AO1- Biological Therapies
Electro-Convulsive Therapy (ECT)
- First studies of ECT as a treatment for schizophrenia were disapointing with recovery lower than control group.
- Combination of medication and ECT is more effective for rapid reduction of symptoms.
- Conventional anti-psychotics reduce the effect of dopamine and so reduce symptoms of schizophrenia.
- Blind to D2 dopamine receoptors but do not stimulate them.
- Atypical antipsychotics only temporarily occupy D2 receptors then dissociate to allow normal dopamine transmission.
- Leads to lower levels of side effects such as tardive dyskinesia (involutary movements of the tongue)
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- Effectiveness of ECT is inconsistent, APA study found no difference between effects of ECT and anti-psychotic medication.
- Sarita found no difference in symptom reduction between ECT and stimulated ECT
- Because of risks of ECT (e.g memory dysfunction, brain damage, death) use has declined.
- Tharyan and Adams reviewed 26 studies and found 'real' ECT more effective than 'sham' ECT.
- Davis et al found higher relapse rate in patients whose drug replaced with placebo than those who remained on the drug.
- Anti-psychotic medication more effective for those living with hostility and critisism.
- Conventional anti-psychotics- 30% develop tardive dyskinesia.
- Being prescribed medication creates motivational deficits which prevents positive action against illness.
- Meta-analysis found superiority over conventional anti-psychotics only moderate.
- Atypical anti-psychotics- only marginal support for effectiveness with negative symptoms.
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A02- Evaluation (cont)
- Lower rates of tardive dyskinedia with atypical anti-psychotics supported by Jesse.
- Patients more likely to continue with medication if fewer side effects.
- Ross and Read- Placebo studies not a fair test because proportion of relapses explained by withdrawl effects
- Ethical issues- human rights issues associated with use of anti-psychotic medication (e.g tardive dyskineia)
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- Ethical problems- Critics argue that is negative effects and cost-benefits were taken into acount then the overall quality and worthwhile of the medication would be negative.
- Is a placebo a fair test?- Studies using meds restricted people which means as there was a previous block of dopamine there will now be a flood of it. This is because of hightened sensitivity and increased number of dopamine receptors. Results in a total overwhelming of dopamine system
- Ethical issues- sometimes no consent in treatment due to unstable patient and/or families havent made decision in treatment.
- Animal research- Animals may be used to see how medication can effect them before used on humans.
- Culture Bias- No variation on how placebos have effected in other cultures which are westernised.
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A01- Psychological Therapies
Cognitive Behavioural Therapy
- Patients 1. Trace origins of symptoms to understand how they might have developed. 2.evaluate content of delusions/hallucinations.
- Patients allowed to develop own alternatives to maladaptive beliefs/
- Outcome studies show that patients receivign CBT experience fewer hallucinaion and delusions than those who receiving anti-psychotic medication alone.
- Lower patient drop-out rates and greater patient satisfaction with CBT than anti-psychotic medication.
- Psychoanalysis based on assumption that individuals unaware of influence of unconscious conflicts on their current psychological state.
- Therapist creates an alliance with patient by offering help with what patient perceives as the problem.
- All psychodynamic therapies build trust with patient by replacing harsh parental conscience with one that is more supportive.
- As patient ges healthier they take more of an active role.
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- Effectiveness- meta analysis found significant decrease in positive symptoms after CBT treatment.
- Most CBT studies also involve anti-psychotic medication therefore difficult to assess effects of CBT alone.
- CBT works by generating less distressing explanations for psychotic experiences rather than trying to eliminate them.
- Psychiartists beleive that older patients are less likely to benefit from CBT.
- Ethical issues arise in placebo condition where patient are denied effective treatment.
- Meta-analysis- 66% of those receiving psychotherapy improved after treatment while 35% didnt.
- Some forms of psychodynamic therapy can even be harmful in treatment of schizophrenia.
- Research on effectiveness of psychodynamic therapy shows contradictory findings.
- 'Supportive' psychotherapies appropriate when combined with anti-psychotic medication.
- Psychodynamic therapy long and expensice, but may have benefits in that it might make patients more able to seek employment.
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- Methodological problems- the small number of studies meant that there is a lack of generalisability because it doesnt assess all the variables.
- Ethical Issues- the studies havent been carried out in a way which means the pp isnt at risk. This could lead to increase harm when dealing with a vulnerable group, harm could include discontinuation of meds, use of placebo or capacity for informed consent.
- Cultural Variation- No variation of studies have taken place to establish a differnce of similarity which could occur in a different society/culture.
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