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  1. 1. By Falguni Upadhyaya Describe one biological and one psychological therapy for schizophrenia and evaluate them in terms of their appropriateness and effectiveness (8+16 marks) One biological therapy available for individuals diagnosed with schizophrenia is the use of antipsychotic drugs, which help to block serotonin and dopamine receptors in the brain. These can come in two forms: typical and atypical. Typical drugs such as phenzothiazines reduce the effects of dopamine the in brain and reduce the symptoms of schizophrenia, namely hallucinations and delusions. These drugs bind to dopamine receptors and block their action. Atypical drugs, or second-generation drugs, such as clozapine, act on both dopamine and serotonin receptors in the brain. These drugs help by temporarily occupying D2 receptors and then quickly detach themselves to allow for the normal release of dopamine in the brain. This particular characteristic of atypical drugs is responsible for the lower levels of side effects (such as tardive dyskensia – the involuntary movement of the mouth and tongue). There is research evidence to suggest that antipsychotic drugs are effective in their ability to provide a solution for dealing with the sz. Davis et al (1990) analysed 29 relevant studies and found that relapse only occurred in 19% of the people with Sz who continued using typical antipsychotic drugs. In contrast 55% of those whose antipsychotic drugs were replaced with a placebo drug relapsed and displayed symptoms of Sz again. This demonstrates the effectiveness of antipsychotic drugs in reducing relapse rates of displaying symptoms of Sz. Furthermore, in support of the effectiveness of antipsychotic drugs it is important for a patients’ recovery, that any treatment they are given works quickly. Drug therapy reduces symptoms more rapidly than psychological therapies as it can have an immediate effect on brain chemistry. In terms of appropriateness, one of the problems with typical antipsychotic drugs is the serious side effects – patients run the risk of developing tardive dyskensia (the involuntary movement of the mouth and tongue). About 30% of people taking typical anti-psychotic medication develop this symptom and it is irreversible in 75% of cases. To add to this, some people have criticized whether the widespread use of drugs in the treatment mental disorders is appropriate, referring to them as ‘chemical straightjackets’. The argument is that drugs are dehumanizing and take away any sense of personal responsibility or control. The issue of informed consent is also a consideration. People in a psychotic state are not really in a position to give truly informed consent about their treatment. One psychological therapy available for individuals diagnosed with Sz is cognitive behavioural therapy (CBT). The aim of this therapy is to challenge the patients distorted beliefs, such as believing that somebody or something else is controlling their thoughts. One form of CBT is Coping StratergyEnhancement (CSE) - Tarrier (1987) found that schizophrenics can often identify triggers for their psychotic symptoms and develop coping strategies to reduce their distress. At least 73% of schizophrenics found these strategies useful.Cognitive strategies – included distraction, concentration on a task and positive self talk andbehavioural strategies involved initiation or withdrawal from social contact, relaxation techniques or physically drowning out voices by shouting or turning up the TV. This technique aims to teach individuals to develop and apply these effective coping strategies in order to reduce the frequency, intensity and duration of psychotic symptoms. There are two main components of this strategy: Education and rapport training: therapist and client work together to improve the effectiveness of the clients own coping strategies and develop new ones and Symptom targeting: a specific symptom is selected and a particular coping strategy is devised to target it.
  2. 2. By Falguni Upadhyaya Research evidence provides support for the effectiveness of CSE as form of CBT technique in helping patients alleviate their symptoms of Sz. Tarrier et al (1993) found significant alleviation of positive symptoms of schizophrenia for those in a CSE group as opposed to a non-treatment group. They also found a significant improvement in the effective use of coping skills. This shows that CSE can help people with the disorder to control their symptoms. In terms of appropriateness, as many symptoms of schizophrenia are cognitive, it is sensible to use cognitive therapy to treat them. Also, many patients naturally use coping strategies to control these symptoms and so developing these strategies seems to be an appropriate approach. However, CBT is specifically designed to reduce only certain positive symptoms eg hallucinations and delusions. Therefore CBT is not an appropriate therapy for reducing or eliminating negative symptom and although some studies have shown that CBT can improve certain symptoms, it does not offer a cure but rather a way of ‘normalising’ symptoms. CBT can be viewed an ethically safe treatment for alleviating symptoms of Sz. It is a collaborative therapy and involves the active cooperation of the client. For this reason it avoids the criticisms made of biological treatments such as drug therapy or ECT where the patient becomes a passive recipient of the treatment. The biological therapy described falls on the nature side of the debate whilst the CBT falls on the nurture side of the debate. Biological therapies aim at reducing the physical aspects of the disorder and in doing so help to reduce positive symptoms of the disorder. It fails to address any potential underlying psychological issues that could be the potential cause for the disorder such as family types who are high in expressed emotion or cognitive deficits. Ross and Read (2004) argue that being prescribed medication reinforces the view that there is ‘something wrong with you’ which reduces the patients motivation to look for other possible causes such as life stressors. Similarly, although cognitive behavioural therapy involves the interaction of cognitive and behavioural techniques it fails to take into account the potential biologically based elements of the disorder such as increased dopamine levels in the brain which affect a patients ability to guide their attention successfully. In order for a patient to truly have a successful treatment that is both effective and appropriate, perhaps they should be prescribed antipsychotic medication in combination with receiving CBT.