Treatments of Schizophrenia

Biochemical The biochemical treatment can be split into antipsychotic drugs and atypical antipsychotics, they both work to reduce the severity of psychotic symptoms in schizophrenia. They work by blocking the dopamine and serotonin receptors. They also affect different neurotransmitter transmitters. After a few weeks positive symptoms should have decreased. The double blind placebos that sometimes test these drugs consistently show that 50% of those taking the drug show significant improvement and around 40%-30% show partial improvement, however some patients are still treatment resistant. Relape rates are also quite high due to unpleasant side effects (drowniesses, weight gain, dry mouth, ect.) and sometimes the patient will stop taking it as they no longer showing positive symptoms ( don't feel the need for them). Atypical drugs are less likely to show symptoms such as spasms (reduced symptoms in general), and they have the same amount of effectivness. However they do increase the symptom of weight gain and obesity, which can lead too heart diseases and diabetes  Strengths- Atypical anti psychotics work on a wider range of neurotransmitter transmitters. A study by Julien (2005) showed that atypical drugs were effective for 50% of people that didn't respond to other drugs  Weaknesses- Atypical drugs are very expensive, more so than other anti-psychotics, it can also produce a potentially fatal blood disease in 2% of patients so it requires weekly blood monitoring. These drugs do reduce positive symptoms but they don very little for negative symptoms. The major side effects is body stiffness or spasms which can deter some people. Due to blocking out some receptors such as the serotonin receptor, it can lead to drug induced depression which can lead to suicides. Drugs also do not cure the problem they only stop symptoms and around 25% show no improvement.

ECT Is a biological treatment to alleviate symptoms of schizophrenia, It works by inducing seizures though 6 - 12 sessions. Patients are given muscle relaxants and sedatives before the shocks. ECT is mainly used to treat depression these days but in some causes like acute psychosis it can be effective. Strengths- It can be used on treatment resistant patients where non other drugs or treatment has worked. It can be useful for a wide rage of disorders and is considered fairly safe  Weaknesses- it can have the side effects of tempoary memory loss, lastings neurological damage  or in severe cases death. It's also very short term, and relapse rates are very high. There is weak evidence that ECT is effective in schizophrenia. its only really used as a very last option for when a patient hasn't responded to any other treatment, it also cant really be used as a solo treatment its best accompanied by another form of treatment. 

Token Economy- Paul & Lentz 1977 This is the behavioural approach to schizophrenia, it believes that symptoms of this disorder are learned response, this treatment gets patients to "unlearn" undesirable behaviours. The study by Paul & Lentz 1977 investigated how effective operant conditioning was to reinforce appropriate behaviours. He has 84 patients with chronic schizophrenia. The study split these patients into 3 groups and used individual measures design to compare the effectiveness of each treatment. The first treatment was called Milieu therapy which involves he use of therapeutic community , patients live collectively in a clinic and are encouraged to look after each other, this promotes social building skills.  Another group was a traditional existing hospital management of schizophrenia  The last group was a token economy group where desirable behaviours (such as self-care, engaging socially and attending therapy)  were reinforced by rewards (tokens) These token rewards could be traded for luxury items such as clothing, tv time, sweets or cigarettes The behaviour of the patient groups was monitored though time-sampled observation, questionnaires and individual interviews. There was an overall reduction of positive and negative symptoms. The system was most effective at removing catatonic behaviour and social withdrawal, however it made little effect on hallucinations and delusional thinking. 97% of the token economy group were able too live independently for between 1.5 and 5 years compared to the 71%in the milieu group and 45% in the hospital group. Strengths- The rewards were administered reliably because staff were getting intensively trained, staff were also monitored ad issued a Manuel to ensure procedures were standardised. After this study only 11% needed drug treatment compared to the 100% of the control group. Weaknesses- Does not work long term at all, 100% of patients relapsed and had to return to the ward. A lack of "reward" in real life for things like taking a shower slowly made participants return to their old habits as there was no longer a reward. The study lacks ecological validity as they were in a controlled environment. There are also obvious ethical issues with this as it ignores the hallucinations they are having and punishes them for showing symptoms. 

Cognitive Behavioural Therapy- Sensky et al 2000 CBT is a taking therapy designed to help people change by recognising thoughts that underlie their behaviour. therapists will get the patient to focus on the voice they hear and ask about the tone of the voice, if the voice is male or female, therapist them try to help the patient understand that the voices are part of their own though process. They are also encouraged to develop strategies against the voice by only paying attention to them at a certain time of the day. CBT aims to: challenge and modify delusory beliefs, look at evidence to challenge those beliefs and help the patient identify delusions a then test the evidence. An example of delusional thinking could be "they want to kill me" and the behaviour presented could be avoiding social situations, this could be helped by being showed the evidence that no one wants to hurt you and going out into social situations to practise this knew ideology. This could then led to reflection on other situations and hopefully engage is self questioning.  Strengths- Has been shown as a promising treatment for reducing distress and hospitalisation  that occurs in individuals with schizophrenia who do not respond well to antipsychotic drugs  Weaknesses- Requires an open minded and willing patient to have their ideas challenged 

This triad shows how our thoughts can affect how we act and feel, our behaviour shows that what we do affects how we think and feel and our emotion shows that what we feel affects how we think and do.

The study by Sensky tested the effectiveness of CBT for persistent symptoms in patients who were treatment (drug) resistant. Patients were used if they met the following criteria  Were aged 16-60 Had a diagnosis of schizophrenia with either the DSM or ICD Had symptoms that lasted least 6 months  Showed no improvement on medication (and showed no evidence of poor adherence)  Didn't abuse alcohol or drugs  There were 90 participants who were randomly assigned the CBT group or a befriending intervention (both delivered by experienced nurses). The patients were originally assessed then at a 9 month follow up ( a blind assessor to the study rated therapy sessions. Both of the interventions resulted in a significant reduction in positive and negative symptoms as well as depression scores improving. However at the 9 month follow up those who had CBT continued to improve but those in the befriending group didn't. So CBT is an effective way at reducing the positive and negative symptoms of schizophrenia patients who were previously treatment resistant. Strengths- Having a blind assessor to rate the therapy sessions, greatly reduces researcher bias  Weaknesses- This treatment doesn't work for everyone, its very expensive and time consuming. Some of the results come from lf report measures and could therefore be subjective (open to bias)