Treatments for Schizophrenia Flashcards
What are the two types of treatments?
1) Drug therapy
2) Psychological therapies
AO1: Drug therapy - intro
Antipyschotic drugs are the most common treatment for SZ. There are two types of anti-psychotic drugs, typical and atypical. Typical anti-pyschotics are used more often, if symptoms don’t improve then atypical may be used.
AO1: Drug therapy - Typical
First generation antipsychotics such as chlorpromazine are dopamine antagonists which reduce the levels of dopamine activity in the brain. Chlorpromazine works by binding D2 receptors on the post synaptic neutron by reducing the action of dopamine. This reduce dopamine activity levels and results in a. reduction of positive symptoms such as hallucinations. It can also be used as a sedative and can be used to calm patients.
AO1: Drug therapy - Atypical
Second generation antipsychotics such as clozapine act upon neurotransmitters dopamine and serotonin. Clozapine binds D2 dopamine receptor sites on the post synaptic neutron reducing positive symptoms such as hallucinations. They also act as agonists upon serotonin receptor sites 2A and 2C to increase levels of serotonin. This reduced negative symptoms such as lack of emotions and helps improve mood and reduce depression and anxiety in patients.
AO3: Drug therapy - Evidence
A strength of the use of antipsychotics to treating SZ is that there is evidence to support their effectiveness. Thornley et al found that in a meta-analysis of 13 studies with 1121 patients which compared Chlorpromazine to a placebo that Chlorpromazine was associated with overall better function and reduced symptom severity. Furthermore Meltzer found that atypical antipsychotics were 30-50% more effective in treatment resistant cases then typical antipsychotics. This supports that antipsychotics are an effective treatment of SZ and it reduces positive and negative symptoms. This increases the validity of drug therapy as a treatment for SZ.
AO3: Drug therapy - Motivation
A strength of drug therapy as a treatment for SZ is that atypical and typical antipsychotics require little motivation. Patients must only take a tablet to reduce their symptoms. Unlike CBT where patients must attend and engage in sessions to identify and challenge their irrational thoughts such as delusion. Thus may be difficult as patients with SZ may have an inaccurate perception of reality. Furthermore, it’s beneficial to patients with negative symptoms such as avolition who struggle to keep up with everyday tasks as they receive immediate positive effects. Therefore drug therapy may be seen as a more approve treatment for SZ as it’s an accessible treatment across all symptoms.
AO3: Drug therapy - Side effects
A weakness of drug therapy is that typical and atypical antipsychotics can produce negative side effectives. Typical antipsychotics such as Chlorpromazine can produce movement side effects such as Parkinsonism. Furthermore atypical antipsychotics can potentially produce life threatening illness such as agranulocytosis (reduced white blood cell count). Unlike CBT where a patient must attend sessions to identify and challenge their irrational thoughts such as delusions without the use of drugs so there no risk of side effects or potential life threatening illnesses. Therefore drug therapy may not be an appropriate treatment for all patients as side effects reduce the effectiveness of drug therapy and may stop patients taking them resulting in a elapse of symptoms.
AO3: Drug therapy - Think further: Ethics
There are ethical issues that surround the use of antipsychotics in treating SZ. Its believed antipsychotics are used in hospital situations to calm patients to make them easier for staff to work with rather than for the benefits of the patients themselves. Some see this as a human rights abuse. Furthermore its questionable whether severely affected patients are able to give their full consent. Therefore drug therapy may not be effective in treating SZ as they are used for ward management rather than treatment.
What is the evaluations for drug therapy? (3) + think further
1) Evidence for effectiveness
2) Little motivation
3) Negative side effects
4) Ethical issues
What are the two psychological therapies?
1) CBT
2) Family therapy
AO1: CBT
The aim of CBT is to help patients identify and challenge their delusional thoughts and change them into rational ones by disputing. Patients must identify their irrational thoughts. E.g. a paranoid delusion that aliens are trying to abduct them. A psychiatrist then helps challenge the patients irrational thoughts in order to encourage them to find a more plausible or less threatening explanation through empirical disputing. Here the patient must provide evidence of their delusion e.g. Where is the evidence that aliens exist? Do you have photos of the aliens? This disputing helps patients understand their delusions aren’t real and are just a symptom of their SZ. It offers a more plausible explanation which reduces anxiety and it helps patients underwent their delusions are not based in reality and their thoughts are less threatening. Behavioural strategies could be taught such as self-distraction techniques for example listening to music to draw out voices.
What are the evaluations for CBT? (4)
1) Research into effectiveness
2) Little motivation
3) Chemical dependence
4) Alternative explanation - art therapy
AO3: CBT - Research into effectiveness
Research into the effectiveness of CBT as a treatment for SZ was conducted by Jauher at al. They reviewed 34 studies and found that CBT has a small but significant effect on both positive and negative symptoms of SZ. This shows that CBT is fairly effective in treating SZ by identifying and challenging delusional thoughts to reduce symptoms. However it’s worth nothing that out of the 34 studies CNT only has a small impact. This places doubts and questions the valid of CBT as a treatment for SZ.
AO3: CBT - Motivation and commitment
A strength of CBT as a treatment for SZ is that it requires motivation and commitment from patients to attend sessions. Patients with negative symptoms such as avolition lack the motivation to attend sessions. CBT also requires patients to engage in the sessions which patients with positive symptoms such as delusion may struggle to do due to having an inaccurate perception of reality and lack of awareness. Therefore in some cases SZ may only be effective with the combination of antipsychotics as this gives them the motivation to attend sessions. Therefore CBT alone may not be an appropriate treatment for SZ.
AO3: CBT - Chemical dependence
A strength of CBT as a treatment for SZ is that it avoids chemical dependence. CBT encourages patients to identify and challenge irrational thoughts independently giving them more control over their behaviour. This is unlike drug therapy which imposes chemical dependence as the drugs controls neurotransmitters such as dopamine in the brain to reduce the symptoms of SZ which could cause defence. Due to this some may prefer CBT and researchers argue by learning how to challenge their SZ symptoms it may be a more appropriate long term treatment.
