Schizophrenia - Methods of modifying

Question 1

1 What are the two types of antipsychotics?

Answer 1

First generation - typical
Second generation - atypical

Question 2

1 What are typical antipsychotics?

Answer 2

Chlorpromazine - low potency, large amounts have to be administered to achieve desired effect, increased side effects
Haloperidol - higher potency, lower does needed, fewer side effects
Fluphenazine - injection, easier than taking daily tablets

Question 3

1 How do typical antipsychotics work?

Answer 3

Block D2 receptors - decrease in dopamine in mesolimbic pathway is thought to be responsible for decline of positive symptoms

Question 4

1 What are atypical antipsychotics?

Answer 4

Clozapine - beneficial for both positive and negative symptoms

Question 5

1 How do atypical antipsychotics work?

Answer 5

Block fewer dopamine D2 receptors but more D1 and D4
Blocks dopamine and serotonin receptors (5HT2A)

Question 6

1 What did Seeman report on?

Answer 6

‘fast off’ theory - atypical bind more loosely to D2 receptor sites than typical. does not last long enough to produce side effecs see in typical

Question 7

1 Supporting research (typical) for antipsychotics?

Answer 7

Cole - 75% given typical considered to be ‘much improved’ compared to 25% given placebo

Question 8

1 Supporting research (effectiveness) for antipsychotics?

Answer 8

Ravanic - significant differences in psychometric scores measuring symptoms favouring clozapine - atypical more effective and preferable
However, atypical not completely useless as beneficial for some

Question 9

1 Difficult to assess effectiveness of antipsychotics?

Answer 9

Valenstein - in 40% of cases, adherence was poor - due to side effects, unaware of delusions so dont trust medication
non-compliance is issues as adherence is different in real world than clinical trials

Question 10

1 Risk of psychological/physical harm from antipsychotics?

Answer 10

side effects - tardive dyskinesia and parkinsonism. Agranulocytosis can also occur which can increase risk of infection or death

Question 11

1 Lack of valid consent from antipsychotics?

Answer 11

Some antipyshcotics are required to be takrn under mental health act going against ethical principle of valid consent

Question 12

1 Risk of psychological harm from antipsychotics?

Answer 12

Why some antipsychotics work is unknown. for those that are known, it is unclear why they work for some but not others. - may have to spend years trying to find the appropriate one for them which could cause stress or make their symtpoms worse

Question 13

1 Economic benefits of antipsychotics?

Answer 13

fewer people are institutionalisedd and people an return to paid employment whcih boosts econmy. Can also peer mentor other SZ to reduce overall suffering

Question 14

1 Why is non-adherence a social implication?

Answer 14

NCISH - 346 homicides committed in England between 2003 & 2013 we by people with a history of SZ - 29% were non-adherent

Question 15

1 Financial costs of antipsychotics?

Answer 15

NHS drug tariff & RDTC estimate that the costs can vary from £19.50-£3160.60 per patient per years. average being £1590.55. Not providing treatment will save money in short term but will cost more in long term as unmedicated SZ more likely to be hospitalised

Question 16

2 What is CBT?

Answer 16

Talking therapy used to treat illnesses like depression and anxiety but also some forms of psychosis

Question 17

2 What do cogntive approaches see mental illnesses as?

Answer 17

Being caused by problems with internal mental processes - result in disorganised thinking.

Question 18

2 What did Smith et al identify?

Answer 18

Key components of using CBT
- Engagement strategies - build relationship
- Psychoeducation - patient will learn about illness
- Cognitive strategies - develop more productive thinking styles
- Empirical disputing - find evidence for delusions
- Behavioural skills training - given strategies to cope
- Dysfunctional thought diary
- Behavioural experiments
- Relapse prevention strategies - taught signs of relapse

Question 19

2 Supporting research (antipsychotics) for CBT?

Answer 19

Kuiper - after 9 months 50% patients given CBT with drugs benefitted in reduction of symptoms while only 31% of control group benefitted

Question 20

2 Contradictory research (application) for CBT?

Answer 20

Kingdon & Kirschen - CBT is not appropriate for elderly patients as they wouldn’t fully engage. Antipsychotics may havea wider application and therefore are more effective

Question 21

2 Methodological issues of CBT?

Answer 21

CBT is rarely the only treatment received therefore it is difficult to isolate effectiveness of CBT

Question 22

2 Why is it difficult to generalise findings to all schizophrenics?

Answer 22

Not suitable for all. if we find that CBT has high levels of effectivenesss , may be because samples hae less severe symtpoms and more willing to overcome illness - more likely to improve regardless of CBT

Question 23

2 Ethical strength of CBT?

Answer 23

No side effects unlike antipsychotics - could be argued that without medication, CBT is ineffective

Question 24

2 Valid consent for CBT?

Answer 24

Entered into with patient’s consent - able to withdraw at any point only risk is no further improvement unlike drug therapy which involves coercion

Question 25

2 How is Kuipers’ study ethical?

Answer 25

reported that clients were generally satisfied and thought it was an appropriate way to deal with illness

Question 26

2 What does Kingdon & Kirschen’s study suggest?

Answer 26

CBT is under used for SZ - risk of psychological harm because potentially effective therapy is not being offered to elderly patients

Question 27

2 Why is postcode lottery a social implication for CBT?

Answer 27

In 2014, the number of SZ offered CBT ranged from 67% to 14% in various trusts - people may be denied a helpful treatment

Question 28

2 Financial implications for CBT?

Answer 28

NICE - cost for CBT is between £1750 and £1800 per patient - additional cost on top of drugs as drug therapy is commonly pffered to all patients with SZ