Treatments for schizohrenia

Question 1

What is the most common biological treatment for schizophrenia?

Answer 1

antipsychotic drugs, which can be long term or short term, and typical or atypical.

Question 2

What are typical anti-psychotics?

Answer 2

These have been used since the 1950s and are dopamine antagonists. Tablet, syrup or injection.
Used to combat positive symptoms and are associated with the dopamine hypothesis.

Question 3

How to typical antipsychotics work?

Answer 3

They bind to D2 receptors and which reduces the amount of dopamine that can stimulate the synapse, therefore reducing production.
This reduces symptoms like hallucinations and delusions.

Question 4

Examples of typical antipsychotics?

Answer 4

Chlorpromazine and haloperidol.

Question 5

Characteristics of chlorpromazine?

Answer 5

Chlorpromazine also induces the sedation effect, caused by its effect on the histamine receptors, so it is used to calm patients with schizophrenia and other conditions.

Question 6

Research support for typical antipsychotics?

Answer 6

Kapur et al 2000 showed that 60-75% of D2 receptors need to be blocked in the mesolimbic pathway. Receptors being blocked in the rest of the brain leads to tight muscles and jaw and involuntary facial muscle movements.

Question 7

What are atypical antipsychotics?

Answer 7

Used since the 1970s, aiming to reduce psychosis and the side effects of the drug. Combats positive and negative symptoms.
Not all of them work in the same way.

Question 8

How do atypical antipsychotics work?

Answer 8

Most act upon the serotonin system as well as the dopamine system. Rather than permanently binding to D2 receptors, they temporarily bind to them and then rapidly dissociate to allow normal dopamine transmission.

Question 9

Examples of atypical antipsychotics?

Answer 9

Clozapine and risperidone.

Question 10

Characteristics of clozapine?

Answer 10

-Blocks dopamine, glutamate and serotonin receptors.
-Has fewer side effects than typical antipsychotics.
-Patients have to take regular blood tests to ensure they are not developing agranulocytosis.
-Pickar et al found it to be the most effective.
-It helps to improve mood and reduce depression, so prescribed to those with high suicide risk.

Question 11

Characteristics of risperidone?

Answer 11

-Blocks serotonin and dopamine receptors, but more strongly to dopamine. Therefore it is more effective with smaller doses than clozapine.
-There is evidence to suggest this also leads to fewer side effects.
-Emsley 2008 found that 84% of ppts had at least a 50% reduction in positive and negative symptoms.

Question 12

Strengths of antipsychotics?

Answer 12

Evidence to support effectiveness- Thorney et al 2013 reviewed 13 studies comparing chlorpromazine to a control and found overall improved functioning and reduced symptoms. Meltzer 2012 concluded that clozapine is more effective than typical antipsychotics as they were effective in 30-50% of treatment-resistant cases.

Question 13

Weaknesses of antipsychotics: flawed evidence?

Answer 13

Healy 2012 suggested some serious flaws in evidence. Most studies are short term and publication bias occurs. Successful trials also published data multiple times. Also, antipsychotics have a calming effect, which cannot be interpreted as reduced symptoms.

Question 14

Weaknesses of antipsychotics: side effects?

Answer 14

dizziness, agitation, sleepiness, weight gain and itchy skin. Long term tardive dyskinesia causes involuntary facial movements which is suffered by 20-25% of patients who take antipsychotics. This is the reason that 50% of sufferers stop taking antipsychotics within one year.

Question 15

Weaknesses of antipsychotics: unclear mechanism?

Answer 15

we do not know why they work, as we have acknowledged that the original dopamine hypothesis is an incomplete explanation. Given issues with effectiveness evidence, it adds to the argument that they are not the most appropriate treatment.

Question 16

What is cognitive behavioural therapy?

Answer 16

=A method based on cognitive and behavioural techniques. Between 5-20 sessions is usually used to treat schizophrenia.
CBT can help a client see that their delusions and hallucinations are irrational and how they impact on their feelings and behaviour.

Question 17

How does CBT deal with hallucinations?

Answer 17

a person may experience auditory hallucinations of voices they believe are demonic. If the therapist can convince the client that the voices are coming from a malfunctioning speech centre in the brain, they become less frightening and debilitating. The symptoms do not go away but people can better cope with them.

Question 18

How does CBT deal with delusions?

Answer 18

Delusions can also be challenged using reality testing. The client and therapist assess the likelihood that the belief is true together, using facts from reality to ‘prove’ the delusions are irrational.

Question 19

What is the aim of CBT?

Answer 19

Reduces distress and therefore improves functioning.

Question 20

How are coping strategies used in CBT?

Answer 20

CBT also reviews coping strategies and assesses whether they are healthy or not, as well as identifying triggers of symptoms. New coping strategies can be introduced that help reduce anxiety and depression.

Question 21

Strengths of CBT: effectiveness?

Answer 21

Jauhar et al 2014 reviewed 34 CBT schizophrenia studies and concluded there was a small but significant effect on positive and negative symptoms. Pontilllo et al 2016 found CBT led to the reduction in severity and frequency on audible hallucinations. The National Institute for Health and Care Excellence recommends CBT for schizophrenia.

Question 22

Strengths of CBT: reducing symptoms?

Answer 22

The main aim of CBT is to improve the quality of life of the patient, helping them to cope with their symptoms better, but Pontillo’s research suggests it can reduce the symptoms.

Question 23

Weaknesses of CBT?

Answer 23

There is a wide range of techniques and symptoms included in the studies. Thomas 2015 showed that in review studies there was a large range of CBT techniques used and a wide range of symptoms treated. This makes it more difficult to say if CBT will be effective for a particular patient and their symptoms.

Question 24

What is family therapy?

Answer 24

=A technique involving all members of the family, aiming to improve the communication within the family and reduce stress.
It aligns with dysfunctional family explanations of schizophrenia.

Question 25

How does the NICE recommend family therapy is carried out?

Answer 25

The NICE recommends a minimum of 10 sessions every 2-4 weeks, taking place in the family home.

Question 26

How does family therapy help?

Answer 26

Therapists work with the family and the patient to develop strategies to cope with the mental disorder and this leads to a warmer and more supportive environment for the patient.
Family members learn more constructive methods of communicating and are encouraged to lower the levels of EE to reduce the chance of relapse.

Question 27

Family therapy: Pharoah et al 2010

Answer 27

identified the strategies used in family therapy. Reducing the level of EE, specifically negative emotions to reduce the chance of relapse. Improving the family’s ability to help- ensures the family maintains a balance of caring for the patient and maintaining their own lives.

Question 28

Family therapy: Burbach 2018 model?

Answer 28

Burbach 2018 proposed a stage model of practice.
1) Sharing basic information and providing practical support.
2) Identifying what different family members can offer.
3) Mutual understanding for all family members to express their feelings.
4) Identifying unhelpful patterns of interaction.
5) Training in stress management.
6) Relapse prevention planning.
7) Planning for the future.

Question 29

Strengths of family therapy: effectiveness?

Answer 29

McFarlane 2016 found that family therapy was one of the most effective treatments for schizophrenia. Relapse rates were reduced by 50-60%. The NICE recommends family therapy for everyone diagnosed with schizophrenia. Provides benefits to everyone.

Question 30

Strengths of family therapy: wider benefits?

Answer 30

Lobban and Barrowclough 2016 concluded that effects are important because most of the care for patients with schizophrenia is provided by families. By strengthening the function of other family members, the care and support strengthens too. So there are wider benefits, not just the impact on the patient.

Question 31

Strengths of family therapy: economic benefits?

Answer 31

If families provide the bulk of care, the state does not need to pay as much, so there are also economic benefits.

Question 32

Weaknesses of family therapy?

Answer 32

Ethics- Family therapy relies heavily on informed consent, and ethical boundaries may be crossed, patients may be uncomfortable sharing such details, and confidentiality issues may arise.

A long process which increases costs.

It is difficult to say directly that family therapy is the cause of lower relapse rates. As Claxton et al. (2017) illustrated, studies tend to ignore the high variability within families studied and the highly specialised nature of specific treatments.

Question 33

What is a token economy?

Answer 33

=A technique which reinforces appropriate behaviour by giving or withholding tokens which can be exchanged for privileges. It is used to manage the behaviour of those who suffer from schizophrenia.

Question 34

The use of token economies?

Answer 34

They were used extensively in the 60s/70s. Their use has now declined because not as many are in long term hospitalisation, due to the focus on community based care and normalisation of schizophrenia.

Question 35

Ayllon and Azrin?

Answer 35

-1968.
-Trailed a token economy system on a ward of women diagnosed with schizophrenia.
-Everytime a patient carried out a task of self care (making the bed, cleaning up) they were rewarded tokens which could be exchanged for privileges.
-Desirable behaviours increased, but then decreased significantly once the system was withdrawn.

Question 36

Why were token economies developped?

Answer 36

To tackle the effects of institutionalisation. It can cause people to develop bad behavioural habits such as lack of socialisation and poor hygiene.

Question 37

Matson et al 2016?

Answer 37

Matson et al 2016 said the three main areas combated by a token economy were personal care, condition related behaviours (apathy) and social behaviour.

Question 38

What are the benefits of using token economies?

Answer 38

Benefits of using token economies in these areas: improving the quality of life in the hospital setting, makes it easier for people to integrate back into society when they are discharged.

Question 39

Token economies and operant conditioning?

Answer 39

An example of behavioural modification which is based on operant conditioning.
The tokens have no intrinsic value so are secondary reinforcers, as they are exchanged for meaningful rewards (primary reinforcers).
In order to create this association. The tokens and rewards at first must be given together.

Question 40

What is involved in a token economy?

Answer 40

Rewards are set up for desirable behaviours to encourage those behaviours.
The tokens can be exchanged later for rewards with value. This is important as delayed rewards have less effect, so tokens are given as soon as possible.
Rewards can include visiting family, treats, unsupervised time, activities.
It is important every part of the system is clearly defined.

Question 41

Strengths of token economies: evidence?

Answer 41

Evidence of effectiveness- Glowaki et al 2016 identified seven high quality studies (small sample) examining the effectiveness of token economies. All studies showed a reduction in negative symptoms and a decline in undesirable behaviours. Ayllon and Milan 1979 reviewed a number of studies and found that token economies work for certain behaviours such as general keeping of rules.

Question 42

Weaknesses of token economies: contradictory evidence?

Answer 42

Milby 1975 found that token economies were successful in helping someone prepare to leave hospital but we do not know if the effects are long term.

Question 43

Weaknesses of token economy: file drawer problem?

Answer 43

more positive findings have been published, negative results tend to be filed away.

Question 44

Weaknesses of token economy: ethics?

Answer 44

professionals have the power to control behaviours of the patient. It is problematic if target behaviours are not identified sensitively, as it is the use of one person’s norms against another. Also restricting the availability of pleasurable activities could be an even worse experience. Legal action against institutions has been a major factor in the decline of token economies.

Question 45

Weaknesses of token economy: alternative approach?

Answer 45

Chiang et al 2019 found that art therapy can be a good alternative. Although the evidence base is small and there are methodological issues, it shows art therapy is a low risk high reward approach. It is recommended by the NICE.