4.3 Biological and Psychological Therapy for Schizophrenia Flashcards
(29 cards)
What are antipsychotics?
Drugs used to reduce the intensity of symptoms (in particular positive symptoms) of psychotic disorders
What are the 2 types of antipsychotic?
- Typical
- Atypical
Name a typical antipsychotic, how it is taken and its dosage
- Chlorpromazine
- Can be taken as tablets, syrup or injection
- 400-800mg per day
How is chlorpromazine a dopamine antagonist?
- Has an inhibitory effect
- Block dopamine receptors in the synapses of the brain
What is a secondary effect of chlorpromazne and how is this useful?
- Sedation effect
- Often given to anxious patients admitted to the hospital, in order to claim/manage mood
What are 2 atypical antipsychotics?
- Clozapine
- RIsperidone
How does clozapine work?
- Similar to chlorpromazine (antagonist which binds to receptors)
- Also acts on serotonin and glutamate receptors
- This improves mood and reduces anxiety/depression (can also improve cognitive functioning)
What is a side effect of clozapine?
- Agranulocytosis (low white blood cell count)
What is the dosage and how is it administered of risperidone?
- 4-8mg per day
- Tablets, syrup or injection
Why is risperidone more effective than clozapine?
- Binds more strongly to dopamine receptors
- This means it is more effective in smaller doses
- Leads to fewer side effects
One strength for the biological therapy for schizophrenia
Evidence for effectiveness:
- Thornley et al: reviewed studies comparing effects of chlorpromazine to control
- Data from 13 trials showed chlorpromazine effective compared to placebo
- Associated with better overall functioning and reduced symptom severity
- Meltzer: clozapine more effective than typical and other atypical drugs
- Effective in 30-50% of treatment-resistant cases (where antipsychotics fail)
Two limitations for the biological therapy for schizophrenia
1. Serious side effects
- antipsychotics associated with e.g dizziness, agitation, sleepiness
- in the long-term may lead to tardive dyskinesia (caused by dopamine supersensivity=involuntary facial movements e.g blinking)
- lead to neuroleptic malignant syndrome (NMS): when drug blocks dopamine action in hypothalamus = can be fatal
- may do more harm than good
2. Mechanism unclear
- lack of understanding about why antipsychotics work
- understanding of the mechanism is tied up with the original dopamine hypothesis (= high DA levels in subcortex of the brain)
- HOWEVER this is an incomplete explanation (as DA levels in other parts of brain too low rather than too high)
- if this true, most antipsychotics should not work (= may not be best treatment/ineffective)
What is cognitive behaviour therapy?
A method for treating mental disorders based on both cognitive and behavioral techniques
What is the duration of CBT?
Over a period of 5-20 sessions
How does CBT help?
Helps make sense of how irrational cognitions (e.g delusions/hallucinations) impact feelings and behaviour in order to challenge negative thoughts
How does CBT work to help with hallucinations + delusions?
HALLUCINATIONS
- Therapist can convince patient that hallucinations e.g hearing voices come from malfunctioning speech centre in their brain = less frightening
- Reduces distress and allows patient to cope with symptoms
- Can also use = Normalisation: teaching that voice-hearing is an extension of the ordinary experience of thinking
DELUSIONS:
- challenged through reality testing
- schizophrenic patient and therapist jointly exame the likelihood that beliefs are true
What is family therapy?
A psychological therapy carried out with some or all members of a family with the aim of improving communications within the family
What did Pharoah et al identify about the strategies used to improve family functioning?
- Reduce negative emotions: reduce levels of expressed emotion e.g anger/guilt which create stress (reduces likelihood of relapse)
- Improve the family’s ability to help: improves family’s beliefs/behaviour towards those with schizophrenia, balance between caring for schizophrenic individual and maintaining own life
Describe Burbach’s model of practice (7 phases)
- Sharing basic information + providing emotional/practical support
- Identifying the resources different family members can offer
- Encourage mutual understanding
- Identifying unhelpful patterns of interaction
- Skill training (e.g stress management techniques)
- Relapse prevention techniques
- Maintenance for the future
Two strengths of family therapy for schizophrenia
1. Evidence for effectiveness
- McFarlane: family therapy as most consistently effective treatment for schizophrenia
- reduced relapse rates (by around 50-60%)
- Clinical advice from NICE recommends family therapy from anyone with a schizophrenia diagnosis
- family therapy most beneficial for those with early and ‘full blown’ diagnosis
2. Benefits to the whole family
- therapy not just for identified parent but also for majority of the family who provide care
- strengthens the functioning of the whole family = lessens the negative impact of schizophrenia on other family members
- also strenghthens the ability of the family to support the person with schizophrenia
- = wider benefits
One strength and one limitation of CBT for schizophrenia
1. Evidence of effectiveness
- Jauhar et al: reviewed 34 CBT studies for treating schizophrenia
- clear evidence for small but significant effects on positive + negative symptoms
- clinical advice from NICE = recommends CBT for schizophrenia
2. Quality of evidence
- CBT techniques + schizophrenia symptoms vary widely from one case to another
- Thomas: found different studies involve the use of different CBT techniques + people with different combinations of postive/negative symptoms
- difficult to tell how effective CBT will be for each paticular person
What are typical antipsychotics?
The first generation of drugs for schizophrenia/psychotic disorders, that have been used since the 1950s (work as dopamine anatongists)
What are atypical antipsychotics?
Drugs for schiophrenia developed after typical antipsychotics (typically target a range of neurotransmitters e.g dopamine/serotonin)
What symptoms does chlorpromazine reduce?
Positive symptoms e.g hallucinations
