Transcript Schizophrenia Treatments Powerpoint 2013

Schizophrenia
Treatments
ECT
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Electro-convulsive therapy (ECT) was widely used for Schizophrenia in the 1950s.
A small current of 0.6 amps is passed through the brain, for about half a second.
This causes a seizure (similar to epilepsy) which lasts for about a minute.
ECT is usually given 3 times per week for up to 5 weeks.
Muscle relaxant drugs are used to prevent full convulsions, along with anaesthetic to calm
the patient.
For Schizophrenia, the standard ECT treatment is unilateral,
i.e. one electrode on the temple of the non-dominant brain hemisphere and one electrode in
the middle of the forehead.
One flew over the cuckoo's nest - YouTube
ECT
• ECT was used because it was observed that, in some
patients with epilepsy, psychotic symptoms and
seizures occur alternately i.e. when the patient has
seizures there are no psychotic symptoms, but
psychotic symptoms appear when seizures are
controlled.
• Also it was noted that when a Diabetic patients was
accidentally overdosed on insulin and had massive
fits as a result all psychotic symptoms disappeared.
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ECT
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Research evidence, criticism and evaluation
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ECT in England today Psychiatrists in England today do not consider it to be an effective
treatment for Schizophrenia, although it is effective for profoundly depressed people who do
not respond to drug treatment or are at high risk of suicide, However, there are schizophrenic
patients who are also drug resistant or experiencing or worried about drug side-effects. The
overuse of ECT to control very disturbed patients in the 50s and 60s is a major factor in its
lack of use today and also raises serious ethical issues, such as a lack of informed consent.
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ECT world-wide. Psychiatrists in other countries (e.g. India, Japan, Nigeria, Iran) may still use
ECT for some patients with Schizophrenia, sometimes without anaesthetic.
(Discussion
point: more repressive societies?)
ECT
• Research study Khalilian (2006)
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Khalilian argues that too little attention is paid to patients with negative
symptoms, since Neuroleptic drugs are more effective for controlling positive
symptoms such as hallucinations.
He proposes that ECT in combination with drug therapy might be effective for
patients with negative symptoms.
ECT might enhance permeability through the blood brain barrier (BBB) so that
clozapine can pass through and act on the brain tissue.
This avoids high oral doses of clozapine, which leads to side-effects on other
organs of the body.
ECT
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Method
Khalilian conducted in a small placebo-controlled trial of drug-resistant patients.
18 participants were assigned to 3 treatment groups: clozapine alone, ECT alone
and a combination clozapine and ECT.
He gained written informed consent from patients before treatment (Can
psychotic patients give consent? Diminished responsibility?). A reliable test, the
Positive and Negative Syndrome Scale, (PANSS) was to assess functioning before
and after treatment; a matched pairs design was based on functioning.
Anaesthetic was used; this also acted as a control so that the clozapine alone
group did not realise they had not had ECT.
Findings: Combination therapy was superior to either therapy on its own;
significant improvement was found in 71% combination treatment patients
compared to 40% having ECT alone and 46% clozapine alone. No adverse effects
were found.
However, Khalilian admits that the number of patients was small and the duration
of remission was not studied.
Can you work out the A02? Memory loss, ethics, just biological, not really sure
why it works.
Chemotherapy
• Medications/ Chemotherapy - Drug treatments
• Medication
– to improve your concentration
– to relieve symptoms such as insomnia,
nervousness, depression, fears, voices, feelings of
suspicion, and confused thinking
Chemotherapy
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The Biological Approach explains mental disorders in terms of abnormalities of the
central nervous system, i.e. that there is something wrong with the workings of
the brain. For example, Schizophrenia has been explained as being caused by an
excess of the neurotransmitter dopamine. This suggests that drugs which alter
levels of the various neurotransmitters, by blocking receptor sites, inhibiting
reuptake or improving the break down of molecules following release for example
may be effective in alleviating symptoms
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Chemotherapy
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The Biological Approach explains mental disorders in terms of abnormalities of the
central nervous system, i.e. that there is something wrong with the workings of
the brain. For example, Schizophrenia has been explained as being caused by an
excess of the neurotransmitter dopamine. This suggests that drugs which alter
levels of the various neurotransmitters, by blocking receptor sites, inhibiting
reuptake or improving the break down of molecules following release for example
may be effective in alleviating symptoms
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Key Terms
• Agonists: Drugs that increase Neurotransmitter
availability, e.g. stimulants.
• Antagonist: Drugs that reduce Neurotransmitter
availability, e.g. Blockers.
• Anti psychotics: Drugs that reduce Neurotransmitter
availability, e.g. Antagonists or Blockers.
• Neuroleptics: Another name for Antipsychotics.
Key Terms
• Typical Antipsychotic drugs: Conventional Antipsychotics (1950’s) that
reduce Dopamine only. Also they usually only reduce positive symptoms.
They are very likely to cause the side effect of Tardive Dyskinesia in 20-30
% of users.
• Atypical Antipsychotic drugs: Newer Antipsychotics (1990’s) that reduce
Dopamine and Serotonin. Also they reduce positive and negative
symptoms. They are much less likely to cause the side effect of Tardive
Dyskinesia. Although more likely to cause Agranulocytosis.
• Tardive Dyskinesia: is a difficult-to-treat form of Dyskinesia (disorder
resulting in involuntary, repetitive body movements) that can be Tardive
(having a slow or belated onset).It frequently appears after long-term or
high-dose use of Typical antipsychotic drugs. Tardive Dyskinesia is
characterized by repetitive, involuntary, purposeless movements, such as
grimacing, tongue protrusion, lip smacking, puckering and pursing of the
lips, and rapid eye blinking.
Key Terms
• Typical Antipsychotic drugs: Conventional Antipsychotics (1950’s) that
reduce Dopamine only. Also they usually only reduce positive symptoms.
They are very likely to cause the side effect of Tardive Dyskinesia in 20-30
% of users.
• Atypical Antipsychotic drugs: Newer Antipsychotics (1990’s) that reduce
Dopamine and Serotonin. Also they reduce positive and negative
symptoms. They are much less likely to cause the side effect of Tardive
Dyskinesia. Although more likely to cause Agranulocytosis.
• Tardive Dyskinesia: is a difficult-to-treat form of Dyskinesia (disorder
resulting in involuntary, repetitive body movements) that can be Tardive
(having a slow or belated onset).It frequently appears after long-term or
high-dose use of Typical antipsychotic drugs. Tardive Dyskinesia is
characterized by repetitive, involuntary, purposeless movements, such as
grimacing, tongue protrusion, lip smacking, puckering and pursing of the
lips, and rapid eye blinking.
Exam Tip
• Focus on ECT and describe Chemotherapy in less
detail.
• Base your work on P234-235 in the text book
3.Cognitive Therapy
• Over the latter part of the 20th Century, one of
the most impressive developments in our
understanding of psychopathology has been
our evolving insight into cognitive factors that
play important roles in causing and
maintaining psychopathology.
Key features of Cognitive Therapy
include:• Cognitive therapy is all about learning how our our
thoughts create our moods.
• In CT we discover that we all have inherent
tendencies to certain negative thoughts that evoke
unhappiness and disturbance - especially in response
to particular trigger situations.
• Once we accept that fact, we can learn to spot these
negative thoughts as they arise, and then challenge
and re-think them.
Who pioneered Cognitive Therapy?
Albert Ellis
• Developed one of the first
cognitive therapies to address
how people construe themselves,
their life and the world (circa
1962)
• He came up with RationalEmotive Therapy (RET) which
challenges irrational beliefs and
persuades patients to set more
attainable life goals.
Aaron Beck
• a medical doctor, psychiatrist and
psychoanalyst who came to
believe that he was not getting
enough improvement in his
patients through analysis. (circa
1967)
• He realised that often what was
holding back patients were
negative thoughts such as: 'I'll be
hopeless at that', or 'I'm
unlovable', or 'I'm stupid'.
Contemporary Cognitive Behaviour
Therapy (CBT)
• CBT came out from these earlier forms of Cognitive Therapies.
• CBT is an intervention for changing both thoughts and
behaviour, representing an umbrella term for many different
therapies that share the common aim of changing both
cognitions and behaviour.
• CBT is generally perceived to be an evidence-based, costeffective form of treatment that can be successfully applied to
a broad range of psychopathologies, including Schizophrenia
and Depression.
Characteristics of a CBT
Intervention
A CBT intervention usually possesses the following characteristics:1.
The client is encouraged to keep a diary noting the occurrence of significant
events, associated feelings, moods and thoughts in order to demonstrate how
these might be interlinked.
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With the help of the therapist, the client is urged to identify and challenge
irrational, dysfunctional, or biased thoughts/assumptions
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Clients are given homework in the form of ‘behavioural experiments’ to test
whether their thoughts and assumptions are accurate and rational.
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Clients are trained in new ways of thinking, behaving and reacting in situations
that may evoke their psychopathology.
Tip:- You may want to visit this link to know more about how CBT is applied to clients
with severe disorders and as well on those who suffer from negative thinking
and stress.
http://www.netdoctor.co.uk/diseases/depression/cognitivetherapy_000439.htm
Evaluation
• Using the handout from the Nursing Times
and the material on P235, evaluate the
appropriateness and effectiveness of CBT as a
treatment for Schizophrenia.
Summary Chart
Approaches to Psychology
Biological
Drug Therapy;
Chemotherapy
Psychodynamic
Psychoanalysis;
Humanistic
Therapy
Classical Conditioning
Client-Centred Therapy
Person Centred Therapy
Behavioural
Cognitive
Operant
Conditioning
RET
And
CBT
Group Therapy
Family Therapy