SZ - bio treatment

Question 1

what is the biological treatment for schizohprenia?

Answer 1

drug therapy (antipsychotics)

Question 2

what do antipsychotics do?

Answer 2

Alleviates and controls symptoms associated with a psychotic episode (hallucinations and delusional thoughts)

These symptoms adversely affect the quality of life for patients and make accessing other forms of treatments such as CBT/ community programs difficult

Question 3

how are antipsychotics taken?

Answer 3

Tablet form or in some cases, if there is a risk that the patients won’t comply with the regimen themselves, administered by injection by a nurse

Initially small dose is given and this is gradually built up so that side effects can be monitored

Question 4

what are typical antipsychotics?

Answer 4

The first antipsychotic drugs, created in the 1950’s. Many reported unpleasant side effects because of too much dopamine.

Question 5

what are the side effects of typical antipsychotics?

Answer 5

• Blocked disturbances of movement and posture - tremors, muscle spasms.
• Long term use could cause tardive dyskinesia, which is irreversible involuntary muscle spasms around the mouth affecting speech.

Question 6

what is an example of a typical antipsychotic?

Answer 6

Haloperidol, Chlorprozamine

Question 7

what are atypical antipsychotics?

Answer 7

• Developed in the 1970’s in response to unpleasant side effects of the typical antipsychotics.
• They have fewer reported side effects than typical because they bind loosely so don’t block too much dopa and serotonin, but they do reduce white blood cell count, weakening the immune system

Question 8

what is an example of an atypical antipsychotic?

Answer 8

Clozapine

Question 9

what are side effects in both typical and atypical antipsychotics?

Answer 9

Drowsiness, weight gain, rapid heart rate, increased risk of diabetes/high cholesterol

Question 10

how do antipsychotics work?

Answer 10

• Reduces the levels of dopamine activity in areas of the brain associated with symptoms - Mesolimbic pathway (pos) and Mesocorical (neg) pathway
• Antipsychotics act as an antagonist at D2 receptor sites which blocks D2 receptors, preventing dopamine from binding to receptors in the synapse, depolarising the neurons, therefore calming them down and reducing dopamine activity.

Question 11

how do atypical antipsychotics work?

Answer 11

Do not bind to receptors quite so tightly and also block 5-HT2A receptors (serotonin receptors), it is thought these differences in action help to reduce side effects which typical antipsychotics produced

Question 12

sz bio treatment - supporting evidence

Answer 12

P - Supporting evidence that antipsychotics are effective

E - Brar et al has found Clozapine is highly effective in treating positive and as well as some negative symptoms, even in patients who hadn’t previously responded to other drugs

T - effective = valid

Question 13

sz bio treatment - contradicting evidence

Answer 13

P - Contradicting evidence that antipsychotics aren’t effective

Patel et al found 20% show only small improvement and 45% experience only partial or inadequate improvement and unacceptable side effects

T - less effective = less valid

Question 14

sz bio treatment - atypical have fewer side effects so people take them

Answer 14

P - atypical have fewer side effects so people take them

McEvoy found that compared to 4 other drugs the most effective was Clozapine because patients took it for considerably longer then the others, because it has fewer side effects
Assessment of symptoms after 3 months showed most improved compared to other drugs

T - therefore they are effective and have greater compliance

Question 15

sz bio treatment - antipsychotics have unpleasant side effects so people don’t take them

Answer 15

P - antipsychotics have unpleasant side effects so people don’t take them

E - Guo found 46% of patients do not continue taking the drugs that are prescribed for them because side effects are too uncomfortable or can’t remember due to cognitive defects (memory problems)

T - less useful/effective

Question 16

sz bio treatment - more ethical than previous treatments

Answer 16

P - more ethical than previous treatments

More ethical and humane than previous treatments such as ECT which involved a current of electricity being passed through the brain to induce a seizure. Relieved catatonic symptoms of SZ, but was criticised as it caused injury and was considered a form of social control to make patients docile and easy to manage

T - drugs are a better form of treatment comapred to others

Question 17

sz bio treatment - Unethical due to unpleasant side effects

Answer 17

P - not ethical due to unpleasant side effects

E - Serious side effects in both typical and atypical - drowsiness, blurred vision, rapid heart rate, weight gain, metabolic changes = risk of diabetes and high cholesterol
* Typical also caused disturbances of movement/posture and long term use caused tardive dyskinesia
* Clozapine increased risk of patients developing reduced white blood cell count ( causes risk of infections). Patients must have blood tests every two weeks to monitor blood count

T - less useful/effective

Question 18

sz bio treatment - improved quality of life

Answer 18

P - improved quality of life

E - Before antipsychotics, people with SZ would have had little choice but to spend their lives in institutional care. Once a person was placed in a mental hospital they became institutionalized and unable to cope on their own.

Antipsychotic drugs meant people had the chance to remain in the community, improving their quality of life. This is important because the segregation of people with mental health problems into long-stay hospitals further increases stigmatization through lack of contact with the rest of the community.

T - useful/effetive

Question 19

sz bio treatment - social control

Answer 19

P - antipsychotics can be considered a form of social contorl

It has been suggested that medication has been used to make patients with abnormal behaviour more manageable
Typical antipsychotics drugs made patients very passive, therefore easier for staff in institutions
They may be oversubscribed and are regarded as pharmacological straitjackets
Oppositions to medication also comes from the argument that pharmacological companies are more interested in making money rather than helping patients in the long term and to overcome side effects

T - ???

Question 20

sz bio treatment - biologically reductionist

Answer 20

P - it may not target the cause (if social) and only alleviate symptoms

Reduce treatment down to focusing on reducing symptoms, drugs don’t take into account a patient’s environmental or social problems which might contribute to relapses.

Social treatments such as community programmes can address these issues and CBT can help an individual cope with their experiences of hallucinations and delusions.

T - therefore it is a reudctionist treatment, meaning it is less useful, a holistic approach which uses a combination of treatments could be the most effective