OCR Psychology A Level Book 2 sample

Application The medical model Topic 2 Part (c) of the exam question may require you to apply one or more biological treatments to a disorder you specify, using your knowledge of psychology. On this spread we consider two biological treatments. For the exam you should also consider the extent to which these treatments would work and how their effectiveness could be researched. Do antipsychotics work for schizophrenia? Usefulness Antipsychotic medications have been found to have significant pharmacotherapeutic benefits—this means they do help to reduce symptoms. In a review of 116 studies, involving a total of 6,493 patients with schizophrenia, Stefan Leucht et al. (2012) concluded that antipsychotic medication reduced the relapse rate of schizophrenia, with 27% of those on neuroleptic medication relapsing within a year compared with 64% of those taking placebo medication. This review also found fewer hospital readmissions, better quality of life and fewer aggressive acts for those taking antipsychotic medication than those taking a placebo. This demonstrates that antipsychotic medication is useful as a treatment for schizophrenia. Effectiveness Research has shown that clozapine in particular is the most effective antipsychotic in terms of reducing hospital admissions and reducing the use of other medications (Stroup et al. 2015). It has also been found to be effective for those people for whom other antipsychotic medications have not been effective. Finding the most effective drug treatment is important, because it could create better health prospects for the patient, peace of mind for their family, fewer expenses for the medical services and could lead to the patient being able to function within society, such as getting and keeping a job. Practicalities – side effects One main drawback to antipsychotic medications is the issue of side effects. The worst of the side effects for the typical antipsychotics are referred to as extrapyramidal —the patient suffers from tremors, spasms, jerky movements, slow movements or restlessness. These side effects can be very distressing for the patient and they often need to take further medication to reduce the side effects. In many cases the severity of the side effects can lead to reduced adherence to the medication, which of course makes the medication become less effective. Stefan Leucht and Stephan Heres (2006) found up to 75% of patients had not adhered to their medical regime within two years of being discharged from hospital. Despite these side effects, typical antipsychotics were a more ethical treatment than the methods used to treat schizophrenia up until the 1950s. Biological treatment for schizophrenia – antipsychotic medication If neurotransmitter functioning causes schizophrenia , then it would be logical to assume that drug treatments that modify those neurotransmitters would alleviate the symptoms. Most people with schizophrenia take some form of medication that does just that. Before the 1950s, schizophrenia was treated physically (and often rather barbarically) with psychosurgery and electroconvulsive therapy (ECT) , but these were largely ineffective. Since the 1950s drug treatments (chemotherapy) have been developed that allow the patient to function relatively ‘normally’. How antipsychotics work Antipsychotic drugs (also called neuroleptics) are dopamine antagonists because they block dopamine . The drugs do this by occupying postsynaptic receptor sites, particularly D2 receptors. This reduces the activity in the postsynaptic neuron . Reduced dopamine activity means less activity in the mesolimbic pathway and consequently a decrease in positive symptoms of schizophrenia. Types of antipsychotics ‘Typical’ or ‘first generation’ antipsychotics were introduced in the 1950s as a tranquiliser to calm patients down. Typical antipsychotics are effective at reducing the positive symptoms of schizophrenia but they do not reduce the negative symptoms. Examples of these include chlorpromazine and haloperidol. ‘Atypical’ or ‘second generation’ antipsychotics are newer and are more widely used. They still work by blocking dopamine receptors, but in a more gradual way. They tend to also reduce the negative symptoms. These include clozapine and risperidone. How antipsychotics are taken Drugs are administered in tablet form, or sometimes by injection which requires a less frequent dose. As the drugs change the levels of dopamine availability in the brain to reduce symptoms, it is important that the patients take medication regularly to stabilise the dopamine levels. If they stop taking the medication it is likely they will relapse quite quickly. The effects of the medication build up slowly in the brain so the patient will need to take the medication over several weeks before symptoms show any real signs of reducing. Using chemotherapy has been referred to as a ‘chemical straitjacket’. This is a metaphor for how the drugs are used to control those with mental illness, just how straitjackets were used to control patients in asylums. Biological treatment of one specific disorder Chapter 1: Issues in mental health 32