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Treatments for Schizophrenia - Coggle Diagram
Treatments for Schizophrenia
Biological treatment: Drug therapy
Typical antipsychotics
E.g. Cloropromazine [aka Thorazine], Haloperidol [Haldol], Fluphenazine
Target D2 receptor for Dopamine and are Antagonistic [reduce Dopamine effect], so reduce positive symptoms of Hallucinations and Delusions
These drugs block dopamine activity within 48 hours and this seems to be why they work for people with schizophrenia; however it can take weeks to see a significant reduction in symptoms
Introduced in 1951 as before this, patients were often sedated and in severe cases, the use of shock therapy or brain surgery
Cloropromazine (CPZ) was first used as an anaesthetic for French soldiers but it was noticed that it made people feel better emotionally and reduced positive symptoms of schizophrenia dramatically
Side effects
Dryness of mouth
Blurred vision and grogginess
Weight gain
Sleep problems (either insomnia or somnolence - excessive sleeping)
More serious
Muscle tremors and spasms
Drooling
The worst side effect is tardive dyskinesia (TD)
Which is causes uncontrollable facial grimaces and ticss. TD affects 25% of all patients who take PTZ for more than 7 years and is often irreversible
Atypical
E.g. Clozapine, Risperidone, Olanzapine [Zyprexa] and Sertindole
Target D2 [but bind less tightly] and 5-HT2A receptors [Type 2A receptor for 5-HT =5-Hydroxy-Tryptamine = serotonin
Side Effects
Less Extra-Pyramidal [motion], nausea, grogginess
However, danger of Agranulocytosis - acute condition, decreasing number of white blood cells and so reduce immunity
Cardiac Arrhythmia - heart problems, requires monitoring
Possible diabetes
They also have withdrawal effects which increase the symptoms of schizophrenia so it is important to come off them slowly
The first atypical drug was clozapine which appeared 1971
They do not block dopamine receptors but clozapine blocks serotonin instead
Atypical antipsychotics benefit 85% of patients with schizophrenia, compared with 65% given PTZ (Awad & Voruganti 1999)
Meltzer (1999) found that a third of patients who had shown no improvement with PTZ responded well to clozapine
New Drug: Cobenfy
Treating positive symptoms and some negative symptoms such as social withdrawal and lack of motivation
It also shows potential of treating cognitive impairments like memory problems which are common in schizophrenia
Reduces side effects like sleepiness, weight gain and movement issues which can cause people to stop medication
Other biological treatments such as shock therapy (electro-convulsive therapy or ECT) and psychosurgery (like the frontal lobotomy procedure)
The National Institute for Health and Care Excellence (NICE, 2014) guidance says doctors should discuss the benefits and side effects of each antipsychotic with the patients and ideally the family members
If one antipsychotic has no effect at all, NICE recommends a different antipsychotic be tried after 4-6 weeks. If that does not work, doctors can prescribe clozapine (which is specifically used for people who have not responded to other drugs
Psychological treatment: Family Therapy
Aims
To educate relatives about schizophrenia
To stabilise the social authority of the doctor and the family
To improve how the family communicated and handled the situation
To teach patients and carers more effective stress management techniques
Pharoah identified how it works:
It helps family members achieve a balance between caring for the individual and maintaining their own lives, it reduces anger and guilt
It also improves their ability to anticipate and solve problems and forms a therapeutic alliance
Families taught to have weekly family meetings solving problems on family and individual goals, resolve conflict between members, and pinpoint stressors.
Preliminary analysis: Through interviews and observation the therapist identifies strengths and weaknesses of family members and identifies the problem behaviours
Information transfer: Teaching the patients and the family the actual facts about the illness, it's causes, the influence of drug abuse, and the effect of stress an guilt
Communication skills training: teaching families to listen, to express emotions and to discuss things. Additional communication skills are taught, such as "compromise and negotiation," and "requesting a time out". This is mainly aimed at lowering expressed emotion.
NICE [National Institute for Health and Care Excellence] advocates and says reduced relapse rates
Goldstein and Miklowitz (1995)
the effectiveness of family therapy - family therapy and medication is the most effective
Drug therapy is usually part of the regime
It also argues that family therapy should be offered to patients during their treatment as it ca help reduce relapse rates
However, it is not widely available on the NHS
The therapy lasts 3-12 months over at least 10 sessions, in conjunction to antipsychotic medication
A meta-analyses by Philling et al (2002) compared the effectiveness of family therapy with CBT as a treatment for schizophrenia and found that there were some differences in the effects of each type of therapy