Treatments for Schizophrenia

Biological
1. Pre-frontal Labotomy: this is a specific part of the brain which is removed during surgery. In this case, it is the removal of the white fibres that connect the Thalamus to the pre-frontal and frontal lobes. This treatment is now rare and mainly for violent behaviour from schizophrenics.
2. Anti-psychotic Drugs
  1. First Generation (typical): these arrest dopamine production by inhibiting receptors. This reduces positive symptoms.
  2. Second Generation (atypical): reduces serotonin as well as dopamine. Therefore, they reduce positive and negative symptoms.
  3. Unfortunately, there can be some disturbing side effects. The repeated taking of the drugs can lead to another disorder called 'Tardivedyskinesia' were the patient has no control over behaviour. It is said this is due to the fact that parts of the brain are cut off, causing the brain to be dysfunctional.
  4. Liberman et al 2005: found 74% of patients taking the anti-psychotics stopped within 18 months because side effects were so bad.
  5. Davis et al 1989: found that schizophrenics improved within 6 weeks of taking anti-psychotic drugs, suggesting that they are very effective. But it is only effective if patent consistently takes them.
3. Electro- convulsive therapy (ECT): the patient is given a nerve blocking agent to prevent full body convulsions. It is a 1-3 second, low voltage shock to the frontal lobes.
  1. Tharyan and Adams 2005: constructed a meta analysis of 26 ECT studies. 50% of patients improved within the first 6 months but it is not effective in the long term.
  2. Fish 1997: found that 20-30 sessions were needed before any improvements. Only 15 sessions are needed for other disorders. Was 60-80% effective and would only help cirtain patients due to individual differences.
  3. only a last resort because it can cause memory loss and 1% suffer from severe memory loss
Cognitive: Cognitive Behavioural Therapy (CBT)
1. Procedure: lasts between 12 and 20 sessions and is based on changing the patients thinking.
2. Assessment: the therapist listens while the patient expresses their thoughts and experiences. Pictures and diagrams are often used to make sense of chaotic thoughts.
3. The ABC model: understanding how an activating event can lead to a belief and then a consequence.
4. Critical Collaborative analysis: after trust has been built up, a new form of questioning called 'socratic questioning' is used. It is to help the patient to realise the illogical thoughts they are having.
5. Gould et al 2001: found that there was a large reduction in positive symptoms reduced by 12% but lower than those who were on anti-psychotic drugs.
  1. CBT is a long process compared to anti-psychotics, so schizophrenic would need to be patient as they slowly improve
    1. Sensky found patients continued to improve after therapy course had finished
6. Beck and Rector: CBT alongside anti-psychotics were more beneficial than receiving routine care. However, he only studied patients in the sort term so improvements may not continue in the long term.
  1. University of Hertfordshire analysed over 50 studies of CBT from around the world. They found that CBT only had a 'small therapeutic effect' on symptoms. They also found that this small effect disappeared when only studies using 'blind testing' were taken into account.
7. Turkington et al 1998: found that CBT was effective in treating positive and negative symptoms
  1. Jones et al 2000: carried out a meta analysis, finding CBT reduced the frequency and intensity of hallucinations, but less effective in reducing delusions.
    1. Drury et al 2000: found that benefits of CBT were not maintained in the long term, as they discovered when they followed up patients 5 years later.
      1. More ethical than treatment with drugs
        Allows patient to have more control over how they want to reduce their symptoms of schizophrenia
Family Intervention
1. Education is provided to patients and families about the biological nature of the illness. A psycho-educational workshop is provided at the beginning of the program giving them support also.
  1. Optimal treatment project: is education of the disorder as well as learning how to cope with it. It trains patients social skills and teaches them how to behave in a normal environment.
2. Jackson: found that relapse rate fell from 60% to 25% for those who had family intervention
  1. Pharoah: constructed a meta analysis and concluded that family intervention reduces relapse rate and hospital re-admissions
  2. Treatment is ethical in reinforces the importance of family

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Treatments for Schizophrenia

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