Biological therapies for schizophrenia

psychology unit 4 aqa a A2

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  • Created on: 14-06-12 13:11

Antipsychotic medication

Antipsychotic drugs block the action of neurotransmitters that bring about the symptoms of schiz and so help the person with schiz to function more effectively

Conventional antipsychotics - reduce the effects of dopamine and so reduce the symptoms of schizo - they bind to dopamine receptors but dont stimulate them so block their action - by reducing stimulation of dopamine system in the brain, conventional antipsychotics can eliminate hallucinations and delusions experienced by those with schiz

Effectiveness of conventional antipsychotics - most studies of effectiveness of conventional antipsychotics have been compared to relapse rates of those on medication and those on a placebo - Davis - 3519 people reviewed 29 studies and found that relapse occurred in 55% of those whose drugs were replaced by a placebo and 19% who remained on the drug - supporting the effectiveness of convetional antipsychotics

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Antipsychotic medication

Atypical antipsychotics - act on the dopamine pathway but only temporarily occupy the D2 recemptors and then rapidly dissociate to allow normal dopamine transmission - its this characteristic which is though to be responsible for the lower levels of side effects associated with atypical antipsychotics such as tardive dykinesia 

Effectiveness of atypical antipsychotics - meta-analysis of studies - leucht - the superiority of these drugs compared to conventional antipsychotics in the treatment of the negative symptoms of schiz was only moderate BUT ross and read argue that placebo studies are not a fair test of the effectiveness of antipsychotics as under a placebo condition the patient is in a drug withdrawal state and is overwhelmed by the dopamine

Appropriateness of antipsychotics - about 30% of people taking conventional antipsychotics develop tardive dyskinesia which is irreversible in 75% of cases - Jeste - 5% of those treated with atypical antipsychotics developed tardive dyskinesia - lower than conventional - fewer side effects with atypical antipsychotics means patients are more motivated to continue with their medication - Ross and read argue that being prescribed medication reinforces the vie that there is something wrong with them whic reduces their motivation to look for other possible causes and then take steps to deal with these to reduce their suffering

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Ethical issues - an inhumane treatment? (antipsych

Problems associated with the use if antipsychotic medication raises significant ethical issues - critics argue that if its side effects, deaths and psychosocial consequences were taken into account, a cost-benefit analysis of its advantages would most probably be negative 

Use of antipsychotics could be seen as a positive - as it gives the schizophrenic hope of being treated whereas if their illness was caused by family issues such as double bind, that would often be untreatable leaving the schizophrenic and their family in a feeling of guilt and depression

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Electroconvulsive therapy ECT

Using ECT in the treatment of schiz is usually restricted to certain forms of the disorder for example catatonic schizophrenia that do not respond to other kinds of treatment - it is used as a last resort - although its rare today catatonic schiz is responsive to ECT which can bring rapid alleviation of its symptoms - in unilateral ECT an electrode is placed on the non-dominant side of the brain and another on the forehead - patient injected with a barbiture to make them unconscious during ECT - given a nerve-blocking agent to prevent fractures during the seizure - small amount of current is passed through the brain for half a second - creates a seizure which affects the whole brain

Tharyan and Adams carried out a review of 26 studies which included 798 pp's in total - they did this in order to assess whether ECT resulted in any meaningful benefit to schizo patients - when real ECT was compared with stimulated ECT, more people improved with real ECT - when ECT was compared with antipsychotics, results favoured patients who recieved the antipsychotics - some evidence that ECT and medication provided a superior outcome to either used alone

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Electroconvulsive therapy ECT

Effectiveness - meta-analysis of studies that used ECT in the treatment of schiz found that ECT either combined with antipsychotics or used alone is no more effective than using antipsychotics alone - Indian study -Sarita - no difference in the reduction of symptoms between 36 schizos given either ECT or stimulated ECT - Khalilian - studied effectiveness of ECT combined with atypical antipsychotics - dounfd that patients responded quickly to the combination treatment which resulted in a significant reduction of both positive and negatvie symptoms - no evidence of any adverse effects

Appropriateness - in conclusion of their meta anaylsis Tharyan and adams cocluded that ECT may be appropriate when rapid reduction of symptoms is required or when patients show a limited response to medication alone - APA task force on ECT states the ECT is an effective treatment during the acute onset of symptoms when the catatonic subtype of schiz is present and where there is a history of postive respone to ECT - ECT can also offer a lifesaving intervention for patients who suffer from neuropletic malignant syndrome - a life threatening adverse reaction to antipsychotics


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Electroconvulsive therapy ECT

Because there are significant risks associated with ECT including cognitive dysfunction, brain damage and even death the use of this technique as a treatment for schiz has declined - in the UK the decline between 1979 and 1999 was 59% and is no longer a recommended treatment for schiz - some difficulties with memory are noted in almost everybody who recieves ECT - not clear how much of this is due to ECT and how much is due to the illness 

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