Download Treatments for Schizophrenia File

TREATMENTS FOR
SCHIZOPHRENIA
UNIT 4
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! 