A2 - Psychology - Treatments for schizophrenia

Physiological treatments

Chemotherapy - antipsychotic drugs

Drugs that are effective in treating most disturbing forms of psychotic illness, such as schizophrenia, are called antipsychotics.

Conventional antipsychotics drugs (such as chlorpromazine) are used primarily to combat the positive symptoms of schizophrenia - such as hallucinations and though disturbances. The positive symptoms are thought to be products of an overactive dopamine system. Conventional antipsychotics reduce dopamine levels. They are dopamine recpetors (particularly the D2 receptors), thus blocking their action. 

Atypical antipsychotic drugs (such as clozapine) also combat the positive symptoms, but may have some beneficial effects on negative symptoms as well. They are thought to act on both dopamine and serotonin levels, though there isn't universal agreement on this. Kapur and Remington (2001) suggest that they act on D2 receptors alone and only occupy the receptors temporarily and then rapidly dissociate to allow normal dopamine transmission. It is this characteristic of atypical antipsychotics that is thought to be responsible for the lower levels of side effects fond with these drugs compared with conventional antipsychotics.

Electroconvulsive therapy

Historical orgins Electroconvulsive therapy (ECT), developed from the idea that schizophrenia could somehow be cured by inducing seizures, following reports that dementia praecox (an early name for what we know as schizophrenia) was rare in patients with severe epilepsy. This led to the belief that seizures in patients with dementia praecox somehown reduced the symptoms of the disorder.

What happens in ECT? An electric current is passed between two scalp electrodes to create a seizure. An electrode is placed above the temple of the non-dominant side of the brain, and a second in the middle of the forehead (unilateral ECT). The patient is first injected with a short-acting barbiturate, so they are unconscious before the electric shock is administered, and givem a nerve-blocking agent, paralysing the muscles of the body to prevent them contracting during the treatment which might cause fractures. A small amount of electric current (approximately 0.6 amps), lasting about half a second, is passed through the brain. This produces a seizure lasting up to one minute, which affects the entire brain. A patient usually requires between three and 15 treatments. The use of ECT in schizophrenia, was reviewed by Tharyan and Adams (2005) who reviewed of 26 studies to assess whether ECT resulted in any meaningful benefit for schizophrenic patients (e.g. in terms of hospitalisation, change in mental state and behaviour.) They found that when ECT was compared with placebo (i.e. ot was simulated) ECT, more people improved in the real ECT condition. However, there was no indication that this advantage was maintained over the medium or long term. When ECT was compared with antipsychotic medication treatment, results favoured hte medication groups. There was some limited evidence to suggest that when ECT was combined with antipsychotic medication, this resulted in a greater improvement in mental state. The authors concluded that a combination of ECT and medication may be appropiate when rapid reduction of symptoms is required, or when patients show…