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Question 1

What is biological treatment based on?

Answer 1

1. The dopamine hypothesis; that schizophrenia is linked to increased dopamine activity in the brain,
2. Antipsychotic drugs (neuroleptics) work by blocking dopamine receptors.

Question 2

What are the two types of antipsychotics?

Answer 2

1. Typical,
2. Atypical.

Question 3

What are typical antipsychotics?

Answer 3

1. Developed in the 1950s,
2. Although they are still used to treat schizophrenia today, they are less widely used due to their side effects,
3. This is because they mainly appear to treat only the positive symptoms and their side effects can be severe,
4. These side effects include dry mouth, blurred vision, dizziness, muscle spasms or cramps, and tremors.

Question 4

What is the difference between typical and atypical antipsychotics?

Answer 4

1. Whilst typical antipsychotics act upon dopamine receptors,
2. Atypical antipsychotics act on both serotonin and dopamine receptors.

Question 5

What are is the most commonly type of antipsychotic used today? When was this developed?

Answer 5

1. People are most often prescribed atypical antipsychotic drugs instead,
2. They were developed in the 1950s and introduced in the 1970s as a result of the adverse side effects of typical antipsychotics,
3. Antipsychotics can treat both positive and negative symptoms, but they can have severe side effects too.

Question 6

Advantages of drug therapy?

Answer 6

1. Drug therapy is more effective at reducing positive symptoms,
2. It is successful for a large number of patients with schizophrenia, meaning that more people can live in the community rather than being institutionalised,
3. It is the most widely-used and effective form of treatment for schizophrenia. Almost all other treatments are used alongside drug therapy.

Question 7

Disadvantages of drug therapy?

Answer 7

1. Drug therapy isn’t very effective for treating negative symptoms like social withdrawal,
2. There are ethical issues surrounding the use of drug therapy. Some people argue that drug treatment is a ‘chemical straitjacket’ - it doesn’t really help the patient, it just controls their behaviour to make it more socially acceptable and easier to manage,
3. Most people will experience some short-term side effects when taking antipsychotic drugs, e.g. drowsiness, blurred vision, dry mouth, constipation, and weight gain,
4. Long-term side effects include increased risk of diabetes and tardive dyskinesia (involuntary repetitive movements that continue even after they’ve stopped taking the medication),
5. Clinical trials have shown that as many as two-thirds of people stop taking anti-psychotic drugs because of the side-effects. However, newer antipsychotic drugs seen to have fewer long-term side effects than the older ones,
6. It treats the symptoms of schizophrenia but not the cause. Symptoms often come back if people stop taking antipsychotic drugs. This leads to the ‘revolving door phenomenon’ where patients are constantly being discharged and re-admitted to hospital.

Question 8

What psychological therapy is sometimes used to treat schizophrenia?

Answer 8

Cognitive behavioural therapy - based on the assumption that patients can be helped by identifying and changing their ‘faulty cognitions’.

Question 9

How is CBT applied to schizophrenic patients?

Answer 9

1. People with schizophrenia are encouraged to reality-test their hallucinations and delusions, e.g. to question and try to accept and ignore the voice they hear,
2. This is with the aim of reducing their levels of distress,
3. They are pushed to challenge their beliefs and to question where the voices may have originated from,
4. Patients are encouraged to use strategies such as positive self-talk to help themselves,
5. They do role-play exercises and homework to test out their ‘faulty thinking’ and are helped to see the consequences of thinking differently,
6. Through this they can gradually realise where the ‘faults’ in their thought patterns are, and can begin to change them.

Question 10

Chadwick et al. (1996), method?

Answer 10

1. Reported the case of Nigel, a man with schizophrenia who believed he had the ability to predict what people were about to say,
2. Nigel himself asked to prove his ‘power’ to Chadwick’s team and so they showed him over 50 video tapes of different scenarios, paused at certain intervals,
3. Nigel was asked to predict what was going to happen next.

Question 11

Chadwick et al. (1996), results?

Answer 11

1. Nigel didn’t get one prediction correct.

Question 12

Chadwick et al. (1996), conclusion?

Answer 12

1. Nigel concluded, through his reality testing form of CBT, that he didn’t hold any special power.

Question 13

Chadwick et al. (1996), evaluation?

Answer 13

1. Although this is a case study, and, therefore, cannot be generalised to a wider population, it does show that CBT can be successful in certain situations.

Question 14

Advantages of CBT treatment method?

Answer 14

1. Sensky et al. (2000) found that CBT was effective in treating patients with schizophrenia who hadn’t responded to drug treatment. It was helpful with positive and negative symptoms, and patients continued to improve 9 months after treatment had ended,
2. CBT puts patients in charge of their own treatment by teaching them self-help strategies. This means there are fewer ethical issues than with other therapies, e.g. drug therapy.

Question 15

Disadvantages of CBT treatment method?

Answer 15

1. CBT only treats the symptoms of schizophrenia - it doesn’t address the cause of the disorder,
2. It is difficult to measure the effectiveness of CBT because it relies on self-report from the patient, and the therapist’s opinions. This makes it less objective,
3. Patients can become dependent on their therapist,
4. The patient has to have a level of self-awareness and to voluntarily participate. This can be difficult when a participant has symptoms such as a lack of awareness or an inability to engage with others,
5. CBT can be very time-intensive treatment and so drop out rates can be high when people have severe symptoms,
6. The style of CBT doesn’t work for everyone - individual differences mean some people don’t respond well to being confronted.

Question 16

What is family therapy as a treatment of schizophrenia?

Answer 16

1. Family therapy, or family intervention, has developed over the past 40 years. It is based on the idea that family dysfunction can lead to an increased risk of relapse in people with schizophrenia,
2. The aim of family therapy is to reduce conflict and high emotion amongst family members,
3. This can happen by helping the family form alliances, reduce the burden of care, limit outbursts of anger expressed by individual family members, and encourage people to set realistic goals,
4. Family therapy is often used alongside other treatments, mainly drug treatments.

Question 17

Advantages of family therapy?

Answer 17

1. Family therapy has experienced some success. Pilling et al. (2002) found family therapy reduced the rate of re-admission in some patients with schizophrenia,
2. It is particularly useful in patients who lack insight into their condition and who can’t coherently explain their thoughts.

Question 18

Disadvantages of family therapy?

Answer 18

1. Getting informed consent from all members of the family can be difficult. There are also issues surrounding confidentiality which need to be addressed,
2. Families need to be engagted and open to changing behaviour - not every family will be.

Question 19

What is the token-economies method of schizophrenia management?

Answer 19

1. A behavioural treatment based on operant conditioning - learning through reinforcement,
2. Token economies can help encourage people in psychiatric institutions to perform socially desirable behaviours, e.g. getting dressed and making their beds. Patients are given tokens which reinforce these behaviours - they can then exchange these for something they want, like sweets or cigarettes.

Question 20

Ayllon and Azrin (1968), method?

Answer 20

1. 45 female patients with schizophrenia received tokens for ‘good’ behaviours, e.g. making their beds,
2. These could later be exchanged for rewards. Tokens were taken away for bizarre behaviour,
3. Naturalistic observation was used to assess the effectiveness of this procedure in changing behaviour in the hospital ward.

Question 21

Ayllon and Azrin (1968), results?

Answer 21

1. The women, who had been institutionalised for an average of 16 years and displayed bouts of screaming, incontinence, aggression, and low social skills (e.g. eating by shoving their faces into the food), showed a massive improvement through the incentive of receiving privileges.

Question 22

Ayllon and Azrin (1968), conclusion?

Answer 22

1. Token economies can exert control over behaviour to give patients back a sense of dignity.

Question 23

Ayllon and Azrin (1968), evaluation?

Answer 23

1. The participants were all women, so the results can’t be generalised to the real world.

Question 24

What is the interactionist approach in treating Schizophrenia?

Answer 24

1. Because it is a holistic approach, it emphasises that the treatment should be holistic too. So, treatment should involve biological, cognitive, and behavioural therapies,
2. Medication only seems to treat the symptoms and not the cause of schizophrenia. Also, lots of patients don’t take it regularly due to forgetting, or stop taking it altogether due to the unpleasant side effects. Therefore, the interactionist approach suggests that other treatments should be used alongside medication.

Question 25

Advantages of the interactionist approach?

Answer 25

1. SInce not one treatment seems to work exclusively to treat or manage schizophrenia, it makes sense to use a variety of treatments, 2. Using psychological therapies alongside drug therapies not only allows the patient to manage their behavioural symptoms, but also provides them with the skills to tackles their condition and challenge any 'faulty cognitions'.

Question 26

Disadvantages of the interactionist approach?

Answer 26

1. It is difficult to know which treatment is working, 2. People with severe symptoms of schizophrenia are more likely to need higher levels of medication. These patients often have a lower willigness to try new things, or learn new social skills, 3. Therefore, the treatments need to be appropriate and flexible to the needs of the patients at the time, 4. It can get very complicated and time-consuming - patients may be required to take medication, undergo family therapy, cognitive therapy, and also to have forms of social support.