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Essential and broad approach to treating schizophrenia
Designed to minimise hospital stays and provide support in the community
Allows sufferers to live a more normal life and hold down paid employment
Should provide for a wide range of support and treatments, including:
o sheltered/supported living arrangements
o ongoing psychotherapy matched to needs and circumstances of the person
o an environment where social skills can be enhanced and developed to prevent
o monitored medication
Proper community care is more beneficial than long-term hospitalisation
Highly effective, but if the support is withdrawn then relapse will occur
Also, the full range of community care is expensive
Aim: Stein and Test (1980) compared the effectiveness of community care and hospitalisation in
people with schizophrenia.
Method: Two groups of 65 people suffering from schizophrenia were compared. One group
received hospital treatment with medication and were then discharged without support. The other
group were given community care to support them living in the community. Community care
consisted of food and shelter, training in social and community skills, educational support and help
with developing a social network of friends. The study lasted for 12 months.
Results: The unsupported discharged patients showed high levels of relapse 58 out of the 65 were
readmitted to hospital within the 1-year period. By contrast, 53 of the people given community care
remained living in the community over the year.
Conclusion: Community care provides successful support to people with schizophrenia and helps
prevent relapse and future hospitalisation.
Hospitals for schizophrenia were dehumanising and increased negative symptoms
Neuroleptic drugs allowed psychiatrists to expand outpatient day care
Evaluation of day care:
o Those who favour community care argue that quality of life can be improved at no
o Hospitals are seen as places that increase some of the symptoms of schizophrenia,
such as apathy and withdrawal, and stigmatise those with mental illness
o Critics of community care argue that services are often patchy and the burden on
o Failings in community care have been highlighted in media reports of tragic cases,
such as the murder of Jonathan Zito on an underground station in London
Evaluation of drug treatment:
o The side effects of Neuroleptic medication are distressing, for example muscular
spasms, Parkinsonism (including tremor and shuffling gait), and tardive dyskinesia
(including involuntary movements of the head and tongue).
o Clozapine is associated with potentially fatal lowering of the white blood count and
its use requires regular blood monitoring. Other side effects of this drug include
sedation, hyper-salivation and weight gain.
o The newer drugs such as Risperidone, do not lead to the distressing side effects
found with the original Neuroleptic medication at normal doses, but these drugs are
not widely used because they are very expensive.
o Neuroleptic medication is best at continual low dosage to control relapse rates, but
these drugs only extend the interval between relapses they do not prevent them.
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The neuroleptics have become popular as bimonthly injections, which ensure
adherence to regimes and help to prevent relapse. However, these drugs are a
means of controlling, not curing, psychosis.
o There is no evidence that Neuroleptic drugs are effective for negative symptoms.…read more