Therapies for SZ

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  • Therapies for SZ
    • Biological therapies
      • 1. Antipsychotic medication
        • Conventional antipsychotics (APs)
        • Dopamine antagonists-reduce stimulation of dopaminergic (nerves which use dopamine) pathways.
        • Eliminate hallucinations/delusions etc
        • Revolution-ised psychiatry.
        • Atypical antipsychotics (e.g Clozapine).
          • Fewer side-effects
          • May affect serotonin as well
          • May also treat negative symptoms
        • Evaluation
          • Traditional APs dont work on negative symtoms
          • They do calm the effects SZ
          • Individual differences-only affective on 30%
          • Irreversible side affects, such as Tardive Dyskinesia (TD) (involuntary movement).
          • Long-lasting injections? if they stop their medication then forced injections would be unethical.
          • Atypicals-smaller likelihood of TD
          • Dosage monitoring is vital-symptoms fluctuate so you need to get the doasge right (high dose for strong symptoms)
      • Electro-convolsive therapy (ECT)
        • 1. anaestetic given, 2.muscle relaxant given,            3. electrodes placed on the temple,         4. 1 minute seizure produced,        5. 3X per week for 2-4 weeks.
        • Evaluation
          • APA review (2001)-ECT no different than APs
          • Relapse rate is high
          • Benefits not long lasting
          • Wipes out long-term memories
          • We dont know how ECT works.
          • Punishment?-used as social control.
          • Effect on neuro-transmitters unknown.
          • Loss of autonomy
          • Not used for SZ anymore-used for severe depression
    • Psychological therapies
      • Psycho-analysis
        • The therapeutic relationship (TR)-emotions about your parents get transferred onto the psycho-analysist
        • Working alliance -under-standing the 'child' in the client.
        • Transference-emotions unconciously shifted onto analyst
        • Freud-this is unsuitable for SZ as they cannot form a TR as they are in a child state.
        • Some have modified the therapy-Sulivan and Pratt (1920's)-the client is encouraged to learn adult forms of communi-cation and gain insight into the past.
        • Evaluation
          • Gottdiener et al (2000)
            • Meta-analysis and concluded that psycho-analysis is effective.
          • Drake and Sederer (1986)-leads to higher rate of hospital-isation
          • Often contradictory findings
          • The diagnosis has changed-earlier clients may not have been SZ
          • Over stimulation causes relapse.
          • Telling them how bad their SZ was made it worse.
          • Expensive, time-consuming.
      • CBT
        • Our behaviour is largely a result of our thoughts
        • 1. Coping Strategy Enhance-ment (CSE
          • Aims to teach SZ patients to develop their own coping strategies.
          • Positive self-talk, initiation/ withdrawal of social contact, relaxation, breathing exercises, drowning out voices.
        • 2. Reality-testing
          • Aims to test the validity of false beliefs.
            • E.g. Chadwick et al (1960): participants watch, it gets paused. then they are asked: a film What happens next? they cant predict it. shows that they cant predict the future.
        • Evaluation
          • Reduction in positive symptoms
          • Reduction in recovery time.
          • Turkington et al (2004)- has a proven role to work with APs. CBT works best with atypical APs.
          • Lomas- CBT is NOT effective . Not a single trial reviewed found CBT to be effective. Affective on depression
          • Older pateints are less suitable. (cant teach an old dog new tricks).
          • Most patients are on APs as well-makes assessing the effectiveness of CBT difficult.


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