Sz treatments

• based on the dopamine hypothesis: people with excess dopamine are more sensitive to it, so leads to positive Sz symptoms

  - therefore if drugs can reduce/block the effect of dopamine in neurones, then positive symptoms should decrease


  what is the rational for using antipsychotic drugs
• antipsychotics contain dopamine antagonists (substances which block dopamine receptors in the post synaptic neuron). This preventing dopamine binding and making the post synaptic neuron fire so frequently


  explain how anti-psychotic drugs work with regards to neurotransmission?
• - atypical

  - typical

  both alter levels of neurotransmitters


  what are the two types of antipsychotic drugs?
• typical= older, dopamine only, reduces positive symptoms

  atypcial= newer, dopamine and seretonin, reduces positive and negative symptoms

  what is the difference between atypical and typical antipsychotics?
• meta-analysis compared effects of chlorpromazine in 13 trials with 1121 participants, participants with chlorpromazine (typical) improved more than placebo control group. HOWEVER, dont know details/controls of each study, so cant accurately say its effective, also dont know long term impacts


  explain how the meta-analysis study on chlorpromazine (typical) supported anti-psychotics?
• patients with anti-psychotics had 70% improvement rate, placebo had 25%, so anti-psychotics must be working. However, those with placebo still improved but had no side effects, furthermore some drug success could be due to hello/goodbye effect


  explain how the meta-analysis study on antipsychotics vs placebos supported anti-psychotics?
• exaggerating your illness to receive treatment. This means the drugs look effective but the effect was actually much smaller, then people downplay their symptoms at the end.


  explain what the hello/goodbye effect is?
• drugs meant patients not in hospital as long anymore (only 3% patients live there now), therefore less older style therapies like labotomys and economically good as less hospital fees

  explain how the use of drugs changing the way patients are treated is a positive?
• it is based on the DH but now we understand there are high and low levels in the subcortex, cant explain why antipsychotics work in areas of low dopamine, so can't fully explain why the drug is working


  explain how we dont fully understand how anti-psychotics work are a negative?
• psychotic episode --> antipsychotic drugs --> worsening side effects

  worsening side effects --> off medication --> psychotic episode

  Cycle continues

  what is the revolving door syndrome
• 40% relpase in first year of treatment, study found 72% stop taking drugs in 18 months due to side effects, leads to revolving door syndrome as patients take drugs then get bad side effects so come off medication then have a psychotic episode so are back on drugs again


  explain why high relapse rates are a negative of the biological treatment?
• companies only publish data that reflects well on their drugs, they may use less participants or apply lower dosage


  explain how publication bias is a negative of the biological approach?
• - cognitive behavioural therapy

  - family intervention therapy

  - token economies


  What are the 3 psychological treatments for schizophrenia ?
• To change dysfunctional thoughts (delusions) into more realistic alternatives, allowing improvements I. The emotional and behavioural state of the patient


  What is the aim of CBT ?
• - patients encouraged to trace origins of their symptoms

  - offering a range of psychological explanations for delusions

  - evaluation of the content of the delusions/ voices

  - given behavioural assignments

  What does CBT involve ?
• 20 hours of individual therapy including:

  1) establish a therapeutic alliance

  2) normalise the symptoms

  3) cognitive element (thought catching)

  4) behavioural intervention (reality testing)

  5) plan for the future- replace irrational thoughts with more rational alternatives


  What are the steps of CBT?
• A review of 34 studies using CBT for schizophrenia showed a small but significant effect on + and - symptoms, implying it's an effective treatment


  Describe supporting evidence for CBT being an effective treatment ?
• CBT techniques and sz symptoms vary widely in differing cases, difficult to prove CBT is helping as patient often also take DRUGS at the same time.

  HOWEVER- highest effectiveness is combination of both, (dual treatment) but this is more expensive

  Give a weakness of CBT
• Study found CBT was effective treatment for sz still after 9 months, so has long term improvement and lower rates of relapse compared to drugs


  Explain how CBT having long term impacts is a strength ?
• Study found CBT reduced delusions in 10/12 patients, shows effectiveness.

  HOWEVER- sample only 12 people


  What study was to do with reduced delusions for CBT?
• No side effects,

  HOWEVER- more expensive treatment than medication and takes longer to complete


  Give a strength of CBT compared to antipsychotics?
• NICE recommends CBT for sz, suggesting majority evidence supports CBT


  Explain what NICE did in regards to CBT?
• The family is the root of the problem especially if they have high expressed emotion


  What does family therapy believe the root of problems with schizophrenia are ?
• EE= expressed emotion.

  Relapse rates for sz are higher in these families as there is high EE (criticism, hostility and over involvement)


  What is EE and how does it relate to sz?
• to improve the quality of communication and interactions within a family

  what is the main aim of family intervention therapy?
• - improve positive and decrease negative forms of communication

  - increase tolerance levels and decrease criticism between family members

  - decrease guilt and feeling responsible for causing the illness

  - educate family about the disorder and what to expect


  What are the specific aims of family therapy?
• - education programs

  - analysis of family relationships

  - family sessions to address issues

  - relatives support group

  Goes on for 9 months with monthly family sessions, reducing EE and improving medication compliance (for less relapse)


  What does the program include ?
• Study found it's effective treatment and stops relapse rates by 50-60% and declines in mental health. NICE also suggests everyone with sz diagnosis does family therapy


  What is some evidence supporting family intervention therapy!
• Study compared the relapse rates of a group of people with sz who were given family therapy, compared to controls given standard care.

  Relapse rates after 9 months = 50% control, 8% family therapy group

  Relapse after 2 years= 75% control group, 50 % family therapy group

  HOWEVER- still 50% relapse rates so perhaps no long term benefits, could just be delaying relapse

  What is some other evidence supporting family therapy as a treatment?
• + no side effects/ medical risks HOWEVER patients often need to be on medication as well

  + extra cost of family intervention is offset by reduction in costs of hospitalisation because of lower relapse rates


  What are the strengths of family intervention therapy ?
• - patients are often on medication at same time as therapy

  - family might feel blame: socially sensitive

  - expensive treatment, families that need it most are least likely to

  - subjective: measurements of expressed emotion

  - treatment improves quality of life but doesn't cure sz

  - most intervention strategies contain more than 1 technique, therefore difficult for evaluate and separate individual techniques and their effectiveness


  What are the limitations of family intervention therapy ?
• If the cause of Sz is maladaptive learning, then treatments that are based on unlearning the faulty behaviour should be effective


  What is the rationale behind token economies?
• Based on operant conditioning. Before T.E the therapist will try and find out what is maintains/ reinforcing the behavioural symptoms of sz and remove it.


  How does token economy work?
• - positive reinforcement

  - extinction procedures


  What are the two "parts" of token economy?
• Target behaviours that are useful to try and increase them: Patient is given a token for target behaviour which acts as a secondary reinforced. Token can then be exchanged for a reward which acts as the primary reinforcement


  How does postive reinforcement come into token economies?
• Certain maladaptive behaviours are ignored, the lack of attention will reduce the repetition of these behaviours


  How does extinction procedures relates to token economies ?
• T.E system implemented for female Sz patients in hospitals, patients given tokens for appropriate behaviour (e.g washing up) which were exchanged for rewards (cinema trips/listen to records)


  what is some supporting evidence for token economy systems - tokens/rewards in hospital
• + findings: positive behaviours carried out by patients increased from 0 to over 40 after the T.E system, BOTH positive and negative symptoms were reduced

  + This supports that the T.E program is effective on symptoms and positive behaviours in patients who were chronically ill and who hadn't responded to other treatments: it prepares them for basic life skills/social skills for life beyond hospital


  what were the findings from this evidence
• HOWEVER some of the rewards are deemed as unethical and should be basic human rights that shouldn't be earnt, especially as the patients there are in hospital who are there for care


  what is a however point for this evidence
• + in hospital, patients given tokens for appropriate behaviour (e.g making their bed) then progress was checked every 6months for 6years:


  what is some supporting evidence for token economy systems - patient progress