Therapies used for schizophrenia (24 marks)

Outline and evaluate two or more therapies used in the treatment of schizophrenia (24 marks)

12 marks on chemotherapy- both typical and atypical drugs

12 marks on CBT

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Outline and evaluate two or more therapies used in the treatment of schizophrenia. (8+16
Chemotherapy involves taking drugs that alter levels of various neurotransmitters. They do this by
blocking receptor sites, inhibiting reuptake or improving the breakdown of molecules in order to
relieve the symptoms of Sz. The first type of drugs used are typical antipsychotics. These work on
dopamine by binding to dopamine receptors, but not stimulating them, therefore blocking their
action. They aim to reduce the positive symptoms of Type 1 Sz such as delusions and hallucinations by
correcting the imbalance of chemicals that enable neurones to communicate with each other. They
are often prescribed following the first psychotic episode but individuals will react differently so are
monitored constantly. Common typical drugs used are chlorpromazine and haloperidol but only one
will be used at a time. The more recent form of drugs used to treat Sz are atypical antipsychotics. The
work on both dopamine and serotonin by blocking certain receptors for both neurotransmitters.
They are seen to be at least as effective at reducing positive symptoms as typical drugs but they also
relieve negative symptoms such as apathy and blocking, they therefore work on both Type 1 and
Type 2 Sz. If symptoms don't improve with typical antipsychotics then they will move onto atypical
drugs; however, they are rarely prescribed first due to the life threatening side effects. Clozapine
was the first atypical drug and seems to be one of the most effective, particularly for people who
haven't responded well to other medication.
The introduction of antipsychotics made a major difference to schizophrenic patients. Before, 50% of
patients were admitted to hospital and stayed there for life. The treatment of these patients was
brutal, there was little focus on care, but more on controlling and containing patients. However, now,
only 3% of schizophrenics are in hospital and it is usually only for a few weeks. The drugs have also
reduced some of the most disturbing symptoms like delusions and there has been some evidence of
negative symptoms also being reduced. Therefore, antipsychotics have changed the lives of
schizophrenics for the better, making them able to cope better in work, relationships and life in
general. However, it is still debatable how effective the drugs have been and to what degree they
are able to live a `normal' life.
The main issue associated with chemotherapy is the side effects. For typical drugs the most serious
side effect is tardive dyskinesia which is characterised by involuntary movements of the face/mouth
such as rapid eye blinking and lip smacking. This side effect can often be more disruptive than
schizophrenia itself. One benefit of atypical drugs is that they greatly reduce the chance of
developing tardive dyskinesia. However, atypical drugs are associated with a more serious illness
known as agranulocytosis which reduces white blood cell count, making people vulnerable to
infections which can be life threatening. It is for this reason that atypical drugs are only used as a last
resort. Another major side effect is excessive weight gain; one study shows that 25% of patients on
Clozapine for 6 months experienced weight gain of over 1.5 stones. Other side effects from both
drugs are dystonia, akathesia, Parkinson's-like symptoms. Some studies have also shown that taking
antipsychotics in the long term can actually cause brain damage, meaning people become more
Another major issue with antipsychotics is that drop-out rates re very high; 50% in first year and 75%
by the end of the second year. The main reasons for this is that people feel the drugs are not
effective so refuse to take them. Of those who do continue to take drugs, 40% relapse in the first
year and 15% each subsequent year. These statistics show that maybe the drugs are not as effective
as psychologists believe as patients don't feel they are working and relapse rates are still extremely

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Recent research has shown that people are much more likely to recover fully in in the third world than
they are in western, modern societies. The WHO organisation completed two long term studies on
people suffering from schizophrenia in different cultures. The results showed people had better long
term outcomes in developing countries such as India, Columbia and Nigeria, compared to the
outcomes in USA, UK, Denmark and Japan.…read more

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This blame could actually make symptoms worse, for example people may
hear voices of others blaming them for their dysfunctional behaviour.
It is also reductionist as it is reducing the complexity of schizophrenia so that it is only due to cognitive
causes and can therefore only be treated by cognitive therapies. However, a lot of research
suggests that CBT is more effective when used alongside drug therapy and that family dynamics,
such as expressed emotion, could play a significant part in reducing relapse rates.…read more


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