Biological Therapies A02

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Development of Tardive Dyskinesia

One of the main claims of the atypical drug is the lower likelihood of developing tardive dyskinesia

The claim was supported in a study by Jeste et al (1999), which found tardive dyskinesia rates of 30% of peoplpe after 9 months of treatment was conventional antipsychotics, but just 5% for those treated with atypical antipsychotics

Atypical antipsychotics may ultimately be a more appropriate form of drug therapy as there are fewer side effects and have been shown to alleviate some negative symptoms

This means patients are moer likely to continue their medication and see a greater improvement in their condition

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Partical Support for ECT

Tharyan and Adams (2205) provided partial support support for use of ECT

They reviewned 26 studies (798 participants) in order to assess whether ECT was beneficial for schizophrenic patients. It was found that there was a greater improvement in the real ECT condition than in the placebo or stimulated ECT condition

However, there was no indication that these advantages were maintained over the medium - or long term. When ECT was compared with antipsychotic medications, results favoured drug therapy

ECT does not satisfy either of the aims of the therapy (to reduce or elimate symptoms and bring about lasting change), therefore the effectiveness of the therapy is questionable

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ECT - Effective as Antipsychotic Medication

It has been suggested that ECT is at least as effective as antipsychotic medication

An American Psychiatric Association review in 2001 listed 19 studies that had compared ECT with 'stimualted ECT' (patients given general anaesthesia but no ECT). It was concluded that ECT produced results which where no different or worse than antipsychotic medication

However, other studies (Sarita et al, 1998) found no difference in symptom reduction between 36 schizophrenic patients given either ECT or stimulated ECT

Therefore, further research is needed to establish the effectiveness of ECT

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Decline in the use of ECT

There has been a significant decline in the use of ECT in previous decades as the appropriateness of the therapy has been questioned

In the UK, the decline between 1979 and 1999 was 59% (Read, 2004)

Althougfh ECT is thought to produce structural changes in nueral networks the process is not completely understood, meaning it had been difficult to devise a more effective form of ECT

Furthermore, the significant risk associated with ECT: including memory dysfunction, brain damage and even death may explain why the use of this technique as a treatment of schizophrenia has declined

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Effectiveness of Antipsychotic Medication

Many studies that have evaluated the effectiveness of antipyschotic medication have compared the relapse rates of those on medication with those on a placebo

A review by Davis et al (1980) analysed the results of of 29 studies (3519 patients). Relapse occured in 55% of patients whose drug was replaced with a placebo, and 19% of those would remained on their antipsychotic medication

The significant difference in relapse rates between treatment and placebo groups demonstrates the therapeutic effectiveness of these drugs

However, it could be argued that the figures are misleading as a significant number of those taking a placebo benefitted from doing so; as shown by the 45% of participants who did not relapse  

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Flaw in Methodology (placebo to antipsychotic medi

There may be a fundermenetal flaw in the methodology of studies comparing placebos to antipsychotic medication

Ross and Read (2004) arguedthat under a placebo condition the patient is actually in a drug withdrawn state. If the antipsychotics are suddenly withdraw, the previously blocked dopamine system becomes floodedwith dopamine because of the heighted sensitivity and the increasednumber of dopamine receptors (caused by antipsychotic medication)

This results in a total overwhelming of the dopamine system

Consequently, a proportion of relapses in the placebo condition can be explained by the withdrawal effects of the drugs

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Not Placing Vunerable People at Risk

Research into therapies for schizophrenia must be carried out in a way that does not place vunerable individuals at unreasonable risk

The potential harm in outcome studies of schizophrenia include those associated with medication discontinuation, the use of placebo conditions and the capacity to give informed consent.

The BPS advises that when participants takepart in a psychological investigation, they should not, in doing so. be increasing the probability that they would come to any form of harm

The possibility of harm is heightened when dealing with vunerable groups such as patients with schizophrenia

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Side Effects

Conventional antipsychotics have worrying side effects which can be permanent and irreversible

Around 30% of patients taking antipsychotic medication develop retarded dyskinesia, characterised by involuntary sucking/chewing, jerky movements of limbs, and writhing movements of the mouth and face

In 75% of cases retarded dyskinesia is permanent (Hill 1986)

This raises significant ethical issues, as the costs associated with the side effects, deathsand psychosocial consequences it would be considered disadvantageous 

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