CBT, family & drug therapy

Aim: Identify & challenge irrational thoughts (hallucinations + delusions) that are causing Sz and change them to a more plausible explanation (reasonable) 

Cognitive aspect (dispute): To come up with a more plausible explanation

• Logical disputing e.g “does it make sense to put tin foil on your head to stop voices” 

• Empirical disputing e.g “where is the evidence that aliens are following you” 

Behavioural: 

• Positive self talk - counteract voices 

• Self distraction strategies - draw out voices i.e listening to music

Outside of the session: 

• Practice disputing techniques

The main aim of family therapy is to reduce levels of expressed emotions/stress by:

•  Improving families’ beliefs about and behaviour towards schizophrenia

•  Reducing the stress of caring for a relative with schizophrenia

•  Decreasing feelings of guilt & anger in family members.

•  Helping family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives.

Therapists meet regularly with patients and family members, over the course of around 9 months to a year, and are encouraged to be open & talk about the patient's symptoms, behaviour and progress.

First-generation antipsychotics are dopamine antagonists; they reduce levels of dopamine activity in the brain. 

Chlorpromazine works by binding to the receptors on postsynaptic neurons in the brain, reducing the action of dopamine. 

This reduces dopamine activity levels and results in a reduction of positive symptoms of schizophrenia, such as hallucinations. 

Common side effect is Parkinsonism - tremors & shakes similar to the symptoms of those diagnosed with Parkinson’s.

They are also used as a sedative and can be used to calm patients.

Act upon neurotransmitters dopamine AND serotonin. 

Clozapine also binds to dopamine receptor sites on the postsynaptic neuron, reducing positive symptoms (i.e hallucinations.) Act as agonists with serotonin receptors - 2A & 2C & reduces negative symptoms (i.e lack of emotions b/c it helps improve mood & reduce depression & anxiety)

Clozapine has fewer side effects than typical antipsychotics (chlorpromazine)  - as they have less action on the dopamine system. 

Atypical antipsychotics (clozapine)  can be used to treat both positive and negative symptoms of schizophrenia as they act upon both dopamine and serotonin.

Patient is prescribed with atypical antipsychotics if typical antipsychotics aren't effective / if patient has severe side effects.

Atypical antipsychotics (clozapine) - associated with a life-threatening illness (agranulocytosis). If the patient is prescribed atypical antipsychotics (clozapine) they will be regularly monitored for signs of agranulocytosis by having blood tests.