Therapies for SCZ

Descrição

Mapa Mental sobre Therapies for SCZ, criado por 09akodun em 24-03-2016.
09akodun
Mapa Mental por 09akodun, atualizado more than 1 year ago
09akodun
Criado por 09akodun quase 9 anos atrás
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Resumo de Recurso

Therapies for SCZ
  1. Biological therapies
    1. Genetics therapy
      1. Ethical issues with changing genetics
        1. Productions of anti-psychotics drugs to reduce dopamine levels such as chlorpromazine, clozapine. These block dopamine receptors, to reduce the amount of dopamine being passed to the next cell
          1. Conventional Anti-psychotics
            1. Chlorpromazine are used to combat positive symptoms of scz, which are products of an overactive dopamine system. these are dopamine antagonists as they block dopamine receptors (D2 especially) which reduces the amount of dopamine passed onto the next cell
              1. The effectiveness of the drugs
                1. Davis et al 1980 analysed 29 studies and found the relapse rates occurred in 55% of patients who were on the placebo, and 19% of those on the drugs. Thus showing how the conventional antipsychotics actually reduce the effects of scz.
                2. Issues
                  1. It only works on the positive symptoms and neglects all negative symptoms. which are those behaviours which lack function ability. It being an issue as these are severe affect on human behaviour.
                    1. Drugs can cause tardive dyskinesia (uncontrollable movements of lips, tongue, face, hand and feet). 30% of people on antipsychotic meds develop this and it isn't reversible, creating an issue for the whole of a persons life. this will affect a persons quality of life which creates the mind set of not taking the drugs in the first place.
                      1. Evidence against Davis' study: Ross and Read claimed that Davis' study was unfair as the relapse rates in the placebo condition could be due to the withdrawal of the real medication. All of the patients were originally on medication and the body may have become biologically adapted to the drug such as increased amount of D2 receptors which occur when the patient is deprived of the drug. Therefore it is argued that the increase in D2 receptors is the real cause of the relapse and not the lack of the drug.
                    2. Conventional antipsychotics have many die effects wand some flaws and since their creation, Atypical antipsychotics (clozapine) were created. These have less side effects as the act on the dopamine system receptors in the brain too. they also work on the positive and some negative symptoms (by acting on serotonin) . this makes it a much better alternative than conventional as they appear and disappear allowing a frequent flow of dopamine. however the is one severe side effect and it also lowers the immune system
                      1. Leucht conducted a meta analysis comparing the effectiveness of conventional and atypical antipsychotics. The researchers found that 2 of the newer atypical were slightly more effective while the 2 other atypical were deemed to be no different in terms of effectiveness. Therefore some atypical may be more effective however there is only a small degree of improvement in effectiveness.
                        1. Atypical can treat negative and positive symptoms: Leucht also looked at the typical effectiveness at treating the negative symptoms. Here they found 2 were slightly more effective than conventional antipsychotics, 1 was just as effective and 1 was slightly less effective.
              2. ECT
                1. Used under false assumptions that inducing epileptic fits would remove the disorder because epilepsy= scz couldn't exist together more effective than placebo- less effective than drugs
                  1. Electrodes placed on scalp with one on non dominant side and other on forehead. Nerve blocking agent to paralyse muscles to prevent contraction. an Electric current is passed and seizures last up to a minute. This is only used as a LAST RESORT. It done 2-3 times a week with 12 treatments.
                  2. Good short term but drugs are more effective
                    1. Useful ion those who aren't responding to antipsychotic drugs + show rapid results which combined.
                      1. ECT could be more effective with treating certain types of scz but the damages are not fully known
                        1. Ethical issues raised due to damage= memory loss
                          1. Reductionist not aware of complications
                        2. Psychological Therapies
                          1. CBT (Cognitive Behavioural Therapy)
                            1. Works by changing the schizophrenics faulty thinking, which influences their maladaptive behaviour. It identifies and corrects delusions.
                              1. Example: Val who said she did have her psychotherapist who would help change her faulty thinking. They also worked on coping startegies, which can be helpful but some don't work. Val did say that the therapy was helpful and helped her out of therapy
                              2. Supporting research shows how useful CBT was. Gould et al 2201 found all 7 studies in their meta-analysis reported a statistically significant decrease in the positive symptoms of scz after treatment and with medication (antipsychotics)
                                1. However, CBT doesn't work for everyone as shown in a study of 142 scz PPs, finding that many patients were not deemed suitable for CBT as some may not fully engage with therapy as it's very long and you have to always go back. Nonetheless it's more human than drugs by leaving less side effects, but it could work as the sczs may have someone to talking to instead of the therapy itself
                              3. Family intervention
                                1. Works by reducing the Levels of EE + stress by:
                                  1. Forming alliances with relatives who care
                                    1. Reducing emotional climates in families
                                      1. Reducing anger and guilt by family members
                                      2. Supporting evidence= 32 studies in a meta analysis= significant evidence of effectiveness of family intervention (NICE, 2009)= effectiveness
                                        1. Appropriateness- cultural limitation= NICE 2009- Most evidence from outside the UK and data may not be applicable in the UK

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