Treatments and Managements of Schizo.

Question 1

Describe the Biochemical treatment of Schizophrenia? [4]

[Falls under Biological].

Answer 1

-The biochemical treatment also known as antipsychotics are drugs or medication that are used to alleviate psychotic symptoms.
-They are normally prescribed to patients with Acute psychosis [full blown].
-It us used to help in lowering; 1.hallucinations.
2. delusions.
3. disorganized thoughts and behavior.

-Antipsychotics are known to be dopamine antagonists as they work by polarizing dopamine receptors causing a massive downregulation. [the number of dopamine receptors are lowered].
-They also have the same chemical strucutre as dopamine. They bind on them hence polarizing them.

Question 2

Name the 2 types of antipsychotics?

Answer 2

1. First generation which is also known as Typical.
2. Second generation which is also known as Atypical.

Question 3

Describe the First generation antipsychotic?

Answer 3

-Typical was the first to be manufactured in the 1950’ to help calm down people with acute psychosis.
-Examples of Typical include;
1. Chlorpromazine.
2. Haloperidol.

• However these first generation are known to have extreme or server side effects which are very fatal and they included;
  1. Agranulocytosis; low white blood cell count.
  2. Extrapyramidal symptoms that includes; Tardive Dyskinesia, Acute dystonia and Akathisia.

Question 4

Describe the 3 types of EPS?

Answer 4

1. TD; involves repetitive involuntary facial movements such as;
   - Facial grimacing.
   - Lip smacking.
   - Tongue twisting.
2. Acute dystonia; involves involuntary muscle contraction such as;
   - Blinking.
   - Twisted head.
   - Protruding tongue.
3. Akathisia;
   - Irritability
   - Physical agitation.
   - Restlessness .

Question 5

Describe the Second generation antipsychotics?

Answer 5

-Atypical was manufactured in the 1990’s as a response to the extreme first generation.

-Compared to the first generation, Atypical has fewer/ less side effects.
-Examples of Atypical include;
1. Clozapine.
2. Olanzapine.

-Despite them having fewer side effects, it still has some unpleasant side effects such as;
1. Fat gain/ Obesity; which leads to diabetes and heart disease.

Question 6

Why can Antipsychotics cause addiction in patients?

Answer 6

• Antipsychotics just like any other medication can cause addiction i.e.; patients depend on the medication and cannot function without them. Eg; High relapse rates in periods of acute psychosis.

Question 7

Describe the Electro- Convulsive therapy treatment of Schizophrenia?

[Falls under Biological].

Answer 7

-ECT is a type of treatment that is prescribed to 3 types of individuals;
1. Patients with Acute psychosis.
2. Drug resistant patients.
3. Pregnant women.

Question 8

What are the six steps in preparing for ECT?

Answer 8

1. Patients will have an IV line inserted in them. The line will be used to deliver 2 things;
   - Anesthesia.
   - Muscle relaxant.
2. The anesthesia will be used to induce unconsciousness while the muscle relaxant will be used to relax the muscles.
3. A blood pressure cuff will be placed around the patients ankle [One of them] and this is to prevent the muscle relaxant from reaching the ankle so as to measure convulsion.
4. The patient must have a bite bar and this is to prevent mouth and teeth injury.
5. All metallic Jewelry must be removed.
6. The patient will have electric pads on their head ready for the procedure.

Question 8

Describe the procedure for the ECT?

Answer 8

-An Electric current of 800 milliamps is passed through the electric pads to the patients brain producing an electric seizure that usually lasts for less than 60 seconds.
-This is done in 2 ways either;
1. Unilateral; electric pads are placed on one hemisphere of the brain usually the less dominant.
2. Bilateral; one pad is placed on each hemisphere of the brain.

Question 9

Out of the 2 [Unilateral and Bilateral], which is frequently used? And give an answer why.

Answer 9

-Unilateral is the one commonly used and this is because it preserves memory and language.

Question 10

How many sessions are prescribed in a week?

Answer 10

-2 to 3 sessions are prescribed.

Question 11

How many sessions are needed for treatment completion?

Answer 11

-6 to 12 sessions are needed for completion.

Question 12

What happens after the ECT therapy?

Answer 12

• After therapy, the patient is taken to a recovery room and they are monitored for some time.

Question 13

Why is ECT rarely used to treat mental disorders?

Answer 13

-It’s rarely used due to the controversies surrounding it’s use.

Question 14

Why does ECT favor pregnant women?

Answer 14

-It favors them because pregnant women cannot ingest antipsychotics due to its extreme and server side effects.

Question 15

What are some risks and side effects of ECT? [3]

Answer 15

1. Confusion; following treatment, patients may experience confusion which can last for a few minutes to several hours especially in adults.
2. Memory loss; some patients may have trouble remembering events before or in weeks and months before treatment.
3. Physical side effects;
   - Headaches.
   - Nausea.
   - Jaw pain.
   - Muscle pain.
   - Heart problems.

Question 16

What is the goal of CBT?

Answer 16

-The goal of CBT is to help patients recognize that their beliefs and perceptions aren’t grounded to reality.
-This is furthermore done through techniques such as Socratic questioning where patients are asked to provide evidence for their assertions.

Question 16

Describe the Cognitive behavioral therapy as a treatment for Schizophrenia?

Answer 16

-CBT uses both cognitive and behavioral techniques to help patients overcome their disabling symptoms.
-It’s a talking therapy that’s designed to help people change by recognizing their thoughts that underlay their behavior.

Question 17

What was the aim of the study by Sensky et al?

[Example study under CBT].

Answer 17

-It was to compare the effectiveness of CBT with a control group who engaged in befriending.

Question 18

Describe the sample used in the study? [4]

Answer 18

-The patients were 90 in total.
-They were aged between 16 to 60 years old.
-The patients had a diagnosis of drug resistant schizophrenia.
-They came from 5 clinical services; 2 in West London and 3 in North of England.

Question 19

What was used in the procedure?

Answer 19

-A randomized control trial was used to test for efficacy of the 2 treatment programs [CBT and BF].

Question 20

What is a randomized control trial?

Answer 20

-This is a Clinical trial where patients are randomly located between the experimental and the control condition.

Question 21

How was the eligibility confirmed?

Answer 21

-It was confirmed through a host of psychometrics such as; CPRS and SANS and many more.

Question 21

What was obtained from the participants before the study took place?

Answer 21

-A written informed consent was obtained from the patients.

Question 22

What is double blind technique?

Answer 22

-This is when both the patients and researchers are completely blind of the patients condition.

Question 23

Describe the BF group? [3]

Answer 23

-BF was done 1 to 1 informal discussions about neutral topics such as; hobbies, sports or current affairs.
-Sessions were spaced at similar intervals.
-Each group received 19 sessions of therapy.
-The therapist was empathetic and non- directive throughout the sessions.

Question 24

What was used during the CBT procedure?

Answer 24

-Specific techniques were used with positive symptoms including;
1. Collaborative critical analysis: this targeted auditory hallucinations. The origin and nature of voices was followed using voice diaries.
2. Guided discovery: this was used to elucidate delusions. Socratic questioning and inference chaining were used.

Socratic questioning; these are questions that ask for evidence.

Inference chaining; building a question from an answer in order to uncover core beliefs about the self, the world and the future.

Question 24

Outline 2 results obtained from the study?

Answer 24

1.Both groups showed significant reduction in both positive and negative functioning.
2.At follow up stage CBT group continued to improve in reduction of positive symptoms while those in BF didn’t implying CBT had enduring effect on positive symptoms.