Drug Therapy - Anti psychotic meds
Neuroleptics- drugs used to treat psychotic disorders
-Phenzothiazines (eg chloropromazine)
-Combat positive symptoms of Sz- eg hallucinations- lead to marked cognitive and behavioural improvements
-Dopamine antagonists- block Dopamine D2 receptors- disallowing the effect of DA as they are blocked
-their EFFECTIVENESS support the Dopamine hypothesis
-Studies hae shown that they are effective in controlling positive sympotms and have allowed ppl to live normal lives (Julien 2005)
-continuous low dosage helps prevent relapse
-reduce positive symptoms but may also be beneficial to negative symptoms
-some believe have fewer side effects - Block DA receptors but some believe this blocking is short lived
Commentary - effectiveness - AO2
Studies look at relapse rates to assess effectiveness, comparing those of phenzothiazines w those on placebo (done in 2 ways:- have 3 groups- drugs, placebo, and no treatment- and compare outcomes; have everyone on AP's, some continue w drugs others take placebos - compare relapse rates)
-meta-analysis of 29 studies w 3519 people
-found sig difference in relapse rates w those on drugs and those w the placebo in every study- this suggests that drugs are effective
-relapse occured in 55% of those w placebo, compared to 19% in those who remained on the drug
-shows effectiveness as less % relapsed whilst on drug
-however, 45% on placebo did not relapse and stayed healthy in placebo condition - no treatment did benefit some p's
Ross and Read (2004)
-davis' findings are misleading, as 45% on placebo did benefit, and this is a large percentage of the 81% who benefited from staying on the drug.
-Ross and Read say that this test is UNFAIR, as those in the placebo group are suffering from drug withdrawal, and that the previously blocked DA receptors now become flooded w DA.
-Also, it is suggested that drugs leads to proliferation of DA receptors, meaning those on placebo are also more sensitive to DA and the effect is overwhelming--> RELAPSE can be explained by this CONFOUNDING VARIABLE
Other issues w eff:
-Phenothiazines ineffective against negative symptoms, eg social withdrawal, apathy
-The drugs usually reduce symptoms in the first 6months, but they will return if meds are stopped (Rzewuska 2002)
-The drugs are ineffective on 30% of people, about half of these can use Atypical drugs eg Clopazine, but this still leaves 15% who can't be helped by these drugs
AP's associated w distressing and sometimes irreversible side effects, minor ones including drowsiness and visual impairment.
A serious one is tardive Dyskinesia, which is irreversible in 75% of cases, involving uncontrollable lip and tongue movements and facial tics. Jeste (1999) found that 30% of ppl taking Ap's suffered from TD after 9 months
-these effects can lead to non-compliance and therefore relapse and the revolving door phenomenon
-In order to prevent this, patients can be given long lasting injections, but there are ethical issues here
-jeste found that atypical drugs had a reduced % of 5% of patients getting TD, however these drugs have other side effects such as reduced immune system impairment, which must be controlled by more drugs which is expensive and may also lead to non-compliance.
Monitoring of AP's is important, as it is important that after an episode, the dose is reduced to 'maintenance level' prevent unnecessary side effects, however it is hard to decipher which ppl will certainly relapse and which do not need drugs at all.
The problems associated raise ethical concerns- critics argue that if a cost-benefit analysis took into the account the side effects, deaths and psychosocial consequences, it would be negative.
-In the US recently, a large settlement was awarded to a TD sufferer on the basis of the Humans Right Act (no one shall be subjected to inhuman or degrading treatment)
Historically, ECT used as a treatment for Sz on the basis that symptoms improved in patients who did have seizures.
-Electric current passed between two electrodes placed on the scalp in order to create a seizure.
-Unilateral ECT- one electrode placed about the temple of the non-dominant side of the brain, and another placed in the middle of the forehead
-patient given tranquiliser to make them unconscious, and they are given nerve blocking agents to stop muscle contractions which could lead to fractures.
-0.6 amps passed through the brain for half a second causing seizure to last up to a minute, affecting entire brain
-course of treatment is between 3 and 15 sessions
ECT - effectiveness - AO2
Tharyan and Adams 2005
-Meta-analysis of 26 studies w 798 P's in total
-Looked at a range of measures of benefit (change in beh, mental state)
-Studies included those w placebo condition where ECT was stimulated, and also comparisons to AP's
-when compared w stimulated ECT, there were greater improvements in the ECT condition, but there was no indication whether this improvemetn was over medium or long term
-When compared w drugs, results favoured AP's
-limited evidence that when combined w AP's there was a greater overall improvement in mental state- the authors suggested this could be a possible treatment plan for those unresponsive to medication alone
An APA review in 2001 found that in 19 studies comparing ECT and stimulation, there was no difference in effectiveness
An Indian study (Satita et al 1998) found no symptom reduction between 36 Sz patients given both kinds of ECT- cultural validity- low pop.val- not effective enough to choose over other options
Due to sig risks w ECt eg memory dysfunction, brain damage and death, this treatment has been declined, in the UK use fell by 59% between 1979 and 1999, and it has been virtually abandoned now.
It is still deemed as a useful tretment for severe depression, but is only used when other options have been exhausted.