Schizophrenia: treatment and management

Psychology A2 · Clinical Psychology. The idea in plain words, the rules to remember, the mistake to avoid and a worked example, written and checked by Mega Lecture.

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The idea

Biological treatments act on the brain. Typical antipsychotics (chlorpromazine, haloperidol) block dopamine D2 receptors and reduce positive symptoms, but can cause movement side effects. Atypical antipsychotics (clozapine, risperidone) also act on serotonin receptors and cause fewer movement problems. Electro-convulsive therapy (ECT) passes a small current through the brain under anaesthetic to cause a brief seizure. It is kept for severe cases that have not responded to drugs.

CBT is the psychological treatment. The patient learns to test the evidence for delusions and to cope with voices. Sensky et al. (2000) compared CBT with befriending in 90 patients whose symptoms had resisted medication. Both groups improved, but only the CBT group kept improving at follow-up.

Rules to remember

Typical antipsychotics: dopamine D2 antagonists; long-term risk is tardive dyskinesia (involuntary movements of the face and tongue).
Atypical antipsychotics: act on dopamine and serotonin; fewer movement side effects, but weight gain is common.
Clozapine can lower white blood cell numbers (agranulocytosis), so regular blood tests are needed.
ECT: anaesthetic and muscle relaxant first, then a brief current to cause a seizure; memory loss is a risk and informed consent is an ethical issue.
Sensky et al. (2000): a randomised controlled trial; befriending controlled for the time and attention of a therapist.
Drugs work fast and need little effort from the patient; CBT needs insight and effort but teaches skills that last.
CBT is normally given together with medication, not in place of it.

Common mistake

Students say the befriending group in Sensky et al. got no treatment. It got the same amount of therapist contact, which is why the extra benefit can be put down to CBT itself.

Worked example

A trial finds that CBT and a supportive chat condition both reduce symptoms by the end of therapy. Nine months later only the CBT group is still improved. What is the best conclusion?

Both groups improved during treatment, so contact with a caring person helps in the short term.
Both groups had equal contact time, so attention alone cannot explain a later difference.
Only CBT gains lasted, so the specific skills taught in CBT are what give the lasting benefit.

Answer: CBT has a lasting effect beyond therapist attention, because patients keep using the skills after therapy ends.

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