Chapter 12 (Pp 422-426) Schizophrenia and Other Psychotic Disorders

Treatment Approaches

Biological Approaches The advent in the 1950’s of antipsychotic drugs (also referred to as tranquilizers or neuroleptics) revolutionized the treatment of schizophrenia

TRUTH or FICTION We now have drugs that not only treat schizophrenia but also can cure it in many cases.

How Antipsychotics (Neuroleptics) Work Antipsychotic drugs work by blocking receptor sites for dopamine, thus reducing the effects of dopamine in regions of the brain – antagonist for dopamine

How Antipsychotics (Neuroleptics) Work Research suggests that in order for antipsychotic drugs to be effective a blockade of 65% of D2 neurons are needed. Any drug that blocks more than 70% of D2 neurons cause an increased risk of side effects – Psychiatrists have to experiment with the dosage for each patient.

Antipsychotic Medications Two classes of antipsychotic medications: Typical (older) and Atypical (newer) medications The Typical antipsychotics work only on Type I (positive) symptoms of schizophrenia. Atypical antipsychotics work better with Type I symptoms, but also have some benefits for Type II (negative) symptoms

Typical vs. Atypical Antipsychotic Medications Typical antipsychotics work on both D1 and D2 producing neurons, thus have more side effects – some of which are permanent – dirty drug Atypical antipsychotic drugs work either exclusively on D2 neurons; some of the newer atypical drugs work also on blocking the reuptake of serotonin, thus give some relief to the negative symptoms of schizophrenia. Less side effects.

Table 15.7 Hockenbury: Psychology, Fourth Edition Copyright © 2005 by Worth Publishers

Side Effects of Antipsychotic Drugs Tardive dyskinesia (TD) - A disorder characterized by involuntary movements of the face, mouth, neck, trunk, or extremities and caused by long-term use of antipsychotic medication. Psuedoparkinson’s symptoms: hand tremors, shuffling of the feet, and face tremors.

Final Notes on Antipsychotic Drugs Antipsychotic medication helped control the more flagrant behavior patterns of schizophrenia and reduced the need for long-term hospitalization when taken on a maintenance or continuing basis after an acute episode. Yet for many patients with chronic schizophrenia, entering a hospital is like going through a revolving door: they are repeatedly admitted and discharged. Many are simply discharged to the streets once they are stabilized on medication and receive little if any follow-up care.

Sociocultural Factors in Treatment Ethnicity may also play a role in the family’s involvement in treatment. In a study of 26 Asian Americans and 26 non-Hispanic White Americans with schizophrenia, family members of the Asian American patients were more frequently involved in the treatment program. For example, family members were more likely to accompany the Asian American patients to their medication evaluation sessions.

Psychodynamic Therapy Freud did not believe that traditional psychoanalysis was well suited to the treatment of schizophrenia. The withdrawal into a fantasy world that typifies schizophrenia prevents the individual with schizophrenia from forming a meaningful relationship with the psychoanalyst. The techniques of classical psychoanalysis, Freud wrote, must “be replaced by others; and we do not know yet whether we shall succeed in finding a substitute”.

Learning-Based Therapies Therapy methods include the following: 1. Selective reinforcement of behavior, such as providing attention for appropriate behavior and extinguishing bizarre verbalizations through withdrawal of attention. 2. Token economy, in which individuals on inpatient units are rewarded for appropriate behavior with tokens, such as plastic chips, that can be exchanged for tangible reinforcers such as desirable goods or privileges. 3. Social skills training, in which clients are taught conversational skills and other appropriate social behaviors through coaching, modeling, behavior rehearsal, and feedback.

Psychosocial Rehabilitation People with schizophrenia typically have difficulties functioning in social and occupational roles and performing work that depends upon basic cognitive abilities involving attention and memory. These problems limit their ability to adjust to community life, even in the absence of overt psychotic behavior. Recently, promising results were reported for cognitive rehabilitation training to help schizophrenia patients strengthen such basic cognitive skills as attention and memory.

Family Intervention Programs Family conflicts and negative family interactions can heap stress on family members with schizophrenia, increasing the risk of recurrent episodes. Researchers and clinicians have worked with families of people with schizophrenia to help them cope with the burdens of care and assist them in developing more cooperative, less-confrontational ways of relating to others. In sum, no single treatment approach meets all the needs of people with schizophrenia.

OTHER FORMS OF PSYCHOSIS

Brief Psychotic Disorder A psychotic disorder lasting from a day to a month and is characterized by at least one of the following features: delusions, disorganized speech, disorganized behavior or catatonic behavior Often follows exposure to a major stressor.

Schizophreniform Disorder A psychotic disorder lasting less than 6 months in duration, with features that resemble schizophrenia.

Delusional Disorder A relatively uncommon psychotic disorder characterized by persistent, clearly delusional beliefs, often involving paranoid themes.

Schizoaffective Disorder A type of psychotic disorder in which individuals experience both severe mood disturbance and features associated with schizophrenia.

Diagnostic Criteria for Schizoaffective Disorder A. An uninterrupted period of illness during which, at some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode concurrent with symptoms that meet Criterion A for Schizophrenia.   B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.  C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.  D. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. 

A Beautiful Mind In the movie A Beautiful Mind, Russell Crowe portrayed Nobel Prize winner John Nash (shown here), a brilliant mathematician whose mind captured the beautiful intricacies of mathematical formulations but was also twisted by the delusions and hallucinations of schizophrenia.

The End