mind map of biological therapies for schizophrenia

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  • Created by: alice
  • Created on: 13-12-12 07:51
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    • Conventional Anti-psychotics
      • Appropriateness
        • Tardive dyskinesia (uncontrollable movements of the lips, tongue, face, hands and feet) is a side effect of anti-psychotics.
          • 30% of people taking anti-psychotic medication develop tardive dyskinesia and its irreversible in 75% of cases (Hill, 1986)
        • Ross and Read (2004) ---argue that being prescribed medication reinforces the view that there is 'something wrong with you'. Preventing the schizophrenic from thinking about possible stressors that may have caused their condition; reduces their motivation to look for solutions that might alleviate these stressors
      • Effectiveness
        • Davis et al. (1980) --- analysed the results of 29 studies (3519 people). Relapse occurred for 55% of patients whose drugs were replaced by a placebo, 19% for those who stayed on the drug
          • Ross and Read (2004) ---say the figures from the Davis et al. (1980) review are misleading. 45% benefited from the placebo and 81% benefited from the drug
        • Vaughnand and Left (1976), a study in the Davis et al review. ---found that anti-psychotics did make a significant difference, but only for those living in a hostile and critical home environment. In such conditions relapse rates were 53% (placebo was 92%) In supportive home environments, relapse rates for medication were 12% and placeo 15%
      • Dopamine antagonists, they bind to the dopamine receptors without stimulating them, so blocking their action. Anti-psychotics can eliminate hallucinations and delusions experienced by schizophrenics.
    • Atypical Anti-psychotics
      • Effectiveness
        • Leucht et al. (1999, meta-analysis. ---superiority of atypical anti-psychotics were only marginally better than conventional anti-psychotics. 2 were 'slightly' more effective and 2 were 'no more effective'
        • the claim that atypical anti-psychotics are effective with negative symptoms has marginal support. Leucht et al (1999), 2 were 'slightly' more effect than conventional anti-psychotics, 1 was as effective and 1 'slightly worse'
      • Also act on the dopamine system, but only temporarily occupy the D2 receptors and then rapidly dissociate to allow normal dopamine transmission
      • Appropriateness
        • Jeste et al (1999) --- found tardive dyskinesia rates in 30% of people after 9 months of taking convention anti-psychotics, 5% for those treated with atypical drugs
        • Atypical anti-psychotics may ultimately be the most appropriate in treating schizophrenia because of the fewer side effects. Patients are more likely to continue their medication and therefore see more benefit
    • Electroconvulsive Therapy (ECT)
      • An electric current is passed between 2 scalp electrodes creating a seizure.
        • 1 electrode is placed on the temple of the non-dominant side of the brain and the other in the middle of the forehead (unilateral ECT)
          • patient is injected with a short-acting barbiturate so they are unconscious for electric shock
            • to prevent contractions that could cause fractures, patients are given a nerve-blocking agent to paralyse the mussels
              • An electric current of 0.6 amps lasting half a second is passed through the brain producing a seizure lasting up to a minute which affects the entire brain
      • Tharyan and Adams (2005) review of 26 studies (798ppts) --- found compared with a placebo or 'stimulated' ECT more people improved in the real ECT condition. Compared with anti-psychotics, medication appeared more effective. limited evidence suggested that ECT worked well in combination with anti-psychotics and so could be appropriate when a rapid reduction of symptoms is required or when patients show a limited response to medication alone
      • The idea for ECT as a treatment for schizophrenia followed reports that demantia praecox (early name for schizophrenia) was rare in patients with severe epilepsy, seizures in patients somehow reduced symptoms of the disorder.
        • early studies for clinical treatment were disappointing. Karagulla (1950) ---found lower rates of recovery for ECT patients compared to those who didn't receive ECT
      • because there are significant risks associated with ECT, such as memory dysfunction, brain damage and even death the use of ECT has declined. Read (2004) UK decline between 1979 and 1999 was 59%
      • American Association review in 2001 listed 19 studies that compared ECT with 'stimulated' ECT. Concluded that ECT produced results no worse or different than anti-psychotic medication
      • Sarita et al (1998) ---found no difference in symptom reduction between 36 schizophrenics given either ECT or 'stimulated' ECT




Very helpful thank you

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