FZ

Treatments_of_Schizophrenia_JK__for_2024_copy

Treatments of Schizophrenia

Objectives

  • Describe various treatments for schizophrenia, including:

    • Biological treatments (biochemical):

      • Typical antipsychotics

      • Atypical antipsychotics

      • Electro-convulsive therapy (ECT)

    • Psychological therapy:

      • Cognitive-behavioral therapy (CBT)

      • Example study: Sensky et al. (2000)

Antipsychotic Drugs

  • Antipsychotic drugs reduce psychotic symptoms and are referred to as neuroleptics.

  • Types of antipsychotic drugs:

    • Typical antipsychotics (1st generation)

    • Atypical antipsychotics (2nd generation)

Biological Treatments for Schizophrenia

Typical vs. Atypical Antipsychotics

  • Typical antipsychotics:

    • Example: Chlorpromazine

    • Mode of action: Blocks dopamine receptors in the brain.

    • Effects: Reduces positive symptoms (e.g. delusions, hallucinations) but has little effect on negative symptoms (e.g. emotional flatness, social withdrawal).

    • Side Effects:

      • Minor: Dry mouth, weight gain, drowsiness.

      • Major: Body stiffness/spasms, Tardive dyskinesia (involuntary movements).

  • Atypical antipsychotics:

    • Example: Clozapine

    • Mode of action: Blocks serotonin and dopamine receptor sites.

    • Findings: Effective for 50% of those who did not respond to other medications (Julien, 2005).

Atypical Anti-Psychotic Drugs

  • Cost:

    • More expensive than typical antipsychotics.

  • Side Effects:

    • Risk of potentially fatal blood disease (1-2% of patients).

    • Requires weekly blood monitoring.

    • Challenges the completeness of the dopamine hypothesis due to effects on other neurotransmitters.

Texas Medication Algorithm Project (TMAP)

  • A protocol to aid prescription of antipsychotics.

    • Initial recommendation: Use atypical drugs (e.g. risperidone).

    • If ineffective, switch to typical drugs (e.g. haloperidol) or different atypicals (e.g. olanzapine).

    • If no relief, trial clozapine.

    • Last resort: Combine antipsychotics with other medications (e.g. lithium).

    • ECT may be considered after exhausting medication options.

Ethical Implications of Biological Treatments

  • Compulsory Medication:

    • Important to consider if patients should receive medication without consent.

  • Human Rights vs. Society's Needs:

    • Ethical dilemma between patient autonomy and societal safety.

  • Advantages vs Disadvantages Table:

    • Creation of table outlining benefits and drawbacks for individuals and society.

Research on Side Effects

  • Ventegodt, Kandel, and Merrick (2009) argue that side effects of antipsychotic medications may outweigh their benefits.

  • Considerations often overlooked in research:

    • Suicides and suicide attempts from drug-induced depression.

    • Drug-induced health complications.

    • Effects on cognitive and social well-being.

General Evaluation of Drug Treatments

  • Antipsychotic drugs are effective for positive symptoms but less so for negative ones.

  • Often described as pharmacological straitjackets; they manage symptoms but do not cure.

  • High re-admission rates; relapse common after stopping medications.

  • Compliancy Issues:

    • Common reluctance to take medications due to side effects.

    • Use of long-lasting neuroleptic injections to circumvent this issue.

  • 25% of patients show no improvement with traditional neuroleptics; further 30-40% do not achieve full remission.

Group Activity: Numbered Heads

  • Group discussion about biological treatments.

  • Questions to address:

    1. Evidence for the effectiveness of antipsychotics.

    2. High relapse rates on antipsychotics.

    3. Weighing benefits against costs of antipsychotic medications.

Electro-convulsive Therapy (ECT)

Procedure

  • Involves an electric current passed through the brain (70-130 volts) after administering anaesthetic and muscle relaxants.

  • Typically involves 6 to 9 treatments over a month.

Historical Context

  • First used by Cerletti and Bini (1938) for schizophrenia treatment; now rarely utilized for this purpose.

  • May still help with acute psychotic episodes.

ECT Effectiveness and Recommendations

  • Limited evidence of ECT's effectiveness for schizophrenia, yet potentially beneficial for treatment-resistant cases.

  • Higher treatment frequency may be needed compared to standard ECT applications in other disorders.

ECT Evaluation

Strengths

  • Useful for a variety of psychotic disorders, particularly treatment-resistant schizophrenia.

  • Generally considered a safe treatment option.

Weaknesses

  • Possible cognitive impairments, including memory loss.

  • Often not utilized alone; typically as an adjunctive treatment.

  • Need for further large-scale studies to establish effectiveness.

Collaborative Learning Task: ECT

  • Pair work to discuss and summarize ECT treatment for schizophrenia.

Behavioral Treatments: Token Economies (Paul and Lentz, 1977)

  • Investigated operant conditioning by reinforcing appropriate behaviors.

  • Patients received tokens for appropriate behaviors that could be exchanged for items.

  • Results: Reduction in symptoms and improved hospital discharge rates.

Limitations

  • While effective in institutions, behaviors may revert post-discharge.

  • Does not address cognitive symptoms such as delusions and hallucinations.

Psychological Therapy: Cognitive-Behavioral Therapy (CBT)

  • Targets disturbed thought processes through techniques focused on managing hallucinations.

  • Encourages patients to engage with and understand their thoughts and voices positively.

Goals of CBT

  • Challenge and modify delusory beliefs.

  • Encourage identification and testing of delusions.

CBT Model

  • Example: Delusion of persecution (“They want to kill me”).

  • Promote social interaction and positive thought processes.

Sensky et al. (2000) Study

  • Tested efficacy of CBT for persistent symptoms in schizophrenia.

  • Criteria for recruitment included age, diagnosis, symptom duration, and prior medication response.

Study Design

  • 90 participants randomly assigned to CBT or befriending intervention.

  • Both showed significant symptom reduction; CBT continued to show improvements at follow-up.

Additional Research on CBT

  • Studies support CBT's effectiveness in reducing symptoms and improving medication compliance.

  • Meta-analysis indicates strong evidence for CBT's impact on various symptoms.

Evaluation of CBT

Strengths

  • Effective in many cases, improves recovery and reduces relapse rates.

  • Can be combined with other therapies without side effects.

Weaknesses

  • Not universally effective; cost and time-intensive.

  • Validity concerns due to subjective outcome measures.

Key Questions for Discussion

  1. Define CBT and its application in treating schizophrenia.

  2. Outline the research design and findings of Sensky et al. (2000).

  3. Evaluate the study findings of Sensky et al. (2000).

Evaluation Frameworks (Tables A and B)

  • Criteria for marking descriptive and evaluative components in treatment discussions.