Schizophrenia- Methods of modifying

Question 1

What is the first method of modifying for SZ?

Answer 1

Antipsychotics

Question 2

What are the 2 types of antipsychotics?

Answer 2

1- Typical
2- Atypical

Question 3

What are typical (conventional) antipsychotics?

Answer 3

First generation 1950s
- dopamine antagonist
- block action of NT dopamine

Question 4

What do Chlorplazmines do?

Answer 4

Block dopamine receptors in the synapses of the brain
- reduce the action of dopamine
- normalise transmission in key areas of brain
- reduce positive symptoms- hallucinations
- mesolimbic pathway, not commonly used

Question 5

What are some negatives to typical antipsychotics?

Answer 5

Serious effects with movement
X Tardive dyskinesia
X agitated, weight gain, itchy skin

Question 6

What are atypical antipsychotics?

Answer 6

Second generation 1970s
- maintain/improve effectiveness

Question 7

What does atypical antipsychotic clozapine do?

Answer 7

Binds to dopamine receptors in the same way and acts on dopamine, serotonin and glutamate receptors
- improve mood, reduce depression
- improve cognitive functioning

Question 8

What are the negative of clozapine- atypical antipsychotic?

Answer 8

X Discontinued for a period of time
X die from weak immune system, low white blood cell count
- can still be used if use regular blood tests

Question 9

What does atypical antipsychotic risperidone do?

Answer 9

The same as Clozapine without serious side effects
- binds more strongly to dopamine receptor sites
- lower dosage
- 1990s

Question 10

What are the negatives of atypical antipsychotic risperidone?

Answer 10

• Fewest side effects
  X breastmilk production
• still used, very common

Question 11

What do both typical and atypical antipsychotics do?

Answer 11

Both affect the process of neurotransmission

Question 12

Atypical - symptoms affected

Answer 12

Positive and negative symptoms- more NTs

Question 13

Typical- symptoms affected

Answer 13

Positive symptoms- just dopamine

Question 14

Evaluation: Antipsychotic drugs
Effectiveness of Conventional

Answer 14

Cole et al- 75% much improved, 25% placebo
- none worse, 48% placebo
X Noll, 1/3 of patients do not respond to conventional antipsychotics
- revolutionary and highly useful research

Question 15

Evaluation: Antipsychotic drugs
Atypical are more effective than 1st generation

Answer 15

Ravanic et al- over 5 years, significant differences in psychometric scores measuring SZ symptoms
- more effective and preferable
X one fits all approach, not all find them to be more effective in reducing
X although typical are P and ME, conventional drugs still play an important role and their effectiveness should not be ignored

Question 16

Evaluation: Antipsychotic drugs
Effectiveness
X What is non-compliance?

Answer 16

Particular issues in individuals with chronic SZ, many tend to lack the necessary insight into their own condition
X don’t believe they have a problem, therefore don’t take the medication

Question 17

Evaluation: Antipsychotic drugs
X non-compliance Rettenbacher

Answer 17

Found full compliance in only 54.2% of individuals with SZ, partial compliance in 8.3% and non-compliance in 37.5%
X in the real world anti-psychotics may not be as effective as they seem to be in closely controlled clinical studies
X Q validity

Question 18

Evaluation: Antipsychotic drugs
Ethics X serious side effects

Answer 18

Tardive Dyskinesia and Parkinsonianism
- uncontrollable, irregular movements
P- A group of conditions that cause slow, stiff, shakey and unsteady movements
X acute episode, not given valid consent
X do benefits outweigh side effects to protect from harm especially when valid consent has not been given

Question 19

Evaluation: Antipsychotic drugs
Ethics X Control ‘chemical straightjacket’

Answer 19

Rather than having a therapeutic value and curing symptoms, reduce patient to a calm zombie like state
X Szasz- method of social control to keep individuals conformist
- are necessary to keep SZ patient from harming themselves and others
X unethical, what is their purpose to alleviate suffering or as a form social control

Question 20

Evaluation: Antipsychotic drugs
Social- New revolution

Answer 20

‘care of the community’
Lawrie- incurable, treated with the potential for independent living and recovery
- social revolution, beneficial for patients (can lead more normal lives) and society (costs of lifetime hospitalisation)
- several benefits

Question 21

Conclusion for antipsychotics drugs

Answer 21

Overall, there is a general consensus amongst scientists that antipsychotics as a method of modifying SZ behaviour has revolutionised treatments for SZ patients. This in turn has resulted in positive social implications. Although there are some questions surrounding ethics the positive outweighs his as the individuals do have a choice the majority of the time

Question 22

What is the second method of modifying SZ?

Answer 22

Cognitive Behavioural therapy for psychosis

Question 23

Intro to CBTp

Answer 23

Alter disorganised thinking, manage and organise
-can’t prevent SZ but help them deal and cope with it

Question 24

CBTp

Answer 24

Aims to alter the way in which the patient thinks, manage their disordered thinking
- cannot prevent but helps them understand and cope with the episodes
- correctly attribute the source of the voices
- challenge false beliefs that underpin delusions
- empower to be more independent and increase confidence

Question 25

Assessment

Answer 25

Client and therapist meet for the first time -client explains their experiences and symptoms to therapist - goals and expectations of therapy are established

Question 26

What are the 3 components of CBTp?

Answer 26

1- Engagement 2- Psychoeducation/normalisation 3- Coping strategies

Question 27

1- Engagement

Answer 27

Provides client opportunity to talk at length about worries and symptoms - therapist develops rapport with the client - therapist empathises with the patients perspective and feelings of distress - C & T discuss coping strategies, client can appreciate their role in this

Question 28

2- Psychoeducation/normalisation

Answer 28

- therapist normalises experience of psychotic symptoms after alternative explanations for symptoms, client feels less stigmatised - increase clients understanding of the context in which their symptoms occur - helps the therapist to assess the SZs understanding of their symptoms

Question 29

3- Coping strategies (5)

Answer 29

1- Relapse prevention 2- Dysfunctional thought diary 3- The ABC model 4- Skills training 5- Behavioural experiments

Question 30

What is relapse prevention?

Answer 30

> T n C identify warning indicators of relapse - thoughts, feelings behaviours before > SZ assesses how well they got on with others, what others may have noticed before becoming unwell > T n C develop plans when they notice indicators - say to family and friends, support options and strategies

Question 31

What is dysfunctional thought diary?

Answer 31

Record feelings due to particular event - write automatic negative thoughts associated with events - client challenged to think differently and record differEnt views, more rational - C n T discuss their entries

Question 32

What is the ABC model?

Answer 32

- patient describes Activating event that causes irrational Beliefs/Behaviour as well as Consequences - beliefs can be challenged, disputed, changed - asked for evidence of belief 'won't like me'- voices 'some may find it interesting'

Question 33

What is skills training?

Answer 33

Behavioural strategies- relaxation, pleasant activity scheduling, problem solving taught - cope with residual symptoms (not managed by medication, anxiety/depression caused by SZ) 1- identify problem 2- potential solution 3- evaluate alternatives 4- decide on solution 5- evaluate outcomes

Question 34

What are behavioural experiments?

Answer 34

Challenge hallucinations - identify situation/action that lessens voices - listen to music, gardening, conversation - Client rates severity of voices, allows them to realise they can control the voices they hear

Question 35

Evaluation: CBTp - Research support

Answer 35

Kuipers- CBT and standard care- 50% improve, 1 worse SC only- 31% improve, 3 worse, committed suicide - although improvements seem marginal, they are significantly better - CBT is more effective at modifying SZ and helping treat patients in comparison to SC only

Question 36

Evaluation: CBTp X Not all R suggests CBTp is an effective method

Answer 36

Jouhar- only a small therapeutic effect Morrison- CBT significantly reduced psychiatric symptoms in individuals with SZ X lacks consistent findings result of 'exercising choice' X M- choice of treatment plan, J not less success X no research consensus, lowers validity and usefulness

Question 37

Evaluation: CBTp X Long term effectiveness

Answer 37

Tarrier- 18m later, received some relapse rates, effects of CNT are short-lived T- CBT condition, less negatively affected, depends on how benefits are assessed ( relapse rate X, reduction of symptoms yes) X not useful if it does not last

Question 38

Evaluation: CBTp Ethics

Answer 38

- C has more control, input and ownership over improvement, boosts self-esteem - no side effects in comparison with antipsychotics X patient blame, the way they think is wrong X psychiatric prejudice, judge the person isn't suitable for CBT without giving them a chance- just prescribe antipsychotics

Question 39

Evaluation: CBTp Social implications

Answer 39

- coping strategies to live a 'normal' life - less intrusive on daily life - return to work, contribute to tax, less reliant on the state X attending is more intrusive, not suit daily routine X in conjunction with APs, more costly as a whole X not all NHS trusts offer CBT 67-14% across the country, long waiting times