Main Ways of Treatment of Schizophrenia

Antipsychotic Drugs (AP drugs) are used to treat the most disturbing psychotic disorders e.g. schizophrenia (Sz) and bipolar disorder, and these drugs are designed to help the person function as well as possible. There are two types that are used: conventional AP drugs are used to treat the positive symptoms of Sz and atypical AP drugs treat the positive symptoms, but also claim to benefit the effects of negative treatments.

Conventional AP drugs reduce effects of dopamine because they are antagonists that bind to D2 receptors, blocking their action, which eliminates hallucinations and delusions. In contrast, atypical AP drugs work on dopamine and are thought to block serotonin receptors. They temporarily block D2 receptors but rapidly dissociate to allow normal transition, making them different to conventional AP drugs.

Appropriate: 30% taking this medication develop tardive dyskinesia, and is irreversible in 75%. Ross & Read argue it prevents them thinking about stressors that trigger the condition, so it reduces their motivation to reduce the stressors to then reduce their suffering.

Effective: Davis et al found significant differences in relapse rates compared to placebos. Relapse was 55% in the placebo group, and 19% in the treatment group. Vaugh & Leff found it only made a difference for those in hostile and critical home situations. Relapse was 53%, but 92% for placebos. In supportive homes relapse was 12%, 15% for placebo.

Appropriate: Lower rates of TD according to Jeste et al. Rates were 30% after 9mths for conventional, but just 5% for atypical. They may be more appropriate due to fewer side effects, so patients are more likely to carry on with medication and see the benefits.

Effective: Superiority compared to conventional was only moderate (Leucht et al). Two of the new drugs tested were ‘slightly’ more effective, and the others were the same. In terms of negative symptoms, two were ‘slightly’ more effective, one was ‘as effective’, and the other was ‘slightly worse’ than conventional antipsychotics.

Psychoanalysis is about the unconscious conflicts. Therapists can create an alliance with the patient to offer them real help; transference is where emotions are associated with one person and shifted onto the therapist. This can only be done if the patient and the therapist develop a good relationship, by replacing harsh consciences with less destructive ones. As the patient gets healthier, they take a more active role in their recovery.

Supporting research: Malmberg and Fenton argue it is impossible to draw definite conclusions of effectiveness. The Sz patient outcome research team argues that some forms of therapy are harmful for patients with Sz. However, Gottdiener’s meta-analysis of 37 studies concluded that psychodynamic therapy was an effective treatment for Sz.

Contradictory findings: May found that paired with antipsychotics, patients had significantly better outcomes than therapy alone. However, antipsychotics alone were also superior to therapy. However, Karon and VandenBos found the opposite, with therapy patients improving more than with medication alone.

Combination therapy: the treatment guidelines of the APA recommend that ‘supportive interventions’ ( e.g. psychodynamic therapy) are appropriate when combined with antipsychotic medications, despite its unconvincing evidence for effectiveness.

Costs and benefits: an argument against is that its expense prevents it being used wide scale. Some argue that because it doesn’t appear more effective than medication, it’s not worth the expense. However, evidence suggests the overall cost decreases with therapy use because patients are less likely to need hospital treatment and more are likely to gain employment (Karon and VandenBos)

10 September 2019
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