The Biological Treatment for Schizophrenia (Clinical Psychology)

Question 1

What is the Biological Treatment of Schizophrenia?

Answer 1

Antipsychotic medication

Question 2

What do Antipsychotics do?

Answer 2

Alleviates positive symptoms, e.g. delusional thoughts and hallucinations.

These symptoms can adversely affect the quality of life for patients, and make accessing other forms of treatment difficult; so the drugs are offered to try to control these symptoms

Question 3

How do Antipsychotics work?

Answer 3

Work by blocking dopamine receptors in the areas of the brain associated with the symptoms - reduces dopamine in the brain.

Blocking receptors prevents dopamine from binding to receptors in the synapse. This depolarises neurons calming them down.

Question 4

How can Antipsychotics be given?

Answer 4

• Pills/tablet
• Injection by a nurse (if there is a risk of the patient not complying with the treatment regiment themselves)

Question 5

What are the two types of Antipsychotics?

Answer 5

• Typical
• Atypical

Question 6

What are Typical Antipsychotics?

Answer 6

First antipsychotic drugs which were developed. These lead to unpleasant side effects. Only worked for positive symptoms. Developed in the 1950s.

Question 7

What are some Examples of Typical Antipsychotics?

Answer 7

• Chlorpromazine
• Haloperidol
• Fluphenazine

Question 8

What are Atypical Antipsychotics?

Answer 8

Atypical drugs seem to have reported fewer side-effects while still being effective, making them preferable for many patients. Developed in the 1990s.

Question 9

What’s the difference between how Typical and Atypical drugs Work?

Answer 9

All antipsychotic drugs seem to act by locating mostly D2 receptors within those areas.

However, there is also evidence that atypical antipsychotics do not bind to the receptors quite so tightly; and that they also block 5-HT2A receptors, which are serotonin receptors.

Question 10

What research evidence shows the the Biological Treatment for Schizophrenia is Effective?

Answer 10

• Hartling et al
• Meltzer et al
• Clozapine effectiveness

Question 11

How does Meltzer et al show the Biological Treatment for Schizophrenia is Effective?

Answer 11

They found haloperidol gave sig improvement in terms of positive symptoms, negative symptoms, severity of illness and the scoring on a psychiatric rating scale, in comparison to a placebo.

• Demonstrates that drugs are an affective treatment.

Question 12

How does Hartling et al show the Effectiveness of the Biological Treatment for Schizophrenia?

Answer 12

Conducted a meta analysis of 114 randomised trials, investigating antipsychotics to compare the efficacy of typical and atypical antipsychotics.

They found that:

• Not much difference in reducing core illness symptoms (positive/negative symptoms and general psychopathology) between typical and atypical antipsychotics:
  
  • Some evidence that haloperidol (typical) was more affective than olanzapine (atypical) for positive symptoms. The reverse was true for negative symptoms.

Question 13

What is an advantage of the Biological Treatment for Schizophrenia?

Answer 13

Clozapine is considered to be one of the most effective antipsychotics. This might be because it has less side-effects; therefore, compliance amongst patience is higher and it therefore is able to reduce symptoms

Question 14

What limitations show the the Biological Treatment for Schizophrenia is not Effective?

Answer 14

• Side effects
• Lieberman et al

Question 15

What are the Side Effects of Atypical Antipsychotics?

Answer 15

Weight gain and metabolic changes that can increase the risk of diabetes + high cholesterol

Question 16

What are the Side Effects of Typical Antipsychotics?

Answer 16

• Disturbance of movement and posture (e.g. tremors and muscle spasms).
• Long term use can leave patients with tardive dyskinesia.
  
  • Involuntary muscle spasms around the mouth which can affect speech (can be irreversible).

Question 17

What are the Side Effects of Drugs in general?

Answer 17

Drugs are known to have serious side-effects for some patients, including:

• Blurred vision
• Drowsiness
• Rapid heart rate

Question 18

How does Lieberman et al show the Biological Treatment for Schizophrenia is Not Effective?

Answer 18

They found that many patients stop taking the medication because of the side-effects, which prevents drug treatment from working for many patients

Question 19

What are the Ethical Issues with Antipsychotics?

Answer 19

Antipsychotics can be prescribed without consent of the patient if they are sectioned under the mental health act, due to posing risk to themselves or others.

Some argue this is unethical, however others argue that this is ultimately for the benefit of the patient.

Question 20

What are the Issues and Debated surrounding the Biological Treatment of Schizophrenia?

Answer 20

Social Control:

• ECT was used to treat people with sz.
  
  • A current of electricity is passed through the bra to induce a temporary seizure.
  • Restraints and mouth guards must be used to avoid injury.
  • Course of up to 12 sessions In the 1960s.
• ECT criticised by the antipsychiatry movement for being barbaric and a method used to render troublesome patients docile and easy to handle, rather than being therapeutic. Now ECT is used successfully in extreme cases of mood disorders such as depression.

However…

• Research suggests ECT can be effective for catatonic symptoms in sz if used in conjunction with antipsychotics.
  
  • However, some argue it is not possible to conduct research of the quality necessary to establish efficacy (double blind, placebo controlled) and this is a problem for any research suggesting it is effective.

Question 21

What 4 points does Jess always tell me to say? (BONUS)

Answer 21

1. Typicals are only effect positve symptoms.
2. Drugs produce side-effects.
3. 85% responded to Atypical. 65% responded to typical.
4. 1/3 of patients who didn’t respond to typical drugs responded to atypical drugs (Meltzer meatball).