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Transcript
Discuss the effectiveness and appropriateness of at least two biological therapies for
schizophrenia
DRUG THERAPY
General intro
Two types of
drugs
Mechanism of
drugs
The vast majority of people who suffer from schizophrenia will receive some sort of
..........therapy to try and alleviate their symptoms. Drugs that are effective in treating the
most disturbing forms of psychotic illnesses, such as schizophrenia are
called............................. which help patients to function as well as possible. In the 1950s drugs
were given to hospital patients to calm their anxiety prior to surgery and were also found to
relieve the...................... symptoms of schizophrenia and subsequently used in the treatment
of schizophrenia.
C............................... antipsychotics are more commonly administered and
.................................. antipsychotics were later developed which are believed to be more
effective but more expensive. Chlorpromazine is a common conventional antipsychotic which
combats the positive symptoms of schizophrenia (e.g......................... and thought
d......................) The drug acts as a.................. antagonist so reduces levels of the
neurotransmitter and therefore reduces the positive symptoms. The dopamine antagonist
binds to but does not stimulate the dopamine D2 receptors, blocking their action. Atypical
antipsychotics work in the same way as conventional antipsychotics but they also act on
serotonin levels and other systems in the brain that might be involved in schizophrenia. They
temporarily occupy D2 r...................... and then dissociate so there are less ........... effects
(such as tardive diskinaesia). Recent research suggests that atypical antipsychotics are the
most effective over the broadest range of positive symptoms with the lowest risk of relapse
and side effects.
The effectiveness of the drug clearly supports the ........................... hypothesis and hence
............... basis of schizophrenia. However, as noted, the drugs are only effective for positive
symptoms and therefore, an alternative explanation and subsequent treatment may be more
appropriate for the ........................... symptoms.
David et al, 2003 found that atypical drugs were more effective than conventional drugs
contrasting Geddes research who found no clear winner. Possibly, atypical drugs are more
effective because patients continue to complete their course due to the lesser side effects.
Research carried out by the World Health organisation found that the placebo effect may play
Effectiveness
a role in drug therapy. The WHO found that the relapse rate after one year was .......% for
placebos, ......% for chlorpromazine and 2 – 23% for chlorpromazine with family intervention.
The results indicate that the drugs are ..................... in the treatment of the disorder
particularly when combined with ..........therapy supporting the view of C..............., 2002 who
suggested that a combination of therapies is the most effective. The drugs are only effective
when administered but the severe side effects which occur in approximately 25% of patients
can lead to discontinuation of treatment and subsequent relapse. They are effective
however, for most sufferers with milder symptoms and can actually have beneficial side
Appropriateness
effects for some people. Drugs are also d.................................. and suggest that the patient
has no control over their recovery and this lack of control can lead to s...................
The findings may be subjected to publication bias and also do not work with everybody
therefore psychological treatments or a combination may be more appropriate. They only
focus on the ...............................and do not deal with the ................... of the schizophrenia
itself. Although this is important to enable the patient to access further more long term
psychological treatments, it also means that patients become dependent on the drugs and
requires higher dosages over time. As a treatment, drugs are very easy to administer with
little effort on the part of the patient, or in fact, the therapist when compared to alternative
................................ treatments. Due to the dependency and focus on symptom removal only,
they are unlikely to be appropriate on a long term basis if used on their own.
PSYCHOSURGERY
General intro
Psychosurgery involves damaging the .................................in order to bring about behavioural
changes. The first use of psychosurgery to treat schizophrenia came in the 1930s with
attempts to sever the connection between the frontal lobes and the rest of the brain. The
patients were calmer and displayed none of the symptoms but were also sluggish with no real
quality of life. By the 1970s, the use of frontal lobe lobotomies for schizophrenia was
essentially replaced by ................................ therapies.
Appropriateness MRI scans have shown that abnormal functioning occurs in the frontal lobes of schizophrenic
patients and therefore some psychosurgery may help alleviate the symptoms. There is strong
debate as to whether such drastic action should be taken and so it is only performed as a last
........................... The main issue is the fact that it is ................................... and so the side
effects are permanent. Side effects include severe ........................ loss, ..........................
change and social inhibition. If the side effects become more of a problem than the original
condition then the surgery clearly offers no benefits at all.
Research
Tooth and Newton, 1961 reported that between 1942 and 1954, 41% of patients recovered,
28% minimally improved, 25% showed no change, 4% died and 2% became worse. The
definition of ‘recovered’ presents an issue in these findings as it is translated as ‘cured’. The
question lies as to whether psychosurgery is ‘curing’ schizophrenia or simply affecting the
symptoms on a permanent basis. We could also question the reliability and validity of the
findings particularly since much research was carried out a long time ago and is possibly not
relevant now and only a small sample of psychosurgeries take place today. .................... of
conducting such a drastic step as intentionally damaging the brain is also an issue.
Overall, the drug therapy offers a more accessible and less extreme treatment to
schizophrenia which is more appropriate and effective when used in combination with
psychological treatments that address the long term cause of the condition.