Biological Treatments for Schizophrenia

Historical origins = ECT was developed int the 1930 but it was found to be ineffective: Karagulla (1950) found lower rates of recovery for ECT patients compare to those who did not receive the treatment. ECT has now been largely abandoned, however in a modified form, it continues as a treatment for people with severe depression.

What happens in ECT = An electronic (approx. 0.6 amps) is passed between two scalp electrodes to create a seizure. One electrode is placed above the temple of the non-dominant side of the brain and the other in the middle of the forehead. The patient is first injected with a barbiturate so they are unconcious and then they are given a nerve-blocking agent which paralyses their body. A patient usually requires 3-15 treatments.

ECT and schizophrenia = Tharyan and Adams (2005) reviewed 26 studies that compared ECT with a placebo condition, with 'simulated' ECT and with antipsychotic medication. They found when ECT was compared with placebo or simulated ECT, more people improved in the real ECT condition. However this advantage wasn't maintained over a long-term and when ECT was compared with antipsychotic medication treatment, results favoured the medication group. There is some evidence to suggest that when ECT was combined with antipsychotic medication, this resulted in a greater improvement in mental state and therefore the authors conclude that a combination of the two may be appropriate when rapid reduction of symptoms is required or when patients show limited response to medication alone.

Effectiveness of ECT = An American Psychiatric Association listed 19 studies that had compared ECT with 'simulated ECT' and concluded that ECT produced results that were no different from or worse than antipsychotic medication. Sarita et al (1998) also found no difference in symptom reduction between 36 schizophrenia patients given either ECT or simulated ECT.

Appropriateness of ECT = Because there are significant risks associated with ECT, including memory dysfuncction, brain damage and even death, the ruse of this technique has declined. In the UK, the decline between 1979 and 1999 was 59% (Read 2004).

Antipsychotic medication = Drugs that are effective in treating the most disturbing forms of psychotic ilness. Antipsychotic medication helps the person with the disorder function as well as increasing their feelings of subjective wellbeing. It is the most common treatment for schizophrenia. Some antipsychotic drugs reduce the effects of dopamine others reduce seretonin activity.

Conventional antipsychotic drugs = The basic goal of these drugs is to reduce the amount of available dopamine or to reduce the number of dopamine receptor sites by blocking them. Phenothiazines work by blocking dopamine receptors, one of the most commonly used is Chlorpromazine. By reducing the stimulation of the dopamine system, they can reduce acute, positive symptoms such as hallucinations and delusions. The effectiveness in reducing the symptoms led to the development of the 'dopamine hypothesis'. The drugs produce maximum benefits within the first 6 months and they show cognitive & behavioural improvements

Atypical antipsychotic drugs = Recently been introduced and are thought to block serotonin receptors in the brain as well as dopamine receptors. Kapur and Remington (2001) have however suggested the drugs don't involve serotonin or other neurotransmitters but only the dopamine system and the D2 receptors. They only temporarily occupying the D2 receptors and then rapidly dissociating to allow for normal dopamine transmission.

Relapse rates = Many studies have evaluated the effectiveness of antipsychotic by comparing relapse rates of those on medication with those on a placebo. Davis (1980) found a significant difference; 55% relpase rates in those with the placebo, compared to 19% of those on the drug. This shows the therapeutic effectiveness of the drug.

Negative symptoms = They're effective in reducing positive symptoms but have little effect on the negative sypmtoms.

Other factors are important = One of the studies in Davis' meta analysis found the drugs did make a significant difference but only for those living with hostility and criticism in their homes. Relapse rater these were 53% with medication and 92% with the placebo. For those living in supportive homes there was no significant difference in medication and placebo.

Effectiveness = Not effective for everyone diagnosed, 30% don't respond or are intolerant to the drugs.

Tardive dyskinesia = The drugs have many side effects, including tardive dyskinesia; uncontrollable movements of the lips, tongue, face, hands and feet. About 30% of those taking the drug develop it and it's irreversible in 75% of cases. Other side effects include drowsiness, visual disturbance, dryness of mouth, changes in weight and depression.

Motivational deficits = Ross and Read (2004) say that being prescribed medication reinforces the idea that there's something wrong. This prevents the person from thinking about possible stressors that trigger the condition, so reduces their motivation to look for solutions that may reduce the stressors and reduce suffering.

Atypical vs Conventional = A meta-analysis revealed that the superiority of these drugs compared to conventional antipsychotic was only moderate. It found that two of the new drugs tested were 'slightly' more effective and the other two were no more effective than conventional drugs.

Effectiveness with negative symptoms = The claim that atypical antipsychotics are particularly effective with negative symptoms has very marginal support. It was found that two atypical drugs were 'slightly' more effective and one was slightly worse.

Fewer side effects = May ultimately be more appropriate as there are fewer side effects which means that patients are likely to carry on taking the drugs and see benefits.

Lower likelihood of tardive dyskinesia = This is supported by Jeste (1999) who found that tardive dyskinesia rates were 30% in those taking conventional antipsychotics after 9 months, compared to 5% in those using atypical antipsychotics.

Clozapine = It has potentially life-threatening side effects resulting in damage to the immune system - other drugs are used to combat this but it makes the treatment expensive & time consuming.

Placebo's = Not a fair comparison between non-treatment & treatment because under the placebo conditions, the patient is actually in a drug withdrawal state. This causes high dopamine levels & overwhelming of the dopamine system. Placebo condition relapses can be said to be the result of this.

Ethical issues = Drugs are dehumanising and take away the sense of personal responsibility or control. Informed consent is also a problem as patients aren't in a position to do so.

Relapse = It has been found that symptoms often return if patients stop taking the drugs (Rzewuska 2002) and patients sometimes have to be kept on meintenance doses for long periods of time. This increases the risk of serious side effects.