Schizophrenia: Biological Treatments

Antipsychotic Medication

Conventional/Atypical Antipsychotics

Conventional/Atypical

Schizophrenia Biological Treatments: ECT

First introduced as a treatment for Sz on the false assumption that inducing an epileptic fit would remove the symptoms of Sz, as the two conditions cannot exist together. ECT involves the application of an electric voltage across the brain. It works best when applied bilaterally and is given in conjunction with anaesthetic and a muscle relaxant. However, its effectiveness is minimal and only shortterm (20-50% relapse after 6 months).

Schizophrenia Biological Treatments: ECT

Schizophrenia Biological Treatments: ECT

Though ECT is no more dangerous than minor surgery performed under anaesthetic, it is thought to be unethical: 1. It can seem brutal and perceived by patients as a punishment for the condition 2. We must consider whether patients in their mentally disordered state are truly able to give informed consent for the treatment.

Q. If no truly informed consent can be gained why do you think the treatments still go ahead?

Schizophrenia Biological Treatments: ECT

Recently ECT has been reintroduced as a treatment for Sz; though it is more effective than placebos - it is still not as effective as drug treatments and so is often only used as last resort if patients do not respond positively to antipsychotics (Tharyan & Adams, 2005). Q. what does this say about its appropriateness? ECT no longer commonly used due to the direct effect of antipsychotics which have revolutionised treatment of Sz.

Conventional (1st generation)Anti-psychotics: Chlorpromazine

Dopamine Antagonists that bind to dopamine (D2) receptors without stimulating them in order to block their action = reduce + symptoms (also marked cognitive & behavioural improvement found). Targets + symptoms of Sz e.g Hallucinations and thought disturbances = the result of overactive dopamine

Evidence for Effectiveness (I)

Comparison of those on antipsychotic medication v placebo. Davis et al (1989): Meta-analysis (AO3) 100 studies = > than 70% of sufferers treated with antipsychotics improved after 6 weeks v 25% on placebo. Suggesting that antipsychotics do have a beneficial medical effect. Motivated sample (I)? Ethics of placebos (I). IF it is a Biological condition they would need the drug they are being denied.

However.
Antipsychotics did make a difference in those from negative or hostile environments Davis et al (1989) Meta-analysis (AO3).

Though Ross & Read argues this is not fair comparison as in placebo conditions pp is in drug withdrawal state if antipsychotics stopped, dopamine system = flooded = negative side effects/symptoms e.g. Tardive Dyskinesia. They also point out that 25% DID benefit from placebo!!

Appropriateness (I)
Conventional antipsychotics have many worrying side effects = Tardive Dyskinesia. Approx 30% develop TD and it is irreversible in 75% of cases. Approx 24% develop this after taking neuroleptics for 7 years. Can lead to non-adherence more likely to relapse and > likely to return to hospital. To combat patients sometimes given long lasting injections which takes away their option to discontinue medication (I = ethics)

Appropriateness (I)
Ross & Read = Giving patients medication gives them a cause to stop looking for real treatment & prevents them addressing possible stressors that might in fact be the cause of Sz; Ethics (I).

Atypical (2nd generation) Anti-Psychotics: Clozapine

Act by blocking the transmission of Serotonin into the brain and temporarily occupying D2 receptors = targets symptoms e.g. < emotional expression.
They then rapidly dissolve to allow normal transmission.

Atypical (2nd generation) Anti-Psychotics: Clozapine

These characteristics of atypical antipsychotics are thought to be the reason for lower levels of side effects compared to conventional antipsychotics; however, it is not clear as to how they affect the brain to alleviate the symptoms.

Effectiveness (I)
Kahn et al (2008): Compared 1st/2nd generation antipsychotics = in general antipsychotics are effective for at least 1 year BUT 2nd generation (atypical) drugs are not necessarily any > effective than 1st generation drugs.

Lieberman et al (2005): Examined the effectiveness of 1st/2nd generation antipsychotics in treating 1,432 chronic Szs = 74% patients discontinued treatment within 18 months due to intolerable side effects. 1st generation = muscular disorders/2nd generation = weight gain and metabolic effects (I).

Effectiveness (I)
Meta-analysis (Leucht) found that superiority over conventional antipsychotics = only moderate effect. Out of the new drugs tested only 2 were slightly more effective; the other 2 were no more effective.

Appropriateness (I)
Despite this Jeste: Tardive Dyskinesia in 30% after 9 months with conventional v 5% with atypical antipsychotics highlighting usefulness (I) of atypical antipsychotics. With fewer side effects pps likely to persevere with medication and thus see more benefits. However, approx 30% of patients either do not respond to treatment or are intolerant to them.

Appropriateness (I)
However, approx 30% of patients either do not respond to treatment or are intolerant to them. Though Clozapine can sometimes be effective With such treatment resistant patients, only about half respond favourably = the majority of Patients with chronic Sz cannot be helped with antipsychotics.

Appropriateness
Although there is evidence to suggest atypical antipsychotics are somewhat effective in treating Sz = ethical issues (I) regarding use are raised by critics AS if psychological factors are taken into account a cost-benefit analysis of advantages would be negative (Lieberman et al, 2005).

Appropriateness
Regulation & monitoring of antipsychotic drugs is vital. It has been found that doses of antipsychotics are sometimes too high (see below) Because they have not been reduced to a maintenance level after the acute stage is over.

This exposes patients to unnecessary risks of side effects. However, it is sometimes difficult for clinicians to gauge the appropriate dosage. Some patients do not require medication maintenance medication after the acute stage, while others quickly relapse without it.

Overall Evaluation
Atypical antipsychotics are generally more effective, are relatively cheaper to produce, are easy to administer & have a positive effect on many sufferers.

However, there is a considerably high relapse rate through not sticking to medication regimes (or just not effective for some people).
Antipsychotics can have serious side effects = Tardive Dyskinesia.

Conclusion
Biological therapies used to treat Sz suggest a biological approach in terms of explanation which highlights the role of physical factors and neurotransmission as the cause.
However, the treatment aetiology fallacy states that the fact that drugs alleviate the symptoms does not mean they are treating the cause. Thus, suggesting only one cause is Deterministic & raises the question of Freewill in terms of control of the disease = psychologically damaging. Maybe a more combined approach would help e.g. social approach too?

Exam Question
Discuss two or more biological treatments for Schizophrenia (8 + 16 marks)

How to revise this topic!

Dont forget to remember to mention HOW each method works on the brain in order to target Sz symptoms. Also, it is important to focus on the effectiveness (quantitative evidence is impressive here) and the appropriateness of each method. Remember, tell a story make it interesting for the reader to want to continue. If it is not interesting, it will make less sense to them.