Schizophrenia: Key Question

Question 1

What is the key question?

Answer 1

How effective are the current clinical treatments for treating schizophrenia?

Question 2

What is schizophrenia?

Answer 2

A long-term, incurable mental disorder involved in the breakdown of thought and behaviour making it difficult to distinguish between reality and fiction.

Question 3

What are the two types of symptoms for schizophrenia, give 2 examples for each?

Answer 3

• Positive (echolalia, hallucinations)

- Negative (apathy, poverty of speech)

Question 4

Why is this issue important?

Answer 4

• 1% of the world population suffers from SZ with no cure and so assessing treatments of their effectiveness can help to improve treatment of symptoms instead
• The average cost of antipsychotic drugs for SZ is around $26,000 per year per patient which burdens the healthcare system in many countries and may be too much to pay for some if no guarantee they will work
• If treatments are ineffective then it puts patients and other who surround them at risk

Question 5

What are the implications for the future if treatments are found to be ineffective?

Answer 5

• No cure wold lead to…
• Waiting lists could lengthen
• Hospitals could get more and more full
• Systems such as the NHS will be put under a lot of strain to accommodate everyone’s needs

Question 6

What are three causes of schizophrenia?

Answer 6

1) Brain structure
2) The Dopamine Hypothesis
3) Social Causation Hypothesis

Question 7

Briefly describe the dopamine hypothesis as an explanation for SZ.

Answer 7

• Having more D2 receptors than normal increases frequency of dopamine stimulation
• Having too much dopamine release in the mesolimbic pathway
• Having too little glutamate release in the mesocortical pathway

Question 8

Briefly describe brain structure as an explanation for SZ.

Answer 8

• Enlarged ventricles cause areas of the brain to decrease in size and become undeveloped
• Damage to frontal lobes can cause negative symptoms as they are frequently seen in patients who have also experience damage to their frontal lobes, such as catatonia
• Loss of up to 25% of grey matter in the brain that starts in the parietal lobes and moves inwards over the span of 5 years can cause tissue loss that leads to positive symptoms

Question 9

Briefly describe the social causation hypothesis as an explanation for SZ.

Answer 9

• Being of a lower social class has a more stressful environment due to trying to find money and living under poor conditions with differing levels of care
• Experiencing social adversity during childhood may put strain on development due to certain pressures experienced
• Being a member of the immigrant population due to experiencing stress of living alone from family separation or trying to find work and living under poor conditions

Question 10

What are the two treatments currently available for patients with SZ?

Answer 10

1) Chemotherapy

2) Assertive Community Therapy

Question 11

Briefly describe chemotherapy as a treatment for schizophrenia.

Answer 11

• It is based on the dopamine hypothesis which states that over-activity of dopamine in the mesolimbic pathway causes positive symptoms due to being the reward pathway and under-activity in the mesocortical pathway causes negative symptoms due to problems with normal cognitive functioning
• Antipsychotics (such as chlorpromazine and clozapine) are used to treat SZ
• First generation drugs work by blocking the D2 receptors by binding to them but not stimulating them which prevents over-stimulation
• Second generation drugs also bind to D2 receptors but only temporarily to allow normal dopamine function which continues to reduce positive symptoms but has less side effects

Question 12

What is a major problem with chemotherapy?

Answer 12

Antipsychotics fail to target negative symptoms effectively as only focus on positive symptoms due to them being easier to treat.

Question 13

Give evidence to support that chemotherapy does reduce symptoms of schizophrenia.

Answer 13

P - Meltzer (2014) supports the effectiveness of drug therapy
E - Compared with the placebo control group he found that the antipsychotic Haloperidol significantly improved all aspects of functioning in patients with SZ
E - This demonstrates the effectiveness of second generation antipsychotics

Question 14

Briefly describe Assertive Community Therapy as a treatment for schizophrenia.

Answer 14

• It is based on the Social Causation Hypothesis which states that stress from the environment in things like lower social class and being an immigrant triggers symptoms
• It targets the social factors that may worsen the disorder through providing support by integrating them into a community of health clinicians and other patients with mental disorders
• The 10:1 staff ratio helps to assist patients in their daily life by helping with activities such as shopping, banking, and maintaining a job

Question 15

What is a major problem with ACT?

Answer 15

It doesn’t actually target symptoms of the disorder only factors that may worsen SZ.

Question 16

Give evidence to support that ACT does reduce the effects of schizophrenia.

Answer 16

P - Bond et al (2000) supports the effectiveness of ACT
E - He found that ACT was highly effective in 25 studies that looked at effectiveness due to engaging clients and preventing rehospitaisation
E - Therefore demonstrating that even if it doesn’t target symptoms, it reduces the effects of the disorder

Question 17

Using the acronym ‘EACH’, evaluate a supporting and rejecting ‘evidence’ points for chemotherapy.

Answer 17

P - Schooler et al (2005) supports the effectiveness of drug therapy to treat SZ
E - He found that second generation drugs work better to prevent relapse with 49% compared to 51% of first generation
E - Therefore showing that medication is constantly improving
P - Harlow et al (2012) rejects the effectiveness of antipsychotics
E - He carried out a 20 year long longitudinal study and found that those who didn’t take their medication had fewer psychotic episodes than those who did
E - This suggests that drug therapy may not be the best treatment for everyone

Question 18

Using the acronym ‘EACH’, evaluate a ‘how’ point for chemotherapy.

Answer 18

P - Meltzer (2014) has high validity
E - He used a placebo on an unsuspecting control group
E - Therefore lack of DCs can establish cause and effect between the antipsychotic improving symptoms of patients

Question 19

Using the acronym ‘EACH’, evaluate 2 ‘credibility’ points of chemotherapy.

Answer 19

P - It masks symptoms
E - Drug therapy only masks the symptoms of SZ and doesn’t try to fix the cause of the disorder due to lack of a cure
E - Therefore this is not an effective treatment if it does not offer a long-term solution by providing a cure
P - High social control
E - Some patients call chemotherapy a ‘chemical straitjacket’ due to not having control over the effects of the drugs and some may also not be able to take the pills on their own so gets someone else to do it for them
E - Therefore this is not an effective treatment if there is an imbalance of power in regards to intrusion on the patients free will

Question 20

Using the acronym ‘EACH’, evaluate a supporting and rejecting ‘evidence’ points for chemotherapy.

Answer 20

P - Vugt et al (2011) supports ACT as an effective treatment for SZ
E - Carried out a study in the Netherlands of 530 patients and found that provided the model was adhered to, ACT was successful at reducing symptoms of SZ
E - Therefore shows that ACT is an effective treatment worldwide
P - Harvey et al (2012) rejected the effectiveness of ACT as a treatment
E - He found that the effectiveness of ACT depends on how the treatment is implemented
E - Therefore this raises questions on its design if variables such as staff training can reduce its effectiveness

Question 21

Using the acronym ‘EACH’, evaluate a ‘how’ point for ACT.

Answer 21

P - Vugt et al (2011) has high generalisability
E - Used a large sample of 530 patients in the Netherlands
E - This shows that ACT works globally and is also a large sample to represent the wider population in terms of how effective it was

Question 22

Using the acronym ‘EACH’, evaluate 2 ‘credibility’ points of ACT.

Answer 22

P - Availability
E - ACT is only available in urban areas where SZ rates are highest and communities largest due to being based on the social causation hypothesis
E - Therefore suggesting that ACT is not very effective due to not being able to help people who live in rural areas
P - Cannot be used on its own
E - Due to not targeting positive symptoms such as hallucinations, antipsychotics need to be taken alongside the programme
E - Therefore showing that ACT is not an effective treatment on its own

Question 23

Are there any applications?

Answer 23

P - Further research has to be done
E - Carlsson (1999) concluded from his literature review of the dopamine hypothesis as an explanation for SZ that further research must be done into the impact of other neurotransmitters
E - And so future medication and other treatments must also be developed and improved alongside this