Where is it done?: Interactionist approach
Hospitals for acute care (medication), outpatient clinics for therapy. Community mental health centers for long-term integrated care.
Where is it done?: Token economies
Psychiatric hospitals, long-term care facilities, and other institutional environments. Rarely used in community settings.
