Schizophrenia- Treatment of Schizophrenia

Question 1

What are antipsychotic drugs?

Answer 1

Most common treatment of Sz.
Depending on severity of psychosis, some may only be on a short course of antipsychotics, whereas others may need them for a lifetime if their symptoms are still there.

Question 2

Types of Antipsychotics: What is Chlorpromazine?

Answer 2

First generation antipsychotic.
Typical- dopamine antagonist- reduce levels of dopamine activity in the brain.

Question 3

How does Chlorpromazine work?

Answer 3

Binds to D2 receptors on post synaptic neurons in brain, reducing dopamine levels, resulting in a reduction of positive Sz symptoms e.g. hallucinations.
Also used as a sedative- used to calm patients.

Question 4

Types of Antipsychotics: What is Clozapine?

Answer 4

Second generation antipsychotics.
Atypical- act upon both dopamine and serotonin.

Question 5

How does Clozapine work?

Answer 5

Binds to D2 receptor sites on post synaptic neuron, reducing positive symptoms e.g. hallucinations.
Act as antagonists upon serotonin receptor sites (2A and 2C) to increase serotonin levels.
Believed this action reduces negative symptoms of Sz e.g. lack of mood, as it helps improve mood and reduce depression and anxiety in patients.

Question 6

Difference between Typical and Atypical Antipsychotics?

Answer 6

Typical: only treat positive symptoms of Sz as they only act upon dopamine.
Atypical: treats both positive and negative symptoms of Sz as they act upon both dopamine and serotonin.

Question 7

AO3: Strength of Antipsychotics as Treatment: Research to Support

Answer 7

P: Evidence to support effectiveness.
E: Large body of research to support effectiveness of typical and atypical.
E: Thornley et al: meta-analysis of 13 studies with over 1000 ppts investigating effect of Chlorpromazine (typical) against placebo, typical antipsychotic associated with better overall functioning, reducing symptoms severity.
Meltzer: concluded Clozapine (atypical) was more effective than typical antipsychotics, effective in 30-50% of treatment resistant cases.
L: Supports antipsychotics are effective treatment for positive and negative symptoms of Sz.

Question 8

AO3: Strength of Antipsychotics as Treatment: Little Motivation

Answer 8

P: Typical and atypical antipsychotics require little motivation from patient.
E: Patient only takes tablet in order to reduce symptoms of Sz, unlike CBT, requires motivation from patients, must attend and engage in sessions to identify and challenge irrational thoughts e.g. delusions.
E: Difficult for those with negative symptoms e.g. avolition, struggle keeping up with everyday tasks, receive immediate positive effects of their symptoms.
L: Drug therapy’s more appropriate than CBT in treating Sz, more accessible treatment across symptoms.

Question 9

AO3: Weakness of Antipsychotics: Negative Side Effects

Answer 9

P: Weakness: negative side effects.
E: Typical antipsychotics e.g. Chlorpromazine, produce movement side effects e.g. Parkison’s, and atypical antipsychotics carry the risk of life-threatening illnesses.
E: Unlike CBT: Involves person identifying and challenging irrational thoughts, without use of drugs, no life-threatening side effects.
L: Drug therapy not appropriate for all patients as side effects reduce effectiveness, some people may stop taking them resulting in symptom relapse.

Question 10

What’s the aim of CBT?

Answer 10

To help patients identify irrational/ delusional thoughts and change them into more rational ones via disputing (making them less threatening).

Question 11

What’s Empirical Disputing?

Answer 11

Therapist asks the patient where the evidence is of their delusion/ hallucination.
Disputing helps patients understand delusions/ hallucinations aren’t real and therapist could explain it’s just a symptom of Sz.
Therapist offers more plausible explanations for these symptoms, reducing anxiety/ stress after patient realises beliefs aren’t based on reality and thoughts are less threatening.

Question 12

What’s Positive Self-Talk?

Answer 12

e.g. an individual hears negative voices, they can say positive statements that challenge auditory hallucinations.

Question 13

What’s Self-Distraction Strategies?

Answer 13

e.g. listening to music to drown out voices when they occur.

Question 14

AO3: Research into Effectiveness of CBT

Answer 14

P: Jauhar et al.
E: Reviewed results of 34 CBT studies as treatment of Sz- concluded CBT has significant but small effect on positive and negative symptoms.
E: Demonstrates CBT’s fairly effective in treating Sz, challenging patients irrational thoughts can reduce symptoms of depression.
L: However, out of 34 studies, CBT may only have small impact on Sz symptoms, placing doubt on effectiveness of CBT as treatment of Sz.

Question 15

AO3: Limitation of CBT: Requires Motivation and Commitment

Answer 15

P: Requires motivation and commitment from patients to attend sessions, something individuals suffering from negative symptoms e.g. avolition often lack.
E: CBT requires patient to engage in therapy, something individuals with proitive symptoms e.g. delusions may have lack of awareness and inaccurate perception of reality.
E: Some cases, Sz only effective when combines with antipsychotics because drugs help motivate patient to attend sessions/ increase awareness.
L: CBT alone may not be effective treatment for all Sz cases.

Question 16

AO3: Strength of CBT

Answer 16

P: Some may prefer therapy as it avoid chemical dependence.
E: CBT encourages individuals to identify and challenge irrational delusions/ thoughts independently, giving control over own behaviour.
E: Unlike drug therapy, imposes chemical straightjacket as drug controls activity of neurotransmitters in brain e.g. dopamine to reduce Sz symptoms, cause dependence.
L: Some may prefer CBT as more appropriate Sz treatment.

Question 17

What’s Family Therapy?

Answer 17

Based on the idea that family dysfunction can play a role in development of Sz, but altering relationship and communication patterns within dysfunctional families can help schizophrenics recover.

Question 18

How Does Family Therapy Work/ What’s the Aim?

Answer 18

Reduces expressed emotion and stress levels within family that may contribute to patient’s risk of relapse.

Question 19

How Does Family Therapy Reduce Levels of Expressed Emption and Stress?

Answer 19

-Improves families beliefs about behaviour towards Sz.
-Reduces stress of caring for relative with Sz.
-Decreases feelings of guilt/ anger in family members.
-Helps family members achieve balance between caring for individual with Sz and maintaining own lives.

Question 20

What Happens in Family Therapy?

Answer 20

Therapists meet regularly with patients and family members over course of around 9 months - 1 year.
Encouraged to be open and talk about patient’s symptoms, behaviour, progresses.

Question 21

AO3: Family Therapy: Research to support

Answer 21

P: Leff et al.
E: Compared family therapy with routine outpatient care for schizophrenics.
E: Found the first 9 months of treatment, 50% of those receiving treatment relapsed, compared with only 8% of those receiving family therapy.
L: Suggests family therapy’s effective in treating those with Sz.

Question 22

AO3: Family Therapy: Limitation

Answer 22

P: Doesn’t get to the root cause of Sz.
E: Works by helping reduce stress of living with Sz in family.
E: For both patient and family members this doesn’t eliminate symptoms completely.
L: Questions appropriateness and effectiveness of therapy as when therapy stops patients could relapse, research found this in follow up study of patients who received family therapy.

Question 23

AO3: Family Therapy: Alternative Therapy

Answer 23

P: Due to weakness, alternative therapy is art therapy.
E: Less well known, less likely to be available to patients.
E: Takes place with specially trained art teacher worked with Sz patients, allows patients to interpret emotions and feelings, express them without necessarily using words in safe environment, acts as healthy form of distraction for various symptoms e.g. hearing voices.
L: Art therapy may be more appropriate treatment than family therapy for Sz.