What treatments are available for schizophrenia and are they effective?

Introduction

Schizophrenia is a psychotic mental illness in which sufferers lose touch with reality by seeing, smelling or feeling things that don’t exist, hear threatening voices and become extremely paranoid. Around 1 in 100 people will develop the disorder at some stage during their lives, however a quarter of these will only experience one episode (1). This statistic and the fact that schizophrenia costs around £3.6 billion pounds per year for the NHS means that it is a huge scale problem, and needs to be treated to help people with the disorder live a life that is as normal as possible.

A chart to show the prevalence of schizophrenia in comparison to other similar illnesses.

(3)

Causes of schizophrenia

The exact cause of schizophrenia is unknown, although it is thought that the balance of certain neurotransmitters, which are needed to pass messages between brain cells, is altered and this may cause the symptoms of schizophrenia.

Genetic factors are also thought to be important, for example a close family member of a schizophrenic sufferer has a 1 in 10 more chance of also developing the disease, which is 10 times the normal probability; however several factors appear to need to be present to trigger the condition. (11)

These include stress, viral infection in early childhood, a lack of oxygen during birth, and the use of illegal or ‘street’ drugs. (2)

Biological treatments for schizophrenia

Over the past few years, many different medications have been developed for use in the treatment of schizophrenia which are referred to as neuroleptics or antipsychotic drugs and were developed in the 1950s.

Antipsychotic drugs alter the balance of neurotransmitters and are used to relieve the symptoms of schizophrenia and to prevent relapses, meaning that antipsychotic medicine is usually taken on a long-term basis. There are two types of antipsychotics- first and second generation, with the first generation being the older type of drug. (3)

These drugs work by blocking the action of the neurotransmitter dopamine in the brain by binding to it, but without stimulating the dopamine receptors. The atypical antipsychotic drugs, such as clozapine, act by only temporarily occupying dopamine receptors, and then rapidly dissociating to allow normal dopamine transmission to resume. This may explain why typical antipsychotics have lower levels of side effects compared to conventional antipsychotics. (11)

Second-generation drugs are often referred to as atypical antipsychotics, and they include amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, aertindole and zotepine. These drugs are often used for new patients as they seem to have a good balance between the chances of success and the risk of side effects. (2)

Antidepressant drugs are also used to treat the symptoms of schizophrenia, and these work by reducing the rate of absorption of neurotransmitters back into the nerve endings, or by blocking the enzyme which is able to break down the neurotransmitters. Both of these methods increase the amount of neurotransmitter available in ...

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The most commonly prescribed anti-depressant drugs for schizophrenia are the SSRIs, which work by blocking the transporter mechanism that reabsorbs serotonin into presynaptic cells. Because of this, the synapse contains more serotonin, which prolongs its activity and makes transmission of the next impulse easier. (11)

How are these methods appropriate?

After taking medications to treat schizophrenia, the symptoms such as agitation, and hallucinations, usually go away within days. After about six weeks, many people will see a lot of improvement.

Research evidence indicates that chemotherapies do work. For example the World Health Organisation reported (2001) that relapse rates after one year were highest (55%) when schizophrenia was treated with placebos which dropped to 25% with antipsychotics, showing how necessary the drugs are.

Another reason why drugs are an appropriate way to treat schizophrenia in everyday life is that it requires less effort from the user than therapies such as psychoanalysis. (11)

Social benefits of treatments for schizophrenia

Due to the new drugs that have been developed, people with schizophrenia no longer need to be hospitalised for years, with most being able to live in the community. This means that there is more hospital space available for the use of other illnesses, and that the schizophrenia sufferer is able to live a comparatively normal life at home.

Drugs that treat schizophrenia also reduce the rates of suicide leading on from the disease, as they tend to also reduce the symptoms. Suicide is one of the leading causes of death among people suffering from schizophrenia, with at least 40% of people that have the disease attempting suicide at least once (9), normally during periods when they are psychotic and out or touch with reality, depressed, or in the first 6-9 months after they first begin taking medication. After treatment, there is a reduced suicide rate of just under 20%. (12)

Economical implications of treatments for schizophrenia

It’s very expensive to treat and care for people with schizophrenia, and this is shown by the overall US cost of schizophrenia (in 2002) which was estimated to be around $62.7 billion (3). With treatment this cost can be reduced as generally sufferers spend less time in hospitals after taking medication, and so are able to integrate more into the community, sometimes even finding jobs.

Another negative issue to consider when thinking about the economic implications, is the cost of medication, as it is very expensive. Source 13 says that “during treatment with perphenazine, the average monthly cost was $960, further by comparison, olanzapine treatment costs $1,404 per month. As most people with schizophrenia are unable to hold down jobs, this medication ends up being heavily subsidised by the government, which places a large strain on society. (13)

Disadvantages of treatment

One of the disadvantages of using neuroleptic drugs to treat schizophrenia is the presence of side effects, which are especially common during the active phase of the illness when a higher dose of medication is required. Common side effects include muscular stiffness, tremors, muscle spasms, restlessness, dry mouth and blurred vision. These side effects may result in patients becoming discouraged and discontinuing the use of the medications, however over time the body usually adjusts to the drugs and this should reduce the side effects on the body.

Another problem with using neuroleptic medication over long periods of time is that it can results in another disorder called tardive dyskinesia (2) which consists of involuntary movements of the face, eyes, tongue, mouth or jaw, and if this condition appears it is wise to change or discontinue the medication.

Some people may not even respond to the traditional antipsychotic medications, or they can develop side effects which cause more expense, such as the drug clozapine, which lowers immunity in some people and therefore causes them to require regular blood tests.

Alternative treatments

An alternative treatment to antipsychotic drugs is known as electroconvulsive therapy (ECT), although it has received some bad press. It involves the patient being put to sleep with a short-acting anaesthetic and then the muscles are temporarily paralysed by the drug succinycholine (4) so that they don’t contract during the treatment. An electrode is then placed above the temple in several positions and a very small current is passed through the brain for one second or less, which produces a seizure. Upon awakening, a patient may experience confusion, headaches, or muscle stiffness but they only last for a short period of time, and there are no long-term problems.

It is not normally recommended for the treatment of schizophrenia, however it can be prescribed for people who are severely ill and are not responding to medication or people who are severely depressed as suicide attempts are relatively rare after ECT.

Psychological treatments such as cognitive behavioural therapy (CBT) can also be used as they aim to change the way the patient thinks, feels and behaves, and involves cognitive and behavioural approaches.

The cognitive approach is based on the belief that how a patient perceives the situation is the most important factor that influences their behaviour, and so CBT aims to change maladaptive thoughts. Some psychologists believe that undesirable behaviours have been learned, and so the behavioural approach aims to reverse the learning process and produce a new set of more desirable behaviours.

Cognitive behavioural therapy combines these two approaches, involving “cognitive techniques such as challenging negative thoughts, and behavioural techniques, such as rewarding desirable behaviour.” (11)

However, therapy is not an alternative to drug treatment and therefore it is only used in addition to medication.

Other methods of helping schizophrenia sufferers include family intervention, art therapy, social and community support, and the encouragement of physical health.

Evaluation of sources

Although ‘Talking Points’ by Vanora Leigh is a scientific book specifically about mental illnesses, it still may not be overly reliable, as it was published in 1998, so the information is fairly old, and some of it might be out of date as medicine is constantly developing at a rapid pace so there are probably new treatments and statistics. There is also the problem that a lot of the information in this book seems to be over-simplified to make it understandable to the reader, so from using this source I may have missed finding important information that is slightly more complex to understand simply because it wasn’t included in the book.

I also used the source (13) which is updated regularly by The American Journal of Psychiatry. This suggests that the information is correct and up-to-date, rather than if I’d found the information from another internet source which may not be entirely reliable, as people are free to post whatever information they want to, and information is not verified by anyone before it is posted.

The specific article I used from this website was written by a group of professional scientists, which also suggests that the information I found is reliable as they are experts in the field that I was looking into.

I made sure that all of the information I found was able to be cross-referenced with another source to make sure that I hadn’t found incorrect information. If the information appeared in more than one source than it is safer to assume that it is correct, as it means that it is not just someone’s opinion on the topic, but contains reliable facts. I especially used this method for the statistics, such as the statistics for the suicide rate in patients with schizophrenia, where I found the same information in sources (1), (7) and (9).

Bibliography