Interactionist Approach

  1. The interactionist approach uses a combination of approaches to explain behaviour. It is also called the biopsychosocial approach.

  2. Because it is a holistic approach, it emphasises that the treatment should be holistic too So treatment should involve biological, cognitive and behavioural therapies.

  3. Medication only seems to treat the symptoms and not the cause of schizophrenia. Also, lots of patients don't take it regularly due to forgetting, or stop taking it altogether due to the unpleasant side effects. Therefore, the interactionist approach suggests that other treatments should be used alongside medication.

Advantages:

  • Since not one treatment seems to work exclusively to treat or manage schizophrenia, it makes sense to use a variety of treatments.

  • Using psychological therapies alongside drug therapies not only allows the patient to manage their behavioural symptoms but also provides them with the skills to tackle their condition and challenge any 'faulty cognitions'.

Disadvantages:

  • It is difficult to know which treatment is working.

  • People with severe symptoms of schizophrenia are more likely to need higher levels of medication. These patients often have a lower willingness to try new things or learn new social skills.

  • Therefore, the treatments need to be appropriate and flexible to the needs of the patient at the time.

  • It can get very complicated and time-consuming - patients may be required to take medication, undergo family therapy and cognitive therapy, and also have forms of social support.

Atypical neuroleptics:

  • Atypical neuroleptics were introduced to avoid some of the problems of older drugs

  • Clozapine, for example, appears to be effective in controlling symptoms in those who have proved resistant to other neuroleptics and have fewer side effects

  • However, it was withdrawn for a while following the deaths of some patients from a blood condition called agranulocytosis

    • (A deficiency of granulocytes in the blood, causing increased vulnerability to infection)

  • This can be counteracted by the use of other drugs and regular blood monitoring. However, this is expensive and time-consuming

How do the Atypical antipsychotics work?

  • Like the first-generation antipsychotics, they block the dopamine receptor but they also block the serotonin receptors

Evaluation:

  • They seem to be more effective against the negative symptoms. They are reported to be more effective for 25% of patients with the first generation of antipsychotics

  • Clozapine can lead to Agranulocytosis, a disorder of the blood in which the number of granulocytes (a type of white blood cells) is reduced

    • This can be fatal

    • Monitoring by regular blood tests is necessary

    • Weight gain of 5kg or more is common

    • Sexual dysfunction

Neuroleptic antipsychotic drugs:

  • The most effective treatment for schizophrenia reduces positive symptoms. However, taking these drugs can cause severe problems

    • ie between 2000 & 2004 there were 45 reported deaths in which

      Atypical antipsychotics were listed as the primary suspect

  • There were 1328 reports of serious side effects. Another issue related to chemotherapy is that patient responses are variable and Patients who don't respond to typical drugs may be prescribed Clozapine (Atypical)

  • A minority of people with chronic schizophrenia cannot be helped with any antipsychotic medication

Clozapine:

  • Although effective it can have serious potentially life-threatening side effects, however, this can be counteracted by the use of other drugs and regular blood monitoring. This makes the treatment expensive and time-consuming.

  • Furthermore, patients who take these drugs become dependent, but currently, there is no cure which means treatment will be for their

  • Adverse side effects sometimes cause patients to stop taking their medication, which leads to the so-called revolving door phenomenon'

Evaluation:

  • Positive:

    • Drugs enable a patient to live a relatively normal life in the community and have transformed schizophrenia from a hospital-long stay to a hospital-short stay.

    • Evidence for effectiveness

      • Moderately effective on symptoms

      • Thornley et al. (2003) effects of Chlorpromazine compared to control groups with placebos

      • 13 trials showed better overall functioning

      • 3 showed lower relapse rates

      • Meltzer (2012) Clozapine more effective In general and in 30-50% of treatment-resistant cases

  • Negative:

    • Drug treatments only offer relief from symptoms and do nothing to tackle the underlying cause.

    • Therefore, drug treatments are an example of the reductionist approach.

    • The use of antipsychotics depends on the dopamine hypothesis

      • Theoretical issue

      • Dopamine levels are too low in other parts of the brain

      • If antipsychotics are dopamine antagonists - not clear how they help

      • Antipsychotics shouldn't work

Ethical:

  • Some people have criticised whether the widespread use of drugs in the treatment of mental disorders is appropriate, referring to them as 'chemical straight jackets

  • Drugs take away any sense of personal responsibility or control

  • Informed consent, people in a psychotic state are not in a position to give fully informed consent about treatment