Treatments for Schizophrenia

• Drug Therapy:

  :) RTS Thornley/Meltzer

  > Thornley - meta-analysis of 13 studies (1121 participants) investigating chlorpromazine against a placebo, found that typical antipsychotic was associated with better functioning and reduced symptom severity

  > Meltzer - clozapine is more effective than typical, and is effective in 30-50% of treatment resistant cases

  > supporting antipsychotics as an effective treatment
• Drug Therapy:

  :( RTC Healy

  > most studies into the effectiveness of antipsychotics are of short-term effects only and some successful trials were published several times with exaggerated results

  > antipsychotics have a calming effect on behaviour, which can be confused for reducing symptoms

  > places doubt on research to support the effectiveness of antipsychotics
• Drug Therapy:

  :) little motivation

  > patient only has to take a tablet in order to reduce symptoms

  > unlike CBT - requires motivation as they have to attend and engage in sessions to identify and challenge delusions - may be difficult for a person with schizophrenia who may not have an accurate perception of reality

  > beneficial for those with negative symptoms who struggle with keeping up with everyday tasks

  > drug therapy may be more appropriate than CBT - more accessible
• Drug Therapy:

  :( negative side effects

  > chlorpromazine = movement side effects, such as parkinsonism, clozapine = agranulocytosis (life-threatening illness)

  > unlike CBT, which involves a person identifying and challenging delusions, which has no negative side effects

  > may not be appropriate for all patients, as side effects reduce effectiveness as people may stop taking them
• CBT:

  :) RTS Jauhar

  > reviewed the results of 34 studies of CBT as a treatment for schizophrenia and concluded that CBT had a significant but small effect on both positive and negative symptoms

  > CBT is fairly effective in treating schizophrenia by challenging irrational thoughts

  discussion - CBT only had a small impact on symptoms, placing doubt on the effectiveness of CBT
• CBT:

  :( requires motivation and commitment

  > requires patients to attend sessions, which may be difficult if they are suffering from negative symptom of avolition

  > requires patients to engage in sessions, which may be difficult if they are suffering from positive symptoms (delusions) and have an inaccurate perception of reality

  > CBT may only be effective when combined with antipsychotics (help motivate patient to attend sessions)

  > CBT alone is not an effective treatment
• CBT:

  :) avoids chemical dependence

  > encourages individuals to identify and challenge their irrational/delusional thoughts independently, giving them control over their own behaviour

  > unlike drug therapy, which could cause dependence as it controls activity of neurotransmitters, such as dopamine, to reduce symptoms of schizophrenia

  > CBT may be more appropriate
• Family Therapy:

  :) RTS Leff

  > compared family therapy with routine outpatient care for schizophrenics

  > in the first 9 months of treatment, 50% of those receiving routine care relapsed, compared with 8% of those receiving family therapy

  > family therapy is an effective treatment
• Family Therapy:

  :( does not get to root cause (aetiology)

  > works by helping to reduce stress for both the patient and family members, but this does not eliminate symptoms completely - when the therapy stops, patients could relapse (Hogarty)

  > questions the appropriateness and effectiveness of family therapy

  also - emphasises openness, which could cause tension