Psya4 - P - Biological Therapies For S, Including Their Evaluation In Terms Of Appropriateness And Effectiveness

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Biological therapies for S, including their evaluation in terms of appropriateness and effectiveness

Conventional antipsychotics
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Conventional antipsychotic (CA) medications – are neuroleptic drugs used to treat psychotic based disorders, such as Schizophrenia.

Neuroleptics are major tranquilizers, the most notable being phenothiazines, which sedate the person and ameliorate symptoms such as delusions and hallucinations. Phenothiazines bind to dopamine receptors and block the build up of dopamine.

Haldol is the trade name of Haloperidol, a ‘conventional’ antipsychotic.

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Biological therapies for S, including their evaluation in terms of appropriateness and effectiveness

Conventional antipsychotics
AO2 - appropriateness

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+ Prior to the introduction of CA in the 1950s, schizophrenia was generally considered to be untreatable - lifetime asylum incarceration.
- CA have more of an impact on the reduction of the positive symptoms of S than negative ones,
-CA need about 6 months to achieve their maximum level of improvement.
- CAs have some serious side effects, most notably ‘tardive dyskinesia’. This does not usually appear until antipsychotics have been taken for a least a year but it t involves involuntary writhing or tic-like movements of the tongue, mouth, face or whole body; involuntary chewing and lip smacking and jerky movements. and continues even if CAs are discontinued.

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Biological therapies for S, including their evaluation in terms of appropriateness and effectiveness

Conventional antipsychotics
AO2 - effectiveness

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Cole et al (1964) conducted one of the first major studies of the effectiveness of antipsychotic drugs (placebo).
75% much improved (25%)
20% minimal improvment (14%)
5% no change (13%)
0% worse (48%)

Comer in fact notes that CA medication reduced symptoms in the majority of individuals with S. He notes that they appear to be more effective than any other approaches used alone, such as psychodynamic therapy or ECT.

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Biological therapies for S, including their evaluation in terms of appropriateness and effectiveness

Atypical antipsychotics
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Atypical Antipsychotics (ATP) have been developed since 1990s, and work differently to conventional antipsychotics, they are received at fewer dopamine D2 receptors and at more D1, D4 and serotonin receptors.
An example of an ATP is Clozapine.

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Biological therapies for S, including their evaluation in terms of appropriateness and effectiveness

Atypical antipsychotics
AO2 - appropriateness

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+ ATP help those with negative symptoms as well as those with positive symptoms and they produce fewer motor side effects such as tardive dyskinesia.
- About 1% of patients suffer from ‘agranulocytosis’ (a life threatening drop in white blood cells) and as a result...
- They are extremely expensive to use as individuals need to undergo a weekly blood test to monitor.

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Biological therapies for S, including their evaluation in terms of appropriateness and effectiveness

Atypical antipsychotics
AO2 - effectiveness

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They appear to be even more effective, helping 85% of people with S, more than those helped by CA.

Also helped 25% of those who were not helped by CA.

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Biological therapies for S, including their evaluation in terms of appropriateness and effectiveness

CONCLUSIONS ABOUT ANTIPSYCHOTICS
(Apply to both CA and ATP)

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+Taking APs requires little effort and its effects can be almost instantaneous.
+ Without the ‘insight’ gained during periods of medicated remission, individuals with S would not be able to access psychological therapies such as CBT.
- SIGNIFICANT ethical issues. Are AP administered to alleviate suffering or to increase compliance with institutions and society? If we offer the ‘right to refuse’ medication, potentially violent individuals may go ‘unchecked’.
- If biochemical imbalances are the result rather than the cause of S, APs merely treat the symptoms rather than cause of S and are consequently only a solution whilst they are being taken.
- Non-compliance with APs is the major reasons for relapse in patients with S. Rettenbacher (2004) found full compliance in 54.2%, partial compliance in 8.3% and non-compliance in 37.5% of patients with S.

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Biological therapies for S, including their evaluation in terms of appropriateness and effectiveness

Electroconvulsive Therapy (ECT)
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ECT is usually a last resort therapy for people with severe life threatening depression who haven’t responded to anti-depressant drugs.
1. Electrodes are placed on the forehead; unilateral has electrode on the temple of the non-dominant hemisphere and the middle of the forehead; bilateral has an electrode above each temple.
2. Patients are given a barbiturate, so they are unconscious.
3. They also receive a ‘nerve blocking agent’ to temporarily paralyse them in order to prevent muscle contraction and fractures.
4. They are also given supplemental oxygen.
5. A brief (½ second) current of approximately 0.6 amps is passed through the brain, causing a seizure which lasts up to one minute.
6. This process is repeated 2-3 times per week, with patients receiving approximately 3-15 treatments.

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Biological therapies for S, including their evaluation in terms of appropriateness and effectiveness

ECT
AO2 - appropriateness

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Is there a placebo effect? Some studies have given patients ‘sham ECT’, where all procedures are followed apart from the electric current. They found that although those give real ECT were quicker and more likely to report feeling better, some given sham ECT also reported feeling better.

There are side effects. Memory loss and anxiety have been reported along with cardiovascular problems and headaches. Are the potential side effects worse than the disorder it is being used to treat.

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Biological therapies for S, including their evaluation in terms of appropriateness and effectiveness

ECT
AO2 - effectiveness

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It can be very effective. Comer (2002) states that 60-70% of people given ECT will show improvement.
Is it really that effective? Sackheim (2001) found that within six months of treatment, 84% of patients had relapsed. This suggests that the ECT may not be an effective long-term treatment.

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Biological therapies for S, including their evaluation in terms of appropriateness and effectiveness

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Although biological therapies have their shortfalls, they are generally quite effective and the development of APs for treating S has undoubtedly released millions of people from a lifetime in psychiatric hospitals.