Anti-Psychotic Drugs DVHR-LJL +xxxx+x
Chlorpromazine: dopamine antagonists. Prevent production by blocking D2 receptors. Reduce positive symptoms. Doesn't cure, only dampens. Degree of functionin. Clozapine: serotonin and dopamine. Affect negaitve symptoms. Don't know effect on brain. Small minority resistant.
Davis: meta analysis 100 studies. compared with placebos. Drug were effective- 70% patients with improved condition after 6 weeks. 25% placebo.
Vaughn: drug made difference when hostile living environment. Relapse on medication 53%. Placebo 92%. Supportive environement no significant difference. Environement considered when deciding appropriateness. Drug effective when environment not ideal.
Hill: Tardive dyskinesia- uncontrollable movement of mouth. 30% taking drugs develop. 75% cases irreversible. Ethical concerns- inhumane treatment.
Ross: prescription reinforces something wrong. prevents indivudual thinking- reduces motivation to look for solution. Reductionist- patients believe they have less control over disorder.
Leucht: meta analysis- superiority over convential. More effective with negative symptoms. TD less likely.
Jeste: Atypical 5% TD after 9 months. 30% conventional. Appropriate as fewer side effects, continue treatment, see more benefits.
Liberman: 1400 people. 74% discontinued due to side effects. Conventional given up due to weight gain. Atypical prescribed due to lower side effects. Advice to change diet and exercies, manage side effects, contrinue treatment, see benefits.
+: Relatively cheap, easy to administer. Normal lives outside institutions. 3% live in hospitals premanently. Previously much higher.
x: Atypical serious side effects- reduction in white blood cells led to infection. Blood tests regularly. prescribed after conventional tried first as high risk.
x: Deterministic assuming due to biology completely. Research suggests psychological role in onset/maintenance
x: Simply take pill is reductionist. Ignores other stressors.
x: Treats symptoms but not cause or disorder completely
+: Reduce symptoms more rapidly than psychological therapies
x: Individuals vary in response to drugs
Electro-Convulsive Therapy CTTF **+**
Cerletti used first. epileptic fit remove disorder more effective than placebo. Not as effective as drugs. Electrodes on scalp. Unconscious and paralyse muscle. Electric current induce seizure. Used when other treatments failed- dont understand effect on brain to produce results.
Tharyan: 26 studies- effective in short term. Drugs more effecitve. Most appropriate when not responsive. Effective when combine with drugs. Alone limited results.
Tang: ECT effective when not responsive to drugs. Last resort to relieve some symptoms.
Fisk reviewed clinical literature: ECT success 60-80%. Effective on certain categories- not fully understand many subsets. Appropriate when targeting sepcific forms.
x: Not fully understood. How effects patients. Unaware of damage.
x: Short term distress: confusion, memory loss, brain damage. Increases with more treatment- ethical: is this appropriate?
x: Ethics: dislike treatment, cant give informed consent, some put under pressure to have treatment. May make disorder worse
x: Reductionist: treat through oversimplified method: current through brain