Schizophrenia: Key Question Flashcards
What is the key question?
How effective are the current clinical treatments for treating schizophrenia?
What is schizophrenia?
A long-term, incurable mental disorder involved in the breakdown of thought and behaviour making it difficult to distinguish between reality and fiction.
What are the two types of symptoms for schizophrenia, give 2 examples for each?
- Positive (echolalia, hallucinations)
- Negative (apathy, poverty of speech)
Why is this issue important?
- 1% of the world population suffers from SZ with no cure
- so assessing treatments of their effectiveness can help to improve treatment of symptoms instead
- The average cost of antipsychotic drugs for SZ is around $26,000 per year per patient
- this burdens the healthcare system in many countries and may be too much to pay for some if no guarantee they will work
- If treatments are ineffective then it puts patients and other who surround them at risk
What are the implications for the future if treatments are found to be ineffective?
- No cure wold lead to…
- Waiting lists could lengthen
- Hospitals could get more and more full
- Systems such as the NHS will be put under a lot of strain to accommodate everyone’s needs
What are three causes of schizophrenia?
1) Brain structure
2) The Dopamine Hypothesis
3) Social Causation Hypothesis
Briefly describe the dopamine hypothesis as an explanation for SZ.
- Having more D2 receptors than normal increases frequency of dopamine stimulation
- Having too much dopamine release in the mesolimbic pathway= intensified emotions
- Having too little dopamine release in the mesocortical pathway= negative symptoms, lack of organisation etc
Briefly describe brain structure as an explanation for SZ.
- Enlarged ventricles cause areas of the brain to decrease in size and become undeveloped
- damage to PFC which occurs in the womb or in childhood can result in damage becoming prevalent in the late teens, early 20s when it matures- also same time as onset of sz
- Damage to frontal lobes can cause negative symptoms as they are frequently seen in patients who have also experience damage to their frontal lobes, such as catatonia
- Loss of up to 25% of grey matter in the brain that starts in the parietal lobes and moves inwards over the span of 5 years can cause tissue loss that leads to positive symptoms
Briefly describe the social causation hypothesis as an explanation for SZ.
- Being of a lower social class has a more stressful environment due to trying to find money and living under poor conditions with differing levels of care
- can cause a schizophrenic breakdown
- Experiencing social adversity during childhood may put strain on development due to certain pressures experienced
- Being a member of the immigrant population due to experiencing stress of living alone from family separation or trying to find work and living under poor conditions
What are the two treatments currently available for patients with SZ?
1) FGA & SGA
2) Assertive Community Therapy
Briefly describe FGA and SGA as a treatment for schizophrenia.
- It is based on the dopamine hypothesis which states that over-activity of dopamine in the mesolimbic pathway causes positive symptoms due to being the reward pathway and under-activity in the mesocortical pathway causes negative symptoms due to problems with normal cognitive functioning
- Antipsychotics (such as chlorpromazine and clozapine) are used to treat SZ
- First generation drugs work by blocking the D2 receptors by binding to them but not stimulating them which prevents over-stimulation
- Second generation drugs also bind to D2 receptors but only temporarily to allow normal dopamine function which continues to reduce positive symptoms but has less side effects. Also target multiple NT’s such as serotonin.
What is a major problem with drug therapy ?
- FGA antipsychotics fail to target negative symptoms effectively as only focus on positive symptoms due to them being easier to treat.
- both FGA and SGA have negative side effects, such as tardive dyskinesia, lack of motivation and emotional spontaneity
- can cause patient to not take them
- can act as chemical straight jackets.
Give evidence to support that drug therapy does reduce symptoms of schizophrenia.
Schooler et al supports the effectiveness of drug therapy. He found a 75% reduction in symptoms when taking antipsychotics- showing the effectiveness at reducing symptoms for patients.
Meltzer et al supports the effectiveness of drugs as a therapeutic technique for the treatment of sz. He found in a double blind study that an antipsychotic showed significant improvements in all aspects of functioning compared to controls. Therefore this shows the effectiveness of drugs at reducing symptoms and allowing patients to function in their life.
Effectiveness of FGA= Barlow and Durand- found that chlorpromazine is an effective treatment method in reducing sz symptoms in about 60% of cases- and made most impact on positive symptoms, however patient may still suffer from severe negative symptoms- reducing its overall efficacy.
Effectiveness of SGA= Pickar et al, compared clozapine with other neuroleptics and found clozapine was most effective in reducing symptoms, even in those who had previously been resistant to treatment- so is a successful method.
Hartling et al conducted a meta analysis of 114 studies on the effectiveness of FGA & SGA and found that there were very few differences in the treatment of core symptoms, haloperidol was highlighted as effective, but SGA were found to be more effective in reducing negative symptoms. Also found that tardive dyskinesia had a higher risk in FGA (9%) when compared to SGA (5%), so as they carry a lower risk and higher overall efficacy, SGA should be prescribed more than FGA.
Briefly describe Assertive Community Therapy as a treatment for schizophrenia.
- It is based on the Social Causation Hypothesis which states that stress from the environment in things like lower social class and being an immigrant triggers symptoms
- It targets the social factors that may worsen the disorder through providing support by integrating them into a community of health clinicians and other patients with mental disorders
- The 10:1 staff ratio helps to assist patients in their daily life by helping with activities such as shopping, banking, and maintaining a job
- 24/7 support
- provides a more personalised, individualised care
What is a major problem with ACT?
- It doesn’t actually target symptoms of the disorder only factors that may worsen SZ
- only available in urban areas with a high population density- requires a lot of government funding, so may not be available for all.
Give evidence to support that ACT does reduce the effects of schizophrenia.
Bond et al (2000) supports the effectiveness of ACT. He found that ACT was highly effective in 25 studies that looked at effectiveness due to engaging clients and preventing rehospitalisation. Therefore demonstrating that even if it doesn’t target symptoms, it reduces the effects of the disorder, and is more effective than other types of community care.
Using the acronym ‘EACH’, evaluate a ‘how’ point for drug therapy.
Meltzer (2014) has high validity, as he used a placebo on an unsuspecting control group. Therefore lack of DCs can establish cause and effect between the antipsychotic improving symptoms of patients
Using the acronym ‘EACH’, evaluate 2 ‘credibility’ points of drug therapy
A weakness of drug therapy is that it masks symptoms. Drug therapy merely targets the symptoms and aims to reduce them- it doesn’t try to fix the cause of the disorder due to lack of a cure. Therefore this is not an effective treatment if it does not offer a long-term solution by providing a cure
Additionally, there is high social control. Some patients call chemotherapy a ‘chemical straitjacket’ due to not having control over the effects of the drugs and some may also not be able to take the pills on their own so gets someone else to do it for them. Therefore this is not an effective treatment if there is an imbalance of power in regards to intrusion on the patients free wil. Patients may therefore refuse to stop taking treatment, or the side effects may lead to them to stop taking the treatment, reducing its efficacy.
Using the acronym ‘EACH’, evaluate a supporting and rejecting ‘evidence’ points for ACT
Gomory et al found that patients experienced high levels of social control- they were offered little choice in making their own decisions and saw it as patronising and coercive. Overall, 11% of the patients felt forced into the treatment. Therefore, these ethical restraints may deter some people from using ACT to improve their symptom, reducing its efficacy.
Using the acronym ‘EACH’, evaluate 2 ‘credibility’ points of ACT.
A weakness of ACT is its availability. ACT is only available in urban areas with a high population density (due to being based on the social causation hypothesis), and extensive government funding is required to carry out ACT with the 24/7 care. Therefore, ACT may not be freely available for everyone, with those in rural areas not having enough funding to afford full care- reducing its efficacy.
ACT also cannot be used on its own. Due to not targeting positive symptoms such as hallucinations, antipsychotics need to be taken alongside the programme. Therefore showing that ACT is not an effective treatment on its own. Patients still may experience the side effects from the antipsychotics which they take- such as tardive dyskinesia, and so may be less inclined to undergo further therapy with higher levels of social control, reducing their motivation to take part- increasing drop out rates and decreasing the efficacy overall.
Are there any applications?
By suggesting that drug therapy and ACT as it stands are insufficient by themselves in treating sz and that further research must be done into the efficacy of treatment methods, it can provide solutions to this issue. Carlssons review suggests that different drugs work for different people, depending on the cause oof their psychosis, new antipsychotics such as “glutamate agonists” are being developed as a result, improving the efficacy of treatment.
