WJEC A2 Psychology PY4 - Two Treatments of Schizophrenia

1. Chemotherapy

• people with Sz almost always treated with anti-psychotic medication
• can be administered to stabilise patients during or after a psychotic episode, either in a psych ward or as patient within the community (self-administration)
• two types of anti psychotics: typical (older) and atypical (newer)
• both work by altering activity level of chemicals (neurotransmitters) in brain
• Sz anti psychotics = dopamine antagonists = lessen activity of dopamine
• anti psychotics work by blocking dopamine receptors in the post synaptic neuron, reduces influence of dopamine on thought, behaviour and emotion

EVALUATION (Typical anti psychotics)

(+) Cole et al (1964)

• investigated effectiveness of drug treatments compared with placebos
• patients given anti psychotics showed 75% improvement compared with 25% improvement if given placebos
• suggests drug therapy is effective for treating psychotic illnesses

(-) HOWEVER...

• anti psychotics not effective for everyone as improvement rate not 100%
• 25% of those given placebo showed improvement = suggests act of receiving treatment alone effective in reducing symptoms regardless of actual treatment

(-) Hello/Goodbye Effect

• success of drug could be due to this effect = when patient overestimates symptoms at the onset of symptoms (to elicit help) and underestimates their symptoms at the end of treatment (to show appreciation for the help)

(+) Other treatments reduced

• drug treatments drastically altered how Sz patients treated; lengthy hospital stays not necessary (reducing overcrowding and institutionalisation)
• older, more barbaric treatments, like insulin shock treatment, reduced; eventually banned = more ethical and humane

(-) Negative symptoms/side effects

• typical anti psychotics effective in treating Sz positive symptoms (hallucinations, delusions), not nearly as effective at alleviating the negative symptoms (lack of emotion, social withdrawal)
• muscle tremors, drowsiness and weight gain; about 1 in 20 experience permanent movement in the tongue and mouth called tardive dyskinesia

(-) Revolving Door Syndrome

• drugs only treat symptoms, not a cure; patients often stop taking the drugs as feel better, cannot cope with side effects or just forget
• leads to 'RD Syndrome' of continual discharge into the community and then readmission to hospital, due to medication non-compliance

EVALUATION (Atypical)

(+) atypical drugs treat negative symptoms and produce less side effects than other anti psychotics (Gelder et al, 1999)

(-) HOWEVER...

• one side effect is possible development of fatal blood disorder - agranulocytosis = causes a depletion of white blood cells, can occur spontaneously at any stage in treatment, therefore monthly blood tests are vital if atypical anti psychotics used

(?) May (1968)

• studied various treatments available to Sz and found most effective to be anti psychotics with psychotherapy, suggests drugs alone cannot provide complete treatment for the illness
• May conducted follow up study in 1976, found very similar results, increases reliability of original findings
• strengthens the view that there is a need for combination of treatment methods in order to effectively manage Sz

2. Family Interventions (Reducing EE)

• Family Intervention target families where there are high levels of EE
• Intervention programme should continue for at least 9 months with family sessions at least monthly
• professional staff part should adopt a non-judgemental approach
• aims of Family Intervention include reductions of relapse frequency into illness and hospital admissions, reduction in the burden of care on families/carers, and improvement in medication compliance
• programme includes education prog; analysis of family relationships/functioning; family sessions to identify/address problems and relative support groups
• help family cope with illness and not to allocate blame for relationship difficulties
• the changes that are hoped for after the programme are: construction of an alliance with the family; improvement of adverse family atmosphere; enhancement of relatives' anticipating and solving problems; reduction of feelings of anger/guilt by the family; attainment of desirable change in relatives' behaviour and belief system
• families may merit priority where patient relapses frequently or highly violent

EVALUATION

(+) Brown, Briley + Wing (1972)

• found that following admission to hospital, Sz patients discharged to environment with high EE are 3 or 4 times more likely to relapse than those moving to environment with low EE
• suggests that if family intervention is successful in reducing EE, this should decrease chances of Sz patients relapsing

(+) Anderson and Adams (1996)

• suggest family interventions have been formulated to reduce features of high EE, to lessen the burden on carers and reduce the frequency of relapse

(-) Research

• no research into effectiveness of family intervention without medication, effectiveness in the absence of medication is not known, reduces the validity

(-) Measurement of EE

• measurement not easily quantifiable, not necessarily objectively measured
• difficult to have one family intervention programme for all families because no guarantee that EE has been measured correctly, even if prog tailored

(-) Intervention Strategy

• most intervention strategies (IS) contain more than one technique (eg social skills training, vocational rehabilitation included in some studies)
• separating and defining effects of individual components of an IS difficult

(+) HOWEVER...

• practice guides have been published = give detailed descriptions of techniques

(-) Resistance from families

• suggested those families who are more receptive to family intervention (and change) need it least; those who need it most are most resistant to having it