Psychosurgery & ECT
Psychosurgery --> Pre-frontal lobotomy - mainly removal of frontal lobe, little evidence of it being efective in reducing the symptoms of SZ. But did cause serious life-threatening side effects, such as cognitive and emotional impairment .:. not appropriate.
ECT - found to have little effect on the symptoms of SZ. It has now been largely abandoned as a treatment of SZ.
Drug therapy (Chemotherapy)
Antipsychotic drugs have revolutionised the treatment of SZ.
There are 2 types:
- Atypical which reduces the effects of dopamine.
- Typical which reduces serotonin activity.
Delay & Deniker (1952) - Chlorpromazine, a derivative of phenothiazine, works by blocking the dopamine receptors in the brain was found to have a thereupeutic effect on schizophrenic patients and alleviate their positive symptoms.
Chlorpromazine is still frequently used - this redices positive symptoms in many people in the first 6 months of treatment. It also leads to increased cognitive and behavioural improvement.
Clozapine is an typical antipsychotic which blocks serotonin neurotransmitters, rather than dopamine.
Julien (2005) suggests that these drugs are more effective than atypical one in reducing the effects of S.
AO2: perhaps the dopamine hypothesis isn't as valid today.
Atypical drugs have been shown to:
- produce sedative effects
- significantly reduce positive symptoms
- reduce length of hospital stays
- allows schizophrenics to live a relatively normal life in the community.
However, atypical drugs don't seem to work on the negative symptoms. Luckily research has shown that typical drugs do seem to improve negative symptoms.
But symptoms often return if a patient stops taking their medication - i.e. relapse and this suggests that drugs only treat the symptoms and not the cause of SZ.
Patients .:. need to be kept on medication for long periods of time, which increases risk of side effects.
Also it's not effective for all patients; 30% of patients either:
- don't respond to antipsychotics
- are intolerant to them
- have short term beneficial effects in 75% of patients
- long term beneficial effect in 55-60%
As effective as atypical drugs on positive symptoms; better for negative symptoms.
More effective with treatment-resistant patients .:. there are a minority of patients who cannot be helped with any antipsychotic medication (aietology fallacy)
Side effects: Minor- drowsiness, visual disturbances, depression and weight changes. Serious - similar symptoms to Parkinson's disease - stiffness, immobility, tremors. Tardive dyskinesia occurs in 25% of people taking neuroleptics for 7 years.
Typical antipsychotics cause fewern side effects. But, drugs like Clozapine can seriously damage the immune system if taken for long periods of time. Other drugs are needed to counteract the effects, this means the treatment becomes very expensive.
- some patients refuse to stick to their drug regimes
- could be due to poor memory or the severity of the side effects
- leads to the "revolving door phenomenon
- can be solved via depot adminstration
- this is an injection that slowly releases the medication into the body over weeks.
weakness: if you're intolerant you have to wait for the depot to wear out in order to stop it.
- should patients have the right to refuse medication?
- the use of drugs in treating mental disorders has been criticised as being chemical straighjackets
- the argument is that drugs are dehumanising and take away the sense of personal control and responsibility
- informed consent is an issue - can people in a deeply psychotic state give truly informed consent about their treatment?
Discuss one biological therapy for SZ (12 marks)
Antipsychotic drugs are used in the biological treatment for schizophrenia. There are two types: atypical which reduce the effects of dopamine and typical which reduces serotonin activity. According to Delay and Deniker (1952) Chlorpromazine, a derivative of phenothiazine, works by blocking the dopamine receptors in the brain, was found to have a thereupeutic effect on schizophrenic patients and alleviate their positive symptoms.
However, it didn't seem to be effective for the negative symptoms of schizophrenia. The typical antipsychotic drug Clozapine was found to alleviate the negative symptoms. But 30% of patients were either intolerant to it or suffered severe side effects. Relatively minor side effects include drowsiness, dryness of mouth, weight changes and depression, more serious side effects involve similar symptoms to Parkinson's - stiffness, immobility and tremors. Also, approximately 24% of patients who take antipsychotics for more than seven years suffer from tardive dysineksia.
These sever side effects, can sometimes lead to patients stop taking their medication resulting in the "revolving door phenomenon" whereby patients relapse and have to return to institutional care. To overcome this, patients can be given depots (injections) which slowly releases the antipsychotic over a few weeks. However, this treatment has been criticised for removing control from the individual, also if the patient is intolerant to the depot then they have to wait weeks for it to wear out.
An issue of using antipsychotic drugs in obtaining full informed consent for the patient themselves. If they are having a psychotic break from reality, are they able to make the decision themeselves or is it right for a relative to decide if medication is the best form of treatment for that person. Finally, the use of drugs in treating mental disorders has been criticised as being "chemical straightjackets" i.e. a form of social control.