Sz

Question 1

Drug treatments for SZ

Answer 1

• typical antipsychotics (eg chlorpromazine) are dopamine antagonists reducing dopamine
activity by blocking dopamine receptors at the synapse. This reduces positive symptoms
such as hallucinations and has a calming/sedative effect
• atypical antipsychotics (eg clozapine and risperidone) block dopamine receptors and also
act on other neurotransmitters eg acetylcholine and serotonin; also address the negative symptoms such as avolition.

Question 2

Psychological therapies : CBT

Answer 2

Cognitive behaviour therapy.
5 - 20 sessions even in groups or as an individual.
Identify irrational thoughts and change them through discussion.
Help cope but not treat

Insight into their delusions and hallucinations and the impact of this on their emotions.
Eg. If a patient hears demons they’ll be afraid, explanations oh why they have hallucinations will alleviate fear.
Delusions can be challenged to show that it’s not reality.

Question 3

Family therapy:

Answer 3

Family therapy: improve communication and interaction.
They see family as the root cause of the condition. Nowadays, reduce stress and expressed emotion that may contribute to a relapse.

Pharaoh et al: form therapeutic alliance , reduce stress of caring for Sz patient, reduction in anger and guilt.

Reduce the likelihood of a relapse and readmission. Reduces stress levels and expressed emotion.

Question 4

Token economies

Answer 4

Reward system
For those who have maladaptive behaviour patterns due to institutionalisation. Eg . Bad hygiene.
Do not cure but improve quality of life and ability to function outside the institution.

Tokens: given immediately when desirable behaviour shown (target for reinforcement)
Prevents “delay discounting” the reduced effect of a delayed reward

Rewards: can be swapped later for more tangible rewards
Operant conditioning
Tokens are secondary reinforcers: only show value once patient knows it can be used to gain rewards. Eg. Sweets, walk outside

Question 5

Ethical issues of CBT / Token economies

Answer 5

Rewards and major privileges only become available to patients with mild similar symptoms and not for those with severe forms of schizophrenia. This means that severely ill patients suffer discrimination and families of patients have challenged the legality of this. This has reduced the use of token economies.
CBT infringes on freedom of thought.
Imposing believes can be used to enforce political agenda

Question 6

Treatments improve quality of life but not cure

Answer 6

Worth doing but doesn’t cure Sz; this is a weakness
Neither does it cure symptoms same as the biological approach
Give details of how they improve quality of life

Question 7

Research support for therapy:

Answer 7

CBT has a small but significant effect on both positive and negative symptoms.
Found in a review of 34 studies.

Pharaoh et al:
There is moderate evidence to show that family therapy significantly reduces hospital readmission and improves the quality of life of patients and their families. However they also noted that the results are different studies were inconsistent and there is product problems with the quality of some evidence.

Sultana found:
Lack of random allocation (subject to bias)only three had been
Of the three, one showed improvement.
Modest and inconsistent support; (disparity in conclusions) which is a limitation.

Question 8

Evaluation on drug therapies

Answer 8

Evaluation:
• use of evidence re effectiveness in reduction of symptoms and/or relapse rates, eg
Thornley 2003
13 trials , 1121 patients showed that Chloropromazine reduced symptoms compared to a PLACEBO.
No one drug appears better or worse due to individual difference.
• side effects – typical antipsychotics: dry mouth, constipation, lethargy and confusion,
involuntary muscle movement - tardive dyskinesia;
atypical antipsychotics: weight gain,
cardiovascular problems, agranulocytosis (autoimmune disorder affecting white blood cells)

• comparison with other treatments, eg cognitive therapy, family therapy

• need to assess long-term benefits – many studies focus on short-term effects only
Healey ; successful trials has data published loads, exaggerating evidence.

• enhanced quality of life: for patients who can live independently/ outside of institutional
care; for family members

Used to calm patients and make life easier for workers rather than benefit patients. It is recommended but is deemed unethical and human rights abuse.