Describe and Evaluate Biological Treatments for Schizophrenia

Historically people suffering from mental health issues were not treated with dignity or respect.

Before the 1950s schizophrenia was considered untreatable and patients were interned in mental institutions

Rosenhan & Seligman vividly explain the back wards of mental hospitals as ‘snake pits’, filled with inmates who were unreachable or mutely catatonic, or were wild with delusions and straitjacketed. Attempts to treat schizophrenia with insulin, ECT and drugs often failed.

BIOLOGICAL - CHEMOTHERAPY Since the 1950s the use of drugs to treat mental disorders has become widespread. They work to either increase or decrease the levels of neurotransmitters in the brain.

Drug treatments are known as chemotherapy - using chemicals to change the way the brain or body works. Drugs that change the way a person thinks or behaves are called psychoactive drugs. Drugs used to treat mental disorders - psychotherapeutic drugs - alter the chemical functioning of the brain by affecting the action of neurotransmitters.

(Drug Therapy) Drugs have been developed to work in the synapse to help sedate a person, and reduce the intensity and frequency of behaviours such as delusions and hallucinations. An example of this is IDOPA for those suffering with schizophrenia which works by blocking the receptor cells to prevent the dopamine being picked up. A careful balance of drugs has to be developed for each individual as everyone reacts differently to chemotherapy.

 Antipsychotic drugs are known as TYPICAL and ATYPICAL  TYPICAL = well established  ATYPICAL = newer and less widely used  ATYPICAL ANTIPSYCHOTIC DRUGS tend to have fewer side effects and act in different ways to typical antipsychotic drugs  A patient is only ever on ONE psychotic drug at a time (anti depressants can be taken at the same time) Antipsychotic Drugs

Antipsychotics There are approximately 20 different anti- psychotic drugs. Typical Antipsychotic Chlorpromazine - £10 per year/per patient Atypical Antipsychotic Clozapine - £1500 per year/per patient

Anti-psychotic drugs have provided a breakthrough in treating schizophrenia and remain the main form of treatment – Although they provide a calming effect….. The problem is …… – They have little effect on Type 2 (negative) – Have dreadful side effects

2. Clozapine: blocks less dopamine and blocks more serotonin. a. Reduces both positive and negative symptoms. b. Fewer side effects;. c. Problem: produces a potentially lethal blood disorder. 1.Phenothiazines: decreases dopamine activity. a.Reduces positive symptoms (hallucinations, delusions, etc.). b.Fails to reduce negative symptoms (flat affect, low motivation, etc.). c.Unpleasant side effects: dizziness, nausea, sexual impotence, tardive dyskinesia (involuntary facial movements), etc.tardive dyskinesia d.May cause permanent biochemical changes reducing possible eventual full recovery. New generation

 The Atypical antipsychotics (also known as second generation antipsychotics) are a group of unrelated anti-psychotic drugs used to treat psychiatric conditions. Atypicals such as Clozapine work differently from typicals in that they only attach to specific D2 dopamine receptors (with a transient blocking action).  A-typicals are preferred to conventional anti-psychotics because they produce less side affects (eg. tardive diskinesia)  Good for ‘positive’ symptoms, however comparative affects on ‘negative’ schizophrenia are marginal (Leucht et al, 1999). Antipsychotic Drugs

Reduce the effects of dopamine and therefore the symptoms of Sz. They bind to dopamine receptors without simulating them. Anti psychotic drugs fit into dopamine receptors … Blocking dopamine and stopping it being picked up… Most effective when given at the onset of schizophrenia Conventional Antipsychotic Drugs

KEY Information: A-typical antipsychotic drugs act on the dopamine pathway but they only occupy the dopamine receptors temporarily. Therefore they have lower side effects than the conventional antipsychotic drugs. A-typical Antipsychotic Drugs

A – To Carry out a one year double blind study to see the effectiveness of Fluphenazine as a treatment for Schizophrenia P – Longitudinal study of 28 Patients referred to a New York clinic with a diagnosis of Schizophrenia. Independent Measures design, random allocation to drug or placebo condition. Patients dropped out if they had toxic side effects or if they relapsed. R – 7/17 (41%) patients receiving the placebo had relapsed by 19 weeks. In the drug treatment condition there were no relapses. The toxic side effects of the drugs did cause 2 receiving treatment to drop out by 32 weeks. C- Patients with one episode of schizophrenia can be successfully treated using Fluphenazine once they are in remission. Now complete your work sheet Kane et al Research

Newer generation anti-psychotics can be effective in normally unresponsive schizophrenics. They also lack some of the debilitating side effects of the older Drugs. These newer generation antipsychotics appear to block multiple subtypes of dopamine receptors (including D1 D2 D3 D4 D5). “Problem Schizophrenics”

Drug Therapy Once someone with schizophrenia is stabilized on medication, psycho-social therapy can help him or her learn to cope with their illness and live as independently as possible. Older antipsychotic drugs, such as Chlorpromazine, typically affect dopamine levels, and have many unpleasant side effects that cause muscle spasms and tremors. Newer drugs, such as Clozapine, are usually more refined and are much safer with fewer unwanted side effects — although the effects that remain can still have a big impact on quality of life.

Strengths One of the main strengths is that the patient is able to live in society, thus avoiding institutionalisation which can occur from a long period of time in hospital. It is successful for a large number of patients so they are able to live a more normal life. Also the ability to remain in society gives the patient access to other therapies, which may improve the recovery process.

Pickar et al (1992) Compared the effectiveness of clozapine with other neuroleptics and a placebo drug. He found that clozapine was the most effective at treating symptoms, even in patients who did not respond to previous drugs Placebo was least effective

Effectiveness: Most studies on the effectiveness of conventional antipsychotic drugs compare the relapse rates of those on medication with those on a placebo. Davis et al. reviewed 29 studies and found that the relapse occurred in 55% of the patients who were on placebo compared to 19% on those who remained on drugs.

Emsley (2008) Studied the effects of injecting the anti-psychotic drug Risperidone Found that those who had the injection early in the course of their disorder had high remission rates and low relapse In 84% of patients there was at least a 50% reduction in positive and negative symptoms Over the 2 years of the study-64% went into remission

Weaknesses One problems with all the drugs is the side effects! Constipation; coughing; diarrhoea; drowsiness; dryness of mouth; headache; heartburn; increased dream activity; increased length of sleep; nausea; sore throat; stuffy or runny nose; unusual tiredness or weakness; weight gain; absence of menstrual periods; breast growth in males; tiredness; increased appetite; sexual problems in both men and women Side effects are a huge problem as they can put people off taking drugs.

Limitation of drug treatment: Szasz (1960) argued that biological treatments do not address the underlying causes of the mental illness and uses the labels of illness to treat them – this could be seen as unethical as patients are put in a ‘chemical straightjacket’ (ethical issue) Drugs do not cure Sz they reduce the symptoms There are long term side effects of drug therapy including an increased risk of diabetes.

 Non compliance or partial compliance when it comes to taking the drugs is a major barrier to the treatment of schizophrenia and can lead to relapses. After several relapses, patients are at an increased risk of never getting back to the functional level they were at before developing the disorder

Rosa et al Found that only 50% of the patients comply with their drug therapy. Even if patients do comply and take their drugs, it has been found that 50% will still have distressing symptoms. Drug therapy can never been seen as a cure… as patients will always have to take their drugs 

Issues Use of drugs may be unethical as it may create a dependency on them and many people think that you can treat any problem with drugs… The use of drugs was cannot ‘cure’ patients and this may be a misleading.  However, taking the drugs allows sufferers to socialise with people ‘normally’ in every day life Allows for the patient to live within society, avoiding institutionalisation by a long-time stay in hospital.

Strengths Highly effective Demonstrated to prevent the reoccurrence of the mental disorder Most people are tolerant to the side effects Enables people to stay out of hospitals and prevents institutionalisation Enables patients to access other forms of therapy Are not effective in treating every patient Nasty side effects – muscle stiffness, slowing, shakiness, change in appetite, diabetes, cardiovascular Drugs do not CURE the disorder Patient is a passive recipient as is not involved in the treatment other than taking the tablets so might reduce the motivation of the patients to look for other causes (life stressors) and tackle these possible causes Evaluation of drug treatment Weaknesses

Summary of drug therapy as a Psychological treatment Living in society Drug treatment allows people to live in society, which avoids institutionalisation. This allows for other therapies to be accessed in order to benefit them further. Effectiveness of Clozapine PICKAR ET AL (1992)- Found that in comparison with other antipsychotics and found that Clozapine was most effective. Complying with therapy ROSA ET AL – Found that only 50% of patients comply with drug therapies. Not a cure Drug treatment can’t be viewed as a cure, due to the fact that patients have to be kept on maintenance doses of the drug to maintain the therapeutic effect.

Ethics and Social Control- Chemotherapy Ethics Physical harm  Patients are at risk of physical harm as they may experience side effects which are unpleasant, including things such as tardive dyskinesia. Consent  Despite the fact that patients have to consent to have drug therapy, there is question over whether they are in a fit state to consent However - this method of treatment can be seen as ethical because it allows for psychotic symptoms to be reduced in intensity and frequency and therefore allow for the individuals to continue with daily life without the need for long term hospitalization. However this could be seen as social control to reduce the level of abnormal behaviour in society. Drug treatment has been called the chemical straitjacket.

Drug therapy Evaluation using ‘CASTLES’ Conflicting evidence – Side effects are often found to outweigh the benefits. It is often difficult to get people to comply to the drug therapy responsibly. Not all patients take their medication (Rosa) Application – Allows people with mental disorders to live in society and avoid institutionalisation. Supporting evidence – Pickar, Kane, Emsley, Davis Testable – Research is used to test the effectiveness of various drug therapies, including placebo and longditudinal studies Limited – Patients mostly become dependant on the drugs and it is not a cure. Ethics – Client has right to leave and withdraw, consent is given for treatment, therapy itself is protecting the individual from harm, although could be open to psychological abuse and therapy should confidential. A competent therapist should always be used. Socially sensitive – yes, potential issues of social control.

After two decades, it is now clear that antipsychotic drugs do not cure schizophrenia. Relapse rates, in general, during withdrawal from psychiatric drugs, are about 10 times higher than would be expected if the drug had never been taken. Would you take antipsychotic drugs if told to do so by a doctor? What questions would you ask the doctor? No other single therapeutic procedure can compete with drug treatment in terms of rapid effectiveness, sustained action, general availability and ease of application.

Use the worksheet to summarise the advise that you would give your friend on their anti-psychotic medication. You must include health warning / side effects information that you would share with them Summary: