UNIT 4 TREATMENTS FOR SCHIZOPHRENIA

WHY DO WE NEED TO TREAT ABNORMALITY? 1) How do we define abnormality? Failure to function adequately Deviation from ideal mental health Deviation from social norms Based on these definitions, what do you think treatments aim to achieve?

CONTEXT Schizophrenia usually first appears in a person during their late teens or throughout their twenties. It affects more men than women, and is considered a life-long condition which rarely is "cured," but rather treated which is why choosing the most appropriate treatment is so important. The primary treatment for schizophrenia is medication. Unfortunately, compliance is a major problem with this treatment. The repercussions of this loss of treatment are acutely felt not only by the individual, but by their family and friends as well.

THE REALITY OF LIVING WITH SCHIZOPHRENIA Successful treatment of schizophrenia depends upon a life-long regime of both drug and psychosocial, support therapies. Medication helps control the psychosis associated with schizophrenia (e.g. the delusions and hallucinations), it cannot however help the person find a job, learn to be effective in social relationships, increase the individual's coping skills, and help them learn to communicate and work well with others. In order to truly manage the condition patients need strong support network of friends and family to accompany their treatment and the psychological treatments will aim where possible to incorporate this network.

WHAT DO TREATMENT SEEKS TO ACHIEVE? With such support, determination, and understanding, someone who has schizophrenia can learn to cope and live with it for their entire life. But stability with this disorder means complying with the treatment plan set up between the person and their therapist or doctor, and maintaining the balance provided for by the medication and therapy. Suddenly stopping treatment will most often lead to a relapse of the symptoms associated with schizophrenia and then a gradual recovery as treatment is reinstated.

TWO STRANDS OF TREATMENT Psychological and biological What is your job in the exam: Outline the available treatments in terms of what they are, how they work and what they do. Evaluate their relative effectiveness and appropriateness.

DRUG THERAPIES Drugs are categorised by their effect. Some drugs work on positive symptoms others work on the negative. The two main categories of drugs are: 1) Neuroleptic Drugs 2) Atypical Drugs

NEUROLEPTIC DRUGS Reduce the positive symptoms of schizophrenia but can produce symptoms of certain neurological disorders. The most common types are: Thorazine, Prolixin and Haldol.

WHAT DO THESE DRUGS DO? These drugs block dopamine within 48 hours. Most therapists agree that the effect these drugs have on dopamine are key to treatment being effective but it is often weeks before a substantial improvement is seen in patients behaviours. Neuroleptic drugs are far more effective at reducing positive symptoms. Birchwood and Jackson 2001 concluded there is no significant evidence that these drugs are effective at reducing the negative symptoms. Comer 2001 however commented that these drugs are more effective than any other treatment used alone.

WHEN DO THESE DRUGS WORK BEST? Usually the first sixth months shows these drugs at their most effective; however patients who cease treatment can suffer severe relapse’s in their behavioural pattern even after many years. Sampath et.al 1992 All participants had been taking neuroleptic drugs for five years. Groups were then split into independent groups design, half continuing the drugs and half taking a placebo. The results showed 75% in the placebo groups relapsed within a year, c.f. only 33% in the treatment group.

WHAT ARE THE SIDE EFFECTS OF NEUROLEPTIC DRUGS? Windgassen 1992 recorded side effects in patients taking neuroleptics and found the following: 50% suffered form grogginess or sedation 18% lacked concentration 16% had blurred vision Many patients develop symptoms of Parkinson's disease – What are the ethical issues here? Approximately 2% (usually older patients) also develop neuroleptic malignant syndrome which involves muscle rigidity and altered consciousness. In some cases this can be fatal and when patients develop these symptoms drugs must be stopped immediately.

WHEN DO SIDE EFFECTS OCCUR? Most side effects happen within a few weeks. However more than 20% of patients who take neuroleptics for over a year develop symptoms of tardive dyskinesia which can be permanent.

CAN THE SIDE EFFECTS BE REDUCED? Side effects are less with lower doses. The difficulty with this is that patients show more improvement with higher does. Most patients treatment programme is therefore a balancing act and are usually established with a trial and error program.

TASK Atypical drugs are the second type of treatment available for Schizophrenia. Research and find out the following: What are is the deference between atypical drugs and neuroleptic treatment? How do atypical drugs work? What are the side effects of atypical drugs? What evidence can you find to show this? Complete by next lesson!