Biological treatment of Sz

History of Therapy for Sz
1. Biological treatments
  1. 1930's Pre - frontal lobotomy
  2. 1930's onwards - ECT
  3. 1950's - Typical anti - psychotics
    1. neuroleptics - antagonists
  4. 1990 - Atypical anti - psychotics
2. Psychological treatments
  1. Not considered to have insight
  2. Therapy done to them not actively involved
  3. Now more responsive due to drugs & employ their own coping strategies to deal w/ pos symptoms - therapists tap into this
  4. Now supportive, collaborative, active involvement
Psychosurgery
1. Brain damage to bring about behaviour change
2. Pre - frontal lobotomy (1930's)
  1. Sever the connections from pre - frontal lobes to rest of brain
3. Patients become calmer & reduced / absent symptoms of Sz
4. Effectiveness
  1. Whilst some studies may indicate effectiveness, it's like saying alcohol 'cures' anxiety & stress
5. Appropriate
  1. Frontal lobe abnormalities in Sz
  2. Surgery may help in severe cases to control symptoms of Sz
  3. Irreversible - can brain damage be justified
  4. Major side effects
Chemotherapy (drug treatment)
1. Typical antipsychotics
  1. Chlorpromazine
  2. Lower DA (block receptors) Antagonist
  3. Only pos
2. Atypical antipsychotics
  1. Clopazine
  2. Temp occupy DA receptors
  3. Also affect serotonin
    1. mood / attention / perception
  4. Pos & Neg
3. Effectiveness AO2
  1. Typical
    1. Relapse rates suggest they are effective
      1. Rzewuska 2002
    2. Chlorpromazine helps 80 - 85%
      1. Kane 1992
    3. Longer periods of usage needed (side effects)
    4. Little effect on neg symptoms
  2. Atypical
    1. Pos & neg symptoms
      1. deLima (2005)
    2. Effect not much greater than typical anti - psychotics
      1. For both pos & neg symptoms
  3. Allows treatment in the community for the maj
4. Appropriateness AO2
  1. Typical
    1. Symptoms similar to Parkinson's disease
    2. Tardive Dyskenia (30%)
    3. Motivational problems (compliance)
  2. Atypical
    1. Fewer side effects
    2. Clozapine
      1. Fatal immune damage - agranulocytosis
  3. Treat symptoms not the cause
  4. Relapse
  5. Dependency & tolerance
    1. Diff people respond to diff drugs in diff ways
Aetiology Fallacy
1. Just because drugs work, doesn't mean biology is root cause
2. They may work in conjunction w/ other treatments / factors
Ethical implications AO2 / 3
1. Chemical strait jacket
2. Inhumane?
3. Reduce control & responsibility
4. Informed consent
5. Depot injections
6. Motivational interviewing
  1. Miller & Rollnick 2002

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Biological treatment of Sz

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