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To effectively treat schizophrenia, considerable research has gone into studying the mental health disorder, and different theories as to how to treat it have been put forward as a result.
The result varies from biological to psychological treatments for schizophrenia. Biological treatments for schizophrenia tend to focus on the use of drugs (mainly antipsychotics), while psychological ones focus on therapy sessions with one-on-one interactions with the patient, talking through their symptoms and addressing them with a focus on behavioural and thought processes changes.
These therapies and treatment plans focus on drugs/medications to treat schizophrenia.
Antipsychotics are a form of drug treatment used to treat the positive and negative symptoms of schizophrenia. The two forms of antipsychotics are typical and atypical.
Typical antipsychotics are the first generation of antipsychotic drug therapy. Developed in the 1950s, they are known for treating positive symptoms. Since the advent of atypical antipsychotics (mentioned below), they have lost favour, as they have side effects some patients consider too severe to continue treatment consistently. Whether or not they are an outdated treatment or the more modern atypical antipsychotic drugs are better is still up for debate.
Typical antipsychotic drugs include:
Chlorpromazine
Haloperidol
They work by affecting the dopamine receptors (D2) in the mesolimbic pathway in the brain primarily (this is the reward centre) but also affect the rest of the brain unintentionally. They’re also known as dopamine antagonists, as they block these receptors and calm the dopamine system in the brain. Positive symptoms result from the increased subcortical dopamine release in the brain, possibly due to a defect in the cortical pathway through the nucleus accumbens (Brisch et al., 2014).
The main dopaminergic pathways of the human brain, GNU Free Documentation Licence, Wikimedia Commons
Side effects include:
Tardive Dyskinesia (uncontrollable muscle movements usually affecting the face).
Akathisia (uncomfortable restlessness).
Dry mouth.
Constipation.
Some consider atypical antipsychotics, which were developed in the 1970s, as an improvement compared to typical antipsychotics. They are the second generation of antipsychotics and address positive AND negative symptoms by affecting multiple neurotransmitter systems.
Atypical antipsychotic drugs include:
Clozapine.
Olanzapine.
Atypical antipsychotics affect dopamine receptors in the limbic system. However, they do not affect the rest of the brain as typical antipsychotics do. They also work on:
Acetylcholine.
Glutamate.
Serotonin.
These neurotransmitters are associated with negative symptoms in schizophrenia. This is where atypical drugs differ, as dopamine affects the positive symptoms, and these neurotransmitters affect the negative symptoms.
Atypical antipsychotics are known for their supposed less severe side effects (although recent research is disputing this notion).
Side effects include:
Diabetes.
Tardive Dyskinesia (uncontrollable muscle movements usually affecting the face), which is less likely to happen with atypical antipsychotics.
Cardiovascular problems.
Weight gain.
Drug therapies have their specific weaknesses and strengths; we will evaluate these in the subtopic articles.
As schizophrenia is a somewhat complex mental health disorder, there are multiple avenues of treatment. Psychological treatment for schizophrenia works through the disorder with an appointed psychiatrist/clinician/therapist.
There are multiple forms of psychological treatment.
Developed in the 1960s by Beck, cognitive behavioural therapy (CBT) focuses on addressing dysfunctional thought processes and behaviours. It encourages patients to work through symptoms such as delusions, hallucinations, and depression by evaluating these symptoms logically.
CBT lasts around 6 to 12 weeks, although this can vary depending on a patient’s needs. Patients work closely with an appointed therapist to build trust.
CBT addresses other issues, such as:
General, irrational beliefs, e.g., hearing people who are not there talking about you or hearing a voice narrate your daily life.
Self-image issues.
Beliefs about people’s perception of the patient (Do they hate the patient? Do people think they’re ugly? Do people think they’re a bad person?).
A process is identified and followed, whereby patients are:
Assessed: Patients explain their issues to a therapist. These are identified, and patients are encouraged to reflect during this stage to understand better where these symptoms originate.
Engaged with: After being assessed, the therapist then begins to logically work through the issues, such as identifying a delusion (for example, believing a neighbour is trying to kill the patient) and explaining why this isn’t the case; the neighbour has no ill intent towards the patient, they are friendly, and it would result in the neighbour being tried and imprisoned.
CBT adopts the ‘ABC (later expanded to the ABCDE model)’ method to work through this process.
This is known as:
Activating Event: What is causing the problem?
Behaviour and Beliefs: How does the patient react in these situations?
Consequences: What impact does this have on the patient’s life and relationships with others?
Disputing Irrational Beliefs: Working with the therapist to logically dispute and deconstruct these irrational beliefs.
If a patient believes someone is following them, this is the activating event. They then begin to act secretive/have extreme behavioural responses, and this is the behaviour and beliefs change. The consequences are irrational thoughts affecting how a patient operates daily life, as they may avoid certain activities crucial to daily living, such as grocery shopping and exercise. The therapist then disputes this irrational belief, working through it logically, which restructures the event for the patient.
Disputing irrational beliefs can be addressed using these methods:
Reality testing.
Normalisation.
Critical analysis of ideas together (therapist and patient).
CBT also can follow the ‘CSE’ model, a method similar to the ABC model.
Coping Strategy Enhancement (CSE) encourages patients to develop and apply their coping strategies, teaching them how to do so in the hopes of reducing the frequency and intensity of psychotic symptoms in schizophrenia.
It has two components:
Education and rapport training: The patient and clinician work together.
Symptom targeting: Clinicians will target a patient’s specific symptom and work towards coping strategies within a given session.
Family therapy is a form of treatment that involves the patient and their respective family members, especially those who live in the same household.
It focuses on reducing expressed emotion (EE), stress, and guilt within family members who live with the patient. Usually, it is given through group sessions involving the patient and their family.
Family therapy tends to last for up to a year.
Like CBT, family therapy involves assessing the patient and the family and providing the appropriate treatment. It does so by:
Preliminary analysis: interviews and active observations are made of the family members and the patient.
Information transfer: the therapist encourages family members to learn about schizophrenia and what it entails, with the goal of education on the disorder reducing issues with EE and stress.
Information transfer is known as psychoeducation. It informs people about schizophrenia, reducing levels of ignorance and misinformation in the hopes of helping family members cope.
Teaching family members communication training can be done in the following ways:
Compromise and negotiation involve weekly meetings to air out issues.
Being family centred: the whole family is the focus, not just the patient.
These methods should improve problem-solving skills for the family involved, rather than resorting to negative behaviours that worsen schizophrenic symptoms in the patient and dismantle relationships.
Token economy systems (TES), developed in the 1960s, are reward systems to encourage good behaviours in a patient with schizophrenia, treating maladaptive behaviours (behaviours preventing a patient from adapting to new situations). This indirectly treats most negative symptoms of schizophrenia.
It involves a system introduced when the patient is first hospitalised, as TES were particularly popular when institutionalisation was common for schizophrenic patients.
Tokens, such as physical items (chips or plastic coins) or a tally system, are used as a secondary reinforcer earned through good behaviour. This can include:
Getting up on time.
Getting washed and dressed.
Brushing teeth.
Once patients earn enough tokens, a patient can trade them in for a reward, known as the primary reinforcer. Secondary reinforcers gain power through being associated with the primary reinforcer.
Three examples, established by Matson et al. (2016), are good examples of behaviours tackled by token economy systems:
Personal care (issues with hygiene such as showering, changing clothes, and brushing teeth).
Condition related behaviour (issues with positive and negative symptoms).
Social behaviour (issues with socialising with other people)
It is a motivational therapy but has underlying issues. Mainly, patients have to want to do the above behaviours.
TES works by being specific to patients, using their favourite things to encourage desirable behaviours. TES has fallen out of favour over the years due to a lack of need for the hospitalisation of patients and questionable ethical issues.
The interactionist approach combines psychological, biological and social factors, and it considers how this affects the development of schizophrenia and the subsequent treatment options for schizophrenia.
It is holistic in that it considers the patient as a whole person, rather than identifying them through their mental health disorder alone (a reductionist issue).
The most well-known interactionist approach is the diathesis-stress model.
The diathesis-stress model suggests schizophrenia is due to an internal vulnerability (diathesis) and an external environmental factor (stressor). This diathesis is predisposed and was potentially (in that, this was what we once believed) due to one specific gene: the schizogene.
We now understand that schizophrenia is a polygenetic disorder and results from dopamine imbalances in the brain.
Studies have found that early childhood trauma can act as a trigger for schizophrenia to develop. Issues such as:
Birthing complications,
General pregnancy complications.
Negative life experiences (such as academic pressures or emotional breakups).
Childhood traumas (expressed emotion, family dysfunction) altering neurological development - Read (2001).
Drug abuse has also been linked to the development of schizophrenia, such as using cannabis (increasing levels of paranoia, a positive symptom in schizophrenia).
Two prominent cases involving the diathesis-stress model are:
Gottesman (1991): twin study, where they compared identical twins with non-identical twins. Only 48% of identical twins developed schizophrenia, despite sharing 100% of their DNA - this suggests that both of these twins have a genetic vulnerability to schizophrenia. However, only one had a psychological experience to trigger the disorder.
Tienari (2004): This study investigated adopted biological children of schizophrenic mothers. 36.8% of the children developed schizophrenia in dysfunctional households, compared to just 5.8% of children in healthy households. There is genetic vulnerability, and the family household acted as a stressor to trigger schizophrenia.
The interactionist approach understandably encourages a combination of biological and psychological therapies to treat schizophrenia. It is supported by studies that show combining antipsychotic treatment with a form of therapy reduces symptoms and rehospitalisation.
Antipsychotics, in a lot of cases, reduce symptoms to allow for patients to undergo therapy.
The interactionist approach and the diathesis-stress model have their own weaknesses and strengths, evaluated in subtopic specific articles.
There are multiple forms of treatment available for schizophrenia, and they can be biological or psychological. Schizophrenia can either be treated through medication, such as typical and atypical antipsychotics, or through therapy, such as family therapy, cognitive behavioural therapy, and token economy systems. Biological and psychological treatments can also be combined.
Treatment for schizophrenia is subjective. One treatment plan may be more effective for one person than another. Typically, drug treatments are quite effective in addressing symptoms of the disorder, and therapy offers effective treatment in addressing the underlying causes.
There are multiple types of therapies for schizophrenia: cognitive behavioural therapy, family therapy, and token economy systems are examples.
Not entirely. It can be treated to lessen the symptoms and improve the quality of life for patients, but the condition is incredibly complex and hard to pinpoint exactly what is causing it.
Typically, patients are assessed and then prescribed medication in the form of antipsychotic drugs as the first line of treatment for their disorder.
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