Download fct - WordPress.com

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




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)
Antipsychotics
•
There are approximately 20 different antipsychotic drugs.
Typical Antipsychotic
Chlorpromazine - £10 per year/per patient
Atypical Antipsychotic
Clozapine - £1500 per year/per patient
http://www.youtube.com/watch?v=Bjd0aF9jK-k
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
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.
d. May cause permanent
biochemical changes
reducing possible eventual
full recovery.
New
generation
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.
Antipsychotic Drugs
 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).
Conventional 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
A-typical 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.
Kane et al Research
• 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 Worksheet – Fluphenazine vs Placebo in patients with Schizophrenia
For each of the experimental groups complete the diagram to demonstrate of the effects of the drugs in the Schizophrenics Brains.
Fluphenazine Hydrochloride / Deaconate
1.
2.
3.
4.
Label Dopamine
Label D2 Receptor
Draw where Fluphenazine binds
Does the rate of Neural firing increase or
decrease in the presence of Fluphenazine?
Findings:
Placebo / No Drug Treatment
1. Label Dopamine
2. Label D2 Receptor
3. Would you expect to find more or less D2
receptors in the brains of schizophrenics?
4. Does the rate of Neural firing increase or
decrease in Schizophrenic patients?
Findings:
Evaluate the research:
“Problem Schizophrenics”
• 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).
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.
Evaluation of drug treatment
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
Weaknesses
•
•
•
•
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
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 ControlChemotherapy
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.
No other single therapeutic
procedure can compete with
drug treatment in terms of
rapid effectiveness, sustained
action, general availability and
ease of application.
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?
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: https://youtu.be/VsDQ0XQcWLc