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Treatments Of Schizophrenia Notes

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Treatments of schizophrenia

Appropriateness Rights and wrongs about using treatments Ethics - can person actually consent to medication - legally force treatment - confidentiality - person might want information to be secret

Some treatments require more commitment than others e.g. medication course is quite complicated - barrier to using medication appropriately - talking therapies require commitment by long length of time/ stress Issues with self-report - could influence whether clinician thinks it is an appropriate treatment Some talking therapies require high level of communication skills - but patient's communication could be impaired - can't engage with therapy Talking about mental health may be very stressful or distressing What value does society put on that treatment - if it is an accepted form of treatment may impact on whether patient engages in treatment Access to treatment - financial cost
- medication and therapy can be very expensive - are there enough therapists - may have to travel to nearest therapist Self-referral - requires drive but lack of motivation is a symptom of schizophrenia

Effectiveness Does treatment actually work?
Experimental research - how does treatment work - studies which have tested treatment - issues with ethics, willing sample, individual differences, self-fulfilling prophecy with placebos (deception) What does effectiveness mean - time period - reducing symptoms or dealing with root cause

Approaches:

Biological o Antipsychotic drugs o Electroconvulsive therapy Psychological o Cognitive behavioural therapy o Psychodynamic therapy

Antipsychotic drugs:


Typical antipsychotics - developed during 1950s Atypical antipsychotics - developed during 1990s Also called narcoleptics - group of psychoactive drugs (altering brain function and resulting in changes to perception/ behaviour) commonly used to treat psychotic disorders - assumption of biological cause Companies, when producing drugs, must think about cost, credibility and side effects (appropriateness and effectiveness)

Typical antipsychotic drugs:




People with symptoms of schizophrenia have problems with seeing things/ hearing voices etc. Main theory is dopamine hypothesis - know that dopamine is involved with perception (seeing, hearing, emotions) - changes dopamine levels If you give a person a drug that increases activity of dopamine, it can produce symptoms of psychosis e.g. amphetamines and L-Dopa (used to treat Parkinson's disease) can both produce schizoform symptoms If you reduce activity of dopamine, reduces symptoms of psychosis e.g. using Haloperidol Remember Aetiology Fallacy (causation problems) - assuming causality that doesn't exist Research suggests people with schizophrenia have been shown to have more dopamine activity/ sensitivity in their brains If a person has too much dopamine activity in one part of the brain, this will produce too much 'perception' e.g. seeing and hearing things that aren't there and thus thinking they come from someone else (stimuli they are trying to understand does not actually exist)

In normal dopamine synoptic event, there is an equal amount of dopamine and receptors - in excessive dopamine synoptic event, there is more dopamine than receptors o Antipsychotics like Haloperidol block dopamine receptors by fitting into receptor space usually reserved for dopamine - if a drug blocks all dopamine receptors, it can upset muscle control (Parkinson's type symptoms) - can impact on other receptors e.g. noradrenaline and serotonin receptors (blood pressure and weight)

Atypical antipsychotic drugs:


Also known as second generation antipsychotics Group of unrelated (unrelated to other antipsychotics) antipsychotic drugs used to treat psychiatric conditions Atypicals such as clozapine work differently from typicals in that they only attach to specific dopamine receptors with a transient blocking action on excessive perceptionalisation (subtle blocking, maybe resulting in less/ less severe side effects) Preferred to conventional typical antipsychotics because they produce less side effects e.g. tardive dyskinesia (involuntary movement of lips and tongue; incidence as side effect of conventional antipsychotics is 30% and irreversible in 75% of these cases - Hill 1986) Good for positive symptoms, however comparative effects on negative symptoms are marginal (Leucht et al 1999)

Effectiveness of drug therapies:

Some neuroleptic drugs, e.g. thorazine, prolixin and haldol, block dopamine activity within 48 hours, however it takes several weeks before symptoms show substantial reduction o Birchwood and Jackson 2001 concluded there's not good evidence that neuroleptic drugs are effective in treating negative symptoms - however, Comer 2001 found these drugs are more effective than any other approach used alone Neuroleptic drugs have strongest effects in first 6 months - serious problems if patient stops taking them o Sampath et al 1992 studied schizophrenics who had been taking neuroleptic drugs for 5 years - one group switched to placebo and other group continued taking drugs - in placebo

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