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New research indicates that drug therapy is more (Click to select text)
For decades, psychologists have devised many treatment regimes for schizophrenia patients, with varying degrees of success and effectiveness. There have been great obstacles in their efforts, mainly due to the fact that patients of schizophrenia lack insight into their impaired conditions. Often patients refuse treatment of any kind because they do not perceive any mental illness associated with their behaviour. In particular, individuals suffering from paranoid schizophrenia regard therapy as intrusions from hostile outside forces, which reduces compliance on the part of the patient (Davison & Neale,1998). Other problems with treatment programs for schizophrenic’s is that they suffer from both positive and negative symptoms, each requiring different type of treatments. In order to combat the difficulty of treating schizophrenia, several techniques have been devised; psychoanalytic therapy, behavioural therapy, family therapy and most predominantly, drug therapies. Drug therapy is the primary form of treatment implemented at the onset of schizophrenia. The drug clozapine is very effective for many patients who do not respond to initial drug treatment programs and treats both the positive and negative symptoms of schizophrenia (Advokat et al., 1999; Robinson et al., 1999). Moreover, a reduction in negative symptoms has also been noted to occur as individuals are treated with amisulpride and (Danion et al., 1999). The use of newer drugs to treat schizophrenia has produced fewer side effects in most patients. However, it has been found that although the use of risperidone to treat patients is very effective in treating the symptoms, there may be negative side effects for women using the drugs (Caracci,1999). As well, haloperidol has been one of the most widely used drugs for treating schizophrenia and is very effective, but if it is over-prescribed it could result in severe side effects for the patient (Yasui et al., 1999). Despite the possible side effects for some patients using drug therapy, it is still the treatment regime which produces in the highest success rate (Davison & Neale, 1998). Psychoanalytical Therapy A revised form of Freud’s psychoanalytical therapy was first devised by Harry Stack Sullivan to treat schizophrenic patients in the early 1920’s. Sullivan believed that schizophrenia was a result of individuals regressing to earlier forms of childhood communication due to the fragile ego’s inability to handling the stress of their interpersonal relationships (Davison & Neale, 1998). He believed that by building a trusting relationship with the patients, the patients would become willing to examine their interpersonal relationships, thus resulting in improvement of symptoms. Freida Fromm-Reichman, a German psychiatrist who worked with Sullivan, also believed that schizophrenic symptoms resulted as a means of avoiding the rejections suffered in childhood (Davison & Neale, 1998). She too believed that by building a trusting relationship with a patient, the past experiences could be examined and symptoms alleviated. There was little evidence to suggest that the treatment was successful for patients who suffered from severe symptoms, but it was effective for individuals who suffered from mild cases of schizophrenia or who were in the beginning stages. The ineffectiveness of psychoanalytic therapy in severe cases has been attributed to the fact that insight into the patient’s own problems and illness worsens the symptoms due to its intrusive and intensive nature (Davison & Neale, 1998). For this reason psychoanalytic therapy has not been widely used to treat individuals suffering from severe forms of schizophrenia. Family Therapy Another favorable form of treatment for individuals suffering from schizophrenia involves family therapy. Individuals who have been institutionalized for schizophrenia are often released back into their family homes. However, evidence has found that if these families show high levels of expressed emotions such as; hostility, hypercritical comments and overprotective behaviour, the chances of relapse and re-hospitalization are high (Davison & Neale, 1998). Therefore, family therapy focuses on reducing the level of expressed emotions in the family through cognitive and behaviour therapy. As well, family members are taught to lower their expectations for the member with schizophrenia to reduce criticism and help the patient remain on their drug therapies. Studies have shown that the families of patients who received family therapy produced lower rates of re-hospitalization, but only on a short-term basis. Over the long run, it was shown that there was no significant difference in the rates of re-hospitalization between the patients who received family therapy and the one’s who did not (Davison & Neale, 1998). The delay of re-hospitalization is a benefit for many individuals, but the patients never become fully functioning members of society despite family therapy. Behaviour Therapy Behaviour therapy is method that has shown good results by helping individuals suffering from schizophrenia learn how to function as members of society. This type of therapy works on the principle that most drug regimes help with the positive symptoms of schizophrenia but not the negative symptoms, therefore, behaviour therapy helps teach the individuals social skills. The limitation to this type of techniques is that it is bound by the cognitive skills of the individuals. Any cognitive deficits may limit the patient’s improvement (Davison & Neale, 1998). One type of behavioural therapy shown to elicit marked improvements is known as the token economy therapy. The token economy system works on the principle where individuals are given tokens when desired behaviour is performed and these tokens can later be traded for wanted items or activities (Davison & Neale, 1998). Studies have shown that schizophrenic patients treated with the token economy have shown marked improvement, improving their re-entrance into society and in some cases reducing their medication dosages (Davison & Neale, 1998). However, it was noted that success in this program is not a cure, many of the individuals still displayed abnormal behaviour and were not functioning members of society. In all the treatment therapies mentioned, the patients are primarily treated with medications. The behavioural and family therapies are a means of supplementing drug therapy to help re-integrate schizophrenic individuals into society through the development of social skills. By re-integrating the individuals back into society, the probability that the patients adhere to their drug therapies increases. Nonetheless, it is important to note that drug therapy is the backbone of treatment for schizophrenic patients, hence, it is the most widespread treatment regime used and one of the most important to understand. Drug Therapy The problems with treatment programs for schizophrenic’s is that they suffer from both positive and negative symptoms, each requiring different type of treatments. Excesses of dopamine in the brain seem to be related to the onset of positive symptoms, which include hallucinations, disorganized speech, bizarre behaviour and delusions. On the contrary, negative symptoms, including behavioural deficits such as; apathy, negative thought disorder, inability to experience pleasure and flat affects, seem to be related to the under activity of dopamine neurons in the prefrontal cortex of the brain. By the nineteen-fifties the most commonly used method of treatment for schizophrenia patients was the prescription of anti-psychotic drugs known as phenothiazines, and derivatives such as; chlorpromazine and butyrophenones (Davison & Neale, 1998). All of these were highly effective in treating the positive symptoms of schizophrenia but not as effective for treating the negative symptoms. As well, these drugs were well known for the side effects that they produced such as dizziness, muscle stiffness, blurred vision, restlessness and sexual dysfunction. More serious side effects produced included extrapyramidal side effects, which resulted from dysfunctions of the nerve tract, descending from the brain to the spinal neurons. The symptoms resembled those of neurological diseases such as Parkinson’s Disease (Davison & Neal, 1998; Advokat et al., 1999). For this reason there was a high non-compliance rate, with half of all patients quitting after the first year and three-quarters ceasing the medications after two years (Davison & Neale, 1998). Additionally, thirty percent of schizophrenia patients who were prescribed the phenothiazine did not respond favorably to the drugs (Davison & Neale, 1998, Advokat et al., 1999). Neither the positive or negative symptoms of the patients were alleviated after taking the drugs. Recent research has lead to the discovery of other anti-psychotic drugs that produced greater success rates for patients who did not previously respond to typical medications and produced fewer side effects. In 1989, clozapine was reintroduced as a treatment for schizophrenia because compared to traditional drugs used, clozapine produced few extrapyramidal side effects and reduced both positive and negative symptoms (Advokat et al., 1999; Robinson et al., 1999). The most important use of clozapine is that of one-third of patients who do not respond to traditional antipsychotic drug therapies, clozapine is very effective (Robinson et al., 1999). Research has shown that 30.5% of patients who normally do not respond to traditional drugs, meet the maximum criteria for improvement when given clozapine (Advokat et al., 1999). As well, the use of clozapine has resulted in the alleviation of symptoms in schizophrenia patients within the first month of administration, while maximum improvement was noted in the first five months of administration (Advokat et al., 1999). There have been reports of patients whom only responded favorably to the clozapine therapy for the first 2 to 3 months, after which, improvement begins to decline. These patients often show more improvements in the negative symptoms as compared to the positive symptoms, leading to the hypothesis that for long term improvement to occur, the positive symptoms must be reduced (Advokat et al., 1999). It has been concluded that the use of clozapine drug treatment is a highly effective treatment regime for a proportion of patients who do not respond at all to traditional antipsychotics and whose negative symptoms are not reduce after traditional treatment (Advokat et al., 1999; Robinson et al., 1999). Other antipsychotic drugs used to help alleviate the negative symptoms of schizophrenia are amisulpride and risperidone (Danion et al., 1999; Caracci, 1999). Risperidone has been prescribed for many years to patients who do not respond to phenotheazine treatments because it produces fewer motor symptoms and alleviates the negative symptoms of schizophrenia better than traditional drugs (Davison & Neal, 1998; Caracci, 1999). One side effect of women using resperidone, is that the elevated prolactin levels produced as a result of usage could result in osteoporosis, and animal studies have shown a link with mammary tumors (Caracci, 1999). However, in men the prolactin level produce by using resperidone also increased, but there are few harmful effects noted as a result (Caracci, 1999). The use of an amisulpride drug therapy is highly effective in alleviating the negative symptoms of schizophrenia because it is highly selective for dopamine receptors. When administered in high doses the amisulpride exhibits a dopamine blocking reaction, while at lower doses the amisulpride helps dopamine transmission through blocked presynaptic dopamine autoreceptors (Danion et al., 1999). Research has shown that at both high and low doses amisulpride is highly effective in reducing the negative symptoms of schizophrenia. Low doses of amisulpride have also resulted in protection against intensification of positive symptoms, and low occurrences of extrapyramidal side effects (Danion et al., 1999). Therefore, it can be concluded that both resperidone and amisulpride are effective means of treating the negative symptoms of schizophrenia, while producing minimal side effects. Another of the most widely prescribed antipsychotic drugs for treating schizophrenia is haloperidol. Haloperidol works best when doses do not exceed levels that produce blood plasma responses above 12 ng/mL because once plasma levels exceed this, negative side effects often result (Yasui et al., 1999). However, haloperidol is still considered one of the most effective antipsypchotics in treating schizophrenia, due to its ability to reduce both the positive and negative symptoms. Most patients are receptive to dosages below the levels which result in harmful blood plasma levels, therefore, halperidol is an effective means for treating schizophrenic patients. As shown above, the use of drug therapy is the most effective means of treating schizophrenia. It is the primary treatment regime used, before any types of behavioural or family therapies are implemented. Results of recent research have shown that the newer drugs developed for the treatments of both positive and negative symptoms of schizophrenia are highly effective. Hopefully, this will result in a higher compliance rate on the side of the patient, thus, helping the patients to re-integrate back into society. However, as of yet the rates of full re-integration into society are low. With further research, improvements on existing drugs and the development of newer ones will further the treatment success rates of many schizophrenic patients. REFERENCES: Advokat, C.D., L.J. Bertman, and J.E Comaty Jr. 1999. Clinical outcome to clozapine treatment in chronic psychiatric inpatients. Prog. Neuro-Psychopharmacol. & Biol. Psychiat, 23:1-14. Caracci, G. 1999. Prolactin levels in premenopausal women treated with risperidone compared with those of women treated with typical neuroleptics. J. Clin. Psychopharmacol, 2:194-196. Danion, J.M, W. Rein, O. Fleurot and Amisulpride Study Group. 1999. Improvement of schizophrenia patients with primary negative sympotms treated with amisulpride. Am J. Psychiatry, 156:610-616. Davison G.C. and J.M. Neale. 1999. Abnormal Psychology. USA: John Wiley & Sons, Inc. Robinson, D. G., M.G. Woerner, J.M. Alvir, S. Geisler, A. Koreen, B. Sheitman, M. Chakos, D. Mayerhoff, R. Bilder, R. Goldman, and J.A. Lieberman. 1999. Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder. Am J Psychiatry, 156:544-549. Yasui, N., T. Kondo, K. Otani, H. Furukori, K. Mihara, A. Suzuki, S. Kaneko and Y. Inoue. 1999. Effects of itraconazole on the steady state plasma concentrations of haloperidole and its reduced metabolite in schizophrenic patients: in vivo evidence of the involvement of CYP3A4 for haloperidol metabolism. Journal of Clinical Psychopharmacology, 19:149-154.
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