Schizophrenia - Treatments Flashcards
what drugs are used to treat schizophrenia?
antipsychotics
what are the 2 types of antipsychotics?
typical and atypical
how do typical antipsychotics treat schizophrenia?
stop hallucinations and delusions by blocking D2 receptors
what are the side effects of typical antipsychotics?
anhedonia, weight gain, tardive dyskinesia (muscle spasms)
what is an example of a typical antipsychotic?
chlorpromazine
how do atypical antipsychotics treat schizophrenia?
act on D2 receptors by rapid dissociation but for a shorter amount of time than typical
act on serotonin to reduce anxiety/depression
what are the side effects of atypical antipsychotics?
lowers white blood cells (agranulocytosis)
headaches
weight gain
when are typical antipsychotics usually taken?
all of the time
when are atypical antipsychotics usually taken?
during episodes only
what are the issues with typical antipsychotics compared to atypical?
taken all the time - side effects all the time
severe side effects
what are the issues with atypical antipsychotics compared to typical?
immunocompromised patients cannot take them as side effects lowers white blood cells
what are the advantages of atypical antipsychotics over typical?
reduces anxiety and depression - good as 30-50% of SZ patients attempt suicide
works on ‘hard to treat’ patients
can take during episodes only - side effects only during episodes
less severe side effects
what are the advantages of typical antispychotics compared to atypical?
can be taken by immunocompromised
what are the advantages of drug therapies to treat SZ?
supporting evidence - study compared with placebo and antipsychotic significantly more effective
enhance quality of life for patients - can live outside inpatient facilities - ecological validity
what are the issues with drug therapies?
consent - patients in psychotic episodes may not be able to consent to drugs, especially with severe side effects
severe side effects
biased research - a lot of research into antipsychotics funded by drug companies - biased results to sell more
what is CBTp?
CBT but modified for psychosis
what is the main difference between CBT for depression and CBT for psychosis?
depression - try to change behaviours to solve issues
psychosis - try to change behaviours to cope with the problem
how long does CBTp usually run for?
5-20 sessions
what are the key componenets of CBTp?
critical collaborative analysis
normalisation of the symptoms
behavioural assignments
uses Ellis’ ABCDE model
what is critical collaborative analysis?
prompting the patient with logic to challenge illogical conclusions or thoughts the patient has
how does normalisation in CBTp help schizophrenic patients?
helps them feel less alienated and isolated from the general population
makes possibility of recovery seem more likely
why are behavioural assignments used in CBTp?
to improve the general level of functioning
what are the advantages of using CBTp to treat schizophrenia?
when compared to standard care (antipsychotics only) it is effective
found to reduce hospitalisation rates up to 18 months following treatment
what are the disadvantages of using CBTp to treat schizophrenia?
most studies on effectiveness had patients on antipsychotics as well - doesn’t show effect of CBTp on own
not widely available - low ecological validity
research consistently shown individuals with more experience of their disorder benefit more - doesn’t help all patients
found that the better study conducted into CBTp, the weaker the findings for its effectiveness
what is the aim of family therapy to treat schizophrenia?
educate family members about schizophrenia so they can support the patient better
family learns how to spot and discuss problems with the patient positively
what finding is family therapy based on?
hostile/overly expressive families lead to more relapses
what % does family therapy reduce relapse by?
up to 50%
what is often used in conjunction with family therapy?
antipsychotics
outpatient care
how long does family therapy tend to last?
3-12 months
at least 10 sessions
how does family therapy improve relationships?
patient encouraged to talk to family about what support is and isn’t helpful
family members encouraged to listen to each other, discuss problems and negotiate solutions together
what are the key strategies used in family therapy?
forming a theraputic alliance with all family members
maintaining reasonable expectations amongst family members towards the patient’s performence
what are the advantages of using family therapy to treat schizophrenia?
strong research support - Pharoah et al meta analysis
economic validity - cheaper than a lot of other treatment options eg hospitalisation
found to be good for family members health - 60% reported positive impact
what are the disadvantages of using family therapy to treat schizophrenia?
issues with the pharoah study - said it used random allocation, in reality didn’t, observer bias as ‘raters’ knew who had SZ and who didn’t
if family already good, doesn’t help patient
what were the findings from the Pharoah et al meta analysis?
reduction in relapse and reduction in hospital readmission during treatment and in the 24 months after
Some studies reported an improvement in the overall mental state of patients, others didn’t
increased compliance with medication.
not much of an effect on more concrete outcomes eg living independently or employment.
what is token economy?
form of behavioural therapy where target behaviours are rewarded with tokens that can be exchanged for rewards/privaleges at a later time
why is token economy effective?
patients are learning to associate positive behaviours with positive outcomes
draw the cyclic process of token economy
what are the advantages of token economy?
research support showing it is effective in psychiatric settings
what are the disadvantages of using token economy to treat schizophrenia?
works in psychiatric settings - but not in the community
unethical - human rights (eg food) can be used as rewards
manages schizophrenia however does not cure/treat it
tend to not have a control group to be compared to so unsure of effectiveness
