Schizophrenia: treatment of Sz Flashcards
(30 cards)
What is the aim of anti-psychotics?
To reduce, modulate or stabilise the balance of dopamine in 4 key dopamine pathway, and alleviate some of the symptoms of schiz
Describe anti-psychotics as a treatment for schiz
Aim: To reduce, modulate or stabilise the balance of dopamine in 4 key dopamine pathway, and alleviate some of the symptoms of schiz
- Typical
- Atypial
Medication must be taken on a regular basis to keep symptoms under control. It takes about 7 days before the drug starts to show an effect and symptoms reduce. Initially, positive symptoms are dramatically reduced and slowly some negative symptoms subside.
Describe an example of a typical antipsychotic
Name: chlorpromazine, Haloperidol
AIM: to antagonise (reduce) levels of dopamine in the brain
ACTION :
By binding to D2 receptor sites, this lowers dopamine transmission and reduces some positive symptoms
Kapur (2000) approx 60-75% of D2 receptors blocked in mesolimbic pathway
Potential problems:
As the 60-75% D2 receptor sites were (permanently) blocked, dopamine levels become too low
This can aggravates negative motor symptoms
Describe examples of atypical antipsychotics
Name: CLOZAPINE, OLANZAPINE, SEROQUEL (QUETIAPINE);
AIM: to modulate levels of dopamine and serotonin in key dopamine pathways in the brain
ACTION :
to regulate functioning of dopamine and serotonin in several areas
To attach to dopamine receptors and then quickly dissociate themselves (hit and run)
Two key pathways are :
MESOLIMBIC PATHWAY
NIGROSTRIATAL PATHWAY
Too much for A level but…
Describe action in the mesolimbic dopamine pathway - the hit and run
This sensory pathway is involved with emotions and sensations of pleasure. Reducing the hyperactivity of dopamine here should reduce positive symptoms like delusions
By using a hit and run action (rapid dissociation) AP have their effect on dopamine receptors and then quickly leave the receptor site. This type of action allows AP to have an effect, but then receptors quickly become available for naturally occurring dopamine before the next dose. This action helps avoid some motor side effects
Describe action in the nigrostriatal dopamine pathway
This sensory pathway has a role in controlling movement, and as such involves dopamine and serotonin . The blocking /reducing of dopamine receptor sites here can lead to motor side effects.
Serotonins presence in this pathway inhibits (reduces) dopamine, so the AP’s action is to block serotonin receptors to actually increase levels of natural dopamine. Hence, natural dopamine fills receptor sites and prevents blockade from AP’s in this area. This helps tackle negative symptoms and reduces motor side effects
What are 3 types of psychological treatments
1- CBT
2- family therapy
3- token economy
What is the aim and types of CBT?
CBT aims to change the maladaptive thinking of schizophrenic individuals.
Two main techniques used in CBT include:
Integrated Psychological Therapy (IPT)
Coping Strategy Enhancement (CSE)
Describe integrated psychological therapy
Strongest one! (incorporate reality tests)
- ## to improve attention and refine concept formation, this technique tried to identify specific cognitive deficits and remedy them in a non-confrontational way
Describe coping strategy enhancement (Tarrier, 1987)
-This technique tries to teach patients with schiz better ways to manage the severity and frequency of their psychotic symptoms to reduce distress and their impact day to day functioning
What behavioural techniques could drown out hallucinations?
Relaxation techniques
Listening to music
Humming or singing a song several times
Reading (forwards and backwards)
Effectiveness of CBT
Evaluation of psychological treatments for schiz: Startup et al 2004
There is research support for the effectiveness of CBT in treating schizophrenia.
Startup et al. (2004) investigated the effectiveness of CBT on 90 patients who had been admitted to hospital with an schizophrenic acute episode. 43 were given standard care (i.e., antipsychotics and nursing care), whilst the other 47 were given standard care plus up to 25 90 minute sessions of CBT.
60% of CBT group showed improvement, compared to 40% of the control group. More importantly, these benefits stood the test of time and remained at 6 and 12 month follow ups, compared to just 17% of the control group.
This implies… CBT is an effective treatment option for schizophrenia and can drastically improve the quality of life of patients by reducing their symptoms.
Evaluation of psychological treatments for schiz: Garrett 2008
In addition, Garrett (2008) argued that CBT is an appropriate mechanism to encourage schizophrenic patients to take their antipsychotic medication.
Garrett described successfully using CBT to change a patient’s mind about taking the antipsychotic drugs she was prescribed and therefore reducing her schizophrenic symptoms in that way.
This implies… CBT can have peripheral benefits alongside biological treatments, and is therefore appropriate for schizophrenic patients.
Are they appropriate for spme more than others?
Evaluation of psychological treatments for schiz: Kingdon and Kischen 2006
Many clinicians have criticised the use of CBT with schizophrenic patients as they characteristically do not have coherent thinking and insight into their condition to actually gain therapeutic benefit.
For example, many delusionary patients may not accept they are ill and need help in the first place.
Kingdon & Kirschen (2006) found that clinicians significantly judged older schizophrenic patients as being far less suitable/appropriate than younger patients to benefit from CBT.
Therefore, CBT may not suitable for all patients – some may be too old to benefit from CBT as cognitions are set.
Different symptoms, different help?
Evaluation of psychological treatments for schiz: Zimmerman et al 2005
Furthermore, the appropriateness of CBT is also called into question when considering patients may suffer from different schizophrenic symptoms.
Zimmerman et al. (2005) found that there does seem to be a place for CBT helping with the auditory and visual hallucinations that sufferers experience; and it particularly helps in reducing the distress and negative emotions experienced by individuals who suffer these hallucinations.
However, it may be less helpful in treating some of the negative symptoms of schizophrenia, like flat affect and avolition.
This could suggest… CBT is of limited usefulness as it can reduce the distress of schizophrenic patients who suffer more from hallucinations, but is less useful for those struggling with their negative symptoms.
Outline family therapy
Family therapy is an attempt to fix the faulty and dysfunctional dynamic of a family that may have caused schizophrenia.
It tries to alter communication practices within a family and trains people to express emotion in a more beneficial way.
What are the main aims of family therapy
The main aims of the therapy are:
Improve positive and decrease negative forms of communication
Increase tolerance levels and decrease criticism within the family dynamic
Decrease feelings of guilt and responsibility for causing the illness.
Therapists aim to hold an open forum about the effects the illness has had on the family.
Outline 5 processes in family therapy
1) Co-operative and trusting relationships-
Both the patient and family meet in a supportive environment, where all family members are valued. This process usually lasts around 6 months, with a minimum of 10 sessions recommended to patients and families.
2) Educate-
Therapist educates the group about the symptoms, causes and prognosis of SZ whilst family members bring together their experiences of the disorder. E.g., the patients will be encouraged to open up to their family about what is helpful and what makes their symptoms worse.
3) Practical coping skills-
The patients and family are provided with a set of practical coping skills that enable then to manage the everyday difficulties involved with SZ. These are behavioural and cognitive techniques. E.g., setting targets so the patient isn’t dependent on their family (i.e., responsibility over household chores).
4) How to express concern without resorting to high EE-
It is accepted that the family may occasionally feel anger and impatience, but they are taught how to express concern without resorting to high EE. E.g., using relaxation techniques to calm yourself down before discussing concerns.
5) Recognising the early signs of potential relapse-
Learning how to detect the early signs of relapse means they can respond rapidly and reduce its severity. E.g., insomnia, social withdrawal, difficulty concentrating, loss of interest, increasing paranoia, and hallucinations.
Evaluation for family therapy as a treatment for schiz: Leff et al 1982
There is evidence to support the effectiveness of family therapy with schizophrenia patients.
For example, Leff et al. (1982) used 24 participants in a programme that involved (i) educational sessions dealing with the nature of schizophrenia, its symptoms and the best way to deal with difficult behaviour. (ii) group meetings between families to discuss how they dealt with schizophrenic family members (iii ) family sessions where social workers and other professionals were present.
Leff found that families involved in the intervention showed a significant decrease in critical comments directed towards the patient and reduced over–involvement (characteristics of high EE). Plus, 78% of patients in control group were readmitted to hospital compared to only 14% of the experimental group with schizophrenia.
This implies that family intervention made a significant difference to the interactions within the families, and also helped to significantly reduce the chance of relapse.
Evaluation for family therapy as a treatment for schiz: methodological flaws
However, research like Leff’s has many methodological flaws that limit the credibility of the support.
In Leff’s research investigating comparing the use of FT & APs against just taking APs, there are multiple extraneous variables that have not been controlled.
For instance, the schizophrenic patients may have had differing severity of symptoms to start with; they may be on different types of APs which all have different levels of effectiveness; some may not have been routinely taking their APs; also it is not reported why some relapsed (it may not be due to their schizophrenia and could be due to a different mental health problem).
This implies that family therapy lacks rigorous experimental support which questions how effective it really is for schizophrenia.
Evaluation for family therapy as a treatment for schiz: Vaughn and leff 1976
Family therapy seems to be most effective when used in conjunction with powerful antipsychotics to treat schizophrenia.
Vaughn and Leff (1976) looked at schizophrenic patients returning to either high or low EE in the household.
The effect of no medication on low EE was insignificant.
In the high EE household, relapse of schizophrenic symptoms increased with more face-to face contact, and with no medication relapse rate rose to 92%, showing the importance of effective treatment.
This implies that focusing on both family dynamics and biochemistry is best for patients with schizophrenia and their families.
Evaluation for family therapy as a treatment for schiz:cost effective
Despite the high costs of family therapy, many argue it can reduce the ‘revolving door syndrome’ often seen with schizophrenic patients.
A study by Anderson et al. (1991) found a relapse rate of almost 40% when patients had drugs only, compared to only 20% when Family Therapy was used and the relapse rate was less than 5% when both were used together with the medication.
With a drastically reduced relapse rate with FT, will reduce the amount of times patients are hospitalised and therefore reduce the cost to the NHS, and therefore the economy.
This could suggest that many psychologists would state that family therapy is a cost effective mechanism for dealing with schizophrenia.
Outline token economies
Token economies aim to manage schizophrenia rather than treat it.
They are a form of behavioural therapy where desirable behaviours are encouraged by the use of selective reinforcement based upon the principles of operant conditioning.
It focuses on the negative symptoms of schizophrenia.
Give examples of 3 negative symptoms and how a token economy may address this
Speech poverty (Alogia)
- Not replying when someone speaks to them
- Receiving a token for when they do give a reasonable length, coherent reply to someone
Flat affect
-Have dulled emotional expression
- A token is taken away
Avolition
- Not engaging in activities in the hospital like playing a sports activity
- Receiving a token when they do engage in activities
