Schizophrenia Treatments

ECT Electro-convulsive therapy (ECT) was widely used for Schizophrenia in the 1950s. A small current of 0.6 amps is passed through the brain, for about half a second. This causes a seizure (similar to epilepsy) which lasts for about a minute. ECT is usually given 3 times per week for up to 5 weeks. Muscle relaxant drugs are used to prevent full convulsions, along with anaesthetic to calm the patient. For Schizophrenia, the standard ECT treatment is unilateral, i.e. one electrode on the temple of the non-dominant brain hemisphere and one electrode in the middle of the forehead. One flew over the cuckoo's nest - YouTube

ECT ECT was used because it was observed that, in some patients with epilepsy, psychotic symptoms and seizures occur alternately i.e. when the patient has seizures there are no psychotic symptoms, but psychotic symptoms appear when seizures are controlled. Also it was noted that when a Diabetic patients was accidentally overdosed on insulin and had massive fits as a result all psychotic symptoms disappeared.  

ECT Research evidence, criticism and evaluation ECT in England today Psychiatrists in England today do not consider it to be an effective treatment for Schizophrenia, although it is effective for profoundly depressed people who do not respond to drug treatment or are at high risk of suicide, However, there are schizophrenic patients who are also drug resistant or experiencing or worried about drug side-effects. The overuse of ECT to control very disturbed patients in the 50s and 60s is a major factor in its lack of use today and also raises serious ethical issues, such as a lack of informed consent.   ECT world-wide. Psychiatrists in other countries (e.g. India, Japan, Nigeria, Iran) may still use ECT for some patients with Schizophrenia, sometimes without anaesthetic. (Discussion point: more repressive societies?)

ECT Research study Khalilian (2006) Khalilian argues that too little attention is paid to patients with negative symptoms, since Neuroleptic drugs are more effective for controlling positive symptoms such as hallucinations. He proposes that ECT in combination with drug therapy might be effective for patients with negative symptoms. ECT might enhance permeability through the blood brain barrier (BBB) so that clozapine can pass through and act on the brain tissue. This avoids high oral doses of clozapine, which leads to side-effects on other organs of the body.

ECT Method Khalilian conducted in a small placebo-controlled trial of drug-resistant patients. 18 participants were assigned to 3 treatment groups: clozapine alone, ECT alone and a combination clozapine and ECT. He gained written informed consent from patients before treatment (Can psychotic patients give consent? Diminished responsibility?). A reliable test, the Positive and Negative Syndrome Scale, (PANSS) was to assess functioning before and after treatment; a matched pairs design was based on functioning. Anaesthetic was used; this also acted as a control so that the clozapine alone group did not realise they had not had ECT. Findings: Combination therapy was superior to either therapy on its own; significant improvement was found in 71% combination treatment patients compared to 40% having ECT alone and 46% clozapine alone. No adverse effects were found. However, Khalilian admits that the number of patients was small and the duration of remission was not studied. Can you work out the A02? Memory loss, ethics, just biological, not really sure why it works.

Chemotherapy Medications/ Chemotherapy - Drug treatments Medication to improve your concentration to relieve symptoms such as insomnia, nervousness, depression, fears, voices, feelings of suspicion, and confused thinking

Chemotherapy The Biological Approach explains mental disorders in terms of abnormalities of the central nervous system, i.e. that there is something wrong with the workings of the brain. For example, Schizophrenia has been explained as being caused by an excess of the neurotransmitter dopamine. This suggests that drugs which alter levels of the various neurotransmitters, by blocking receptor sites, inhibiting reuptake or improving the break down of molecules following release for example may be effective in alleviating symptoms.

Chemotherapy The Biological Approach explains mental disorders in terms of abnormalities of the central nervous system, i.e. that there is something wrong with the workings of the brain. For example, Schizophrenia has been explained as being caused by an excess of the neurotransmitter dopamine. This suggests that drugs which alter levels of the various neurotransmitters, by blocking receptor sites, inhibiting reuptake or improving the break down of molecules following release for example may be effective in alleviating symptoms.

Key Terms Agonists: Drugs that increase Neurotransmitter availability, e.g. stimulants. Antagonist: Drugs that reduce Neurotransmitter availability, e.g. Blockers. Anti psychotics: Drugs that reduce Neurotransmitter availability, e.g. Antagonists or Blockers. Neuroleptics: Another name for Antipsychotics.

Key Terms Typical Antipsychotic drugs: Conventional Antipsychotics (1950’s) that reduce Dopamine only. Also they usually only reduce positive symptoms. They are very likely to cause the side effect of Tardive Dyskinesia in 20-30 % of users. Atypical Antipsychotic drugs: Newer Antipsychotics (1990’s) that reduce Dopamine and Serotonin. Also they reduce positive and negative symptoms. They are much less likely to cause the side effect of Tardive Dyskinesia. Although more likely to cause Agranulocytosis. Tardive Dyskinesia: is a difficult-to-treat form of Dyskinesia (disorder resulting in involuntary, repetitive body movements) that can be Tardive (having a slow or belated onset).It frequently appears after long-term or high-dose use of Typical antipsychotic drugs. Tardive Dyskinesia is characterized by repetitive, involuntary, purposeless movements, such as grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking.

Key Terms Typical Antipsychotic drugs: Conventional Antipsychotics (1950’s) that reduce Dopamine only. Also they usually only reduce positive symptoms. They are very likely to cause the side effect of Tardive Dyskinesia in 20-30 % of users. Atypical Antipsychotic drugs: Newer Antipsychotics (1990’s) that reduce Dopamine and Serotonin. Also they reduce positive and negative symptoms. They are much less likely to cause the side effect of Tardive Dyskinesia. Although more likely to cause Agranulocytosis. Tardive Dyskinesia: is a difficult-to-treat form of Dyskinesia (disorder resulting in involuntary, repetitive body movements) that can be Tardive (having a slow or belated onset).It frequently appears after long-term or high-dose use of Typical antipsychotic drugs. Tardive Dyskinesia is characterized by repetitive, involuntary, purposeless movements, such as grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking.

Exam Tip Focus on ECT and describe Chemotherapy in less detail. Base your work on P234-235 in the text book

3.Cognitive Therapy Over the latter part of the 20th Century, one of the most impressive developments in our understanding of psychopathology has been our evolving insight into cognitive factors that play important roles in causing and maintaining psychopathology.

Key features of Cognitive Therapy include:- Cognitive therapy is all about learning how our our thoughts create our moods. In CT we discover that we all have inherent tendencies to certain negative thoughts that evoke unhappiness and disturbance - especially in response to particular trigger situations. Once we accept that fact, we can learn to spot these negative thoughts as they arise, and then challenge and re-think them.

Who pioneered Cognitive Therapy? Albert Ellis Developed one of the first cognitive therapies to address how people construe themselves, their life and the world (circa 1962) He came up with Rational-Emotive Therapy (RET) which challenges irrational beliefs and persuades patients to set more attainable life goals. Aaron Beck a medical doctor, psychiatrist and psychoanalyst who came to believe that he was not getting enough improvement in his patients through analysis. (circa 1967) He realised that often what was holding back patients were negative thoughts such as: 'I'll be hopeless at that', or 'I'm unlovable', or 'I'm stupid'.

Contemporary Cognitive Behaviour Therapy (CBT) CBT came out from these earlier forms of Cognitive Therapies. CBT is an intervention for changing both thoughts and behaviour, representing an umbrella term for many different therapies that share the common aim of changing both cognitions and behaviour. CBT is generally perceived to be an evidence-based, cost-effective form of treatment that can be successfully applied to a broad range of psychopathologies, including Schizophrenia and Depression.

Characteristics of a CBT Intervention A CBT intervention usually possesses the following characteristics:- The client is encouraged to keep a diary noting the occurrence of significant events, associated feelings, moods and thoughts in order to demonstrate how these might be interlinked. With the help of the therapist, the client is urged to identify and challenge irrational, dysfunctional, or biased thoughts/assumptions Clients are given homework in the form of ‘behavioural experiments’ to test whether their thoughts and assumptions are accurate and rational. Clients are trained in new ways of thinking, behaving and reacting in situations that may evoke their psychopathology. Tip:- You may want to visit this link to know more about how CBT is applied to clients with severe disorders and as well on those who suffer from negative thinking and stress. http://www.netdoctor.co.uk/diseases/depression/cognitivetherapy_000439.htm

Evaluation Using the material on P235, evaluate the appropriateness and effectiveness of CBT as a treatment for Schizophrenia.

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