SZ treatments

How do Typical (First-Generation) Antipsychotics work?

They are dopamine antagonists that work by blocking post-synaptic D2 dopamine receptors in the brain, reducing the intensity of positive symptoms like hallucinations and delusions.

What is a key strength of antipsychotics from meta-analyses?

Zhao (2016) reviewed 56 trials with over 10,000 people and found that 17 out of 18 antipsychotics had significantly lower relapse rates than a placebo, providing strong empirical support.

What are the major limitations of Typical Antipsychotics?

Up to 40% of patients get no relief; 45% experience only partial improvement (Patel et al.); side effects like Tardive Dyskinesia (often irreversible) are common.

How do Atypical (Second-Generation) Antipsychotics differ from Typical ones?

They also block D2 receptors but additionally act on serotonin and glutamate receptors, making them effective at reducing both positive and negative symptoms.

What is the major advantage and risk of Clozapine?

Advantage: Effective for up to 60% of treatment-resistant patients. Risk: Can cause agranulocytosis, a potentially fatal blood condition, requiring regular blood tests.

What is a key weakness of using animal studies to research these drugs?

Kapur (2000, 2008) notes that high doses given to animals to block D2 receptors may not predict human side effects or compliance issues, reducing the generalisability of findings.

What does the treatment protocol recommend for managing schizophrenia with drugs?

Patel et al. (2014) recommend starting medication early and continuing maintenance dosages for at least 12 months to prevent relapse after symptoms subside.

What is a major societal application of antipsychotic drugs?

They enable deinstitutionalization, allowing individuals to live in the community, be more independent, and reduce stigma, rather than being in long-term hospitals.

What is the 'Texas Project' protocol for treatment-resistant cases?

A 6-stage plan: 1. Start with one SGA 2. Change to another SGA 3. Try an FGA 4. Try Clozapine 5. Try different drug combinations 6. Provide treatment for substance abuse.

What ethical issue is associated with publication bias in drug research?

Turner (2012) found evidence of publication bias favoring studies with positive outcomes, driven by pharmaceutical company profits, potentially leading to inappropriate treatment decisions.

What is a major reason for non-compliance with medication?

Patients often stop taking their drugs due to unpleasant side effects (e.g., weight gain, tremors), a poor relationship with their clinician, or not understanding their illness.

What is the core aim of CBT for schizophrenia?

To help patients identify and challenge irrational thoughts (delusions) and reality-test hallucinations, thereby changing their maladaptive thinking and behavior to reduce symptom severity and prevent relapse.

How does the 'Hot Cross Bun' model aid in CBT?

It expands the focus to include Physical Sensations alongside thoughts, emotions, and behaviors, which helps patients recognize and discuss intense physical sensations.

What are 'Behavioral Experiments' in CBT for schizophrenia?

Personal experiments where the client tests the reality of their delusions rather than just verbal challenges from the therapist, using collected evidence to debunk false beliefs.

What key evidence supports CBT's effectiveness from NICE?

NICE (2014) found CBT reduced symptom severity, improved psychosocial functioning, and decreased hospital stays by an average of 8.26 days for up to 18 months.

How does Kuipers et al. (1997) demonstrate a key strength of CBT?

They found that drug-resistant patients improved with CBT, showing it as a valuable alternative or addition for those who do not respond to medications.

What is a major limitation of CBT according to McKenna & Kingdon (2014)?

CBT was only superior in 2 out of 9 methodologically rigorous studies, suggesting its effectiveness may not be as robust as claimed by organizations like NICE.

How does 'Behavioral Activation (BA)' specifically help with negative symptoms?

BA addresses motivational deficits by using a structured rewarding process for positive behaviors, requiring less verbal abstraction than traditional CBT.

What is the 'Hawthorne Effect' criticism of CBT?

Critics argue that benefits may arise from the non-specific, supportive relationship with the therapist rather than from specific CBT techniques.

What is a key argument against the Hawthorne Effect criticism?

CBT's long-term efficacy suggests it's more than just temporary support; it equips patients with coping strategies and self-management skills.

Why is CBT often considered a 'complementary' treatment, not a replacement for drugs?

For patients with severe psychosis, cognitive capacity is often too impaired for rational dialogue; antipsychotic medication is necessary to stabilize their condition first.

How does CBT empower patients compared to drug therapy?

CBT is active and empowering, giving patients skills to manage their condition long-term, while drug therapy is passive and can create dependency.