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Describe and evaluate at least two biological treatments for schizophrenia.

There is no known cure for schizophrenia but there is treatment aimed at reducing the
symptoms. An early form of treatment of schizophrenia is Electro-convulsive Therapy (ECT)
which was developed in the 1950s. This is where a small current is passed through the brain,
causing a seizure which lasts for roughly one minute. It is given to the patient up to three
times a week for up to five weeks. The treatment was first used as a result of observations of
some patients with epilepsy where psychotic symptoms and seizures occur alternately, but
psychotic symptoms appear when seizures are controlled. Another observation which caused
the onset of the use of the treatment was when diabetic patients accidentally overdosed on
insulin and went into states of fitting, and as a result of the fits all psychotic symptoms seem
to disappear.

However this treatment is not considered by English psychiatrists as an effective treatment for
schizophrenia and it is rarely used today, rarely even as a last result. Instead other treatments
are used such as drug treatment, although the effects of ECT are more rapid than those
induced by drug treatments. Furthermore the treatment raises many ethical issues, one being
the consideration of informed consent as if the patients are ill, are they truly in a position to be
giving consent? Therefore making the consent lack in validity. Moreover, the treatment has a
large history of abuse as it was previously used a means of punishment or control when first
introduced in mental institutions, also it must be taken into account that this type of treatment
was abandoned for a reason. Also the precise mechanism underlying the therapeutic action of
the treatment is unknown, therefore long term effects are not known, and there may even be
immediate side-effects which are not apparent, but which are not known but could cause
damage later on to the patient. Furthermore although the effects have been shown to be mildly
positive, the side effects of memory loss, confusion and bone fractures perhaps are not
outweighed by the positive effects. Moreover Khalian argues that too little attention is paid to
patients with negative symptoms as Neuroleptic drugs are more effective for the control of
positive symptoms, he proposes that ECT combined with drug therapies may be effective for
patients with negative symptoms. Khalian undertook a small placebo controlled trial of drug
resistant participants who were assigned to three treatment groups, clozapine, ECT and a
combination of the two, and he was to asses the functioning before and after treatment using a
matched pairs design based on functioning. He found that combination therapy was superior
to either therapy on its own with improvement in 71% of combination treatment patients but
just 40% of those having ECT alone and 46% of those having clozapine alone. However, the
sample size was small, as was admitted by Khallian and furthermore the duration of remission
was not studied, therefore the effects looked at were only immediate. Furthermore this study
was taken out in 2006 which is long after the abandonment of ECT, therefore ethics could be
a problem as previously mentioned the treatment was abandoned for a reason and to perform
it again on patients, although given consent (can psychotic patients give consent?) is unethical
and unprofessional to backtrack on the orthodox view of this treatment and to perform it.

Drug therapy also known as chemotherapy is the most common treatment for schizophrenia
and it uses antipsychotic drugs. Conventional or typical antipsychotic drugs reduce the effects
of dopamine while atypical antipsychotic drugs reduce serotonin activity. Antipsychotic drug
therapy therefore works to reduce the amount of available dopamine or reduce the number of
dopamine receptors by blocking them. Drug therapy is highly strong in research support, and
furthermore drug therapy seems to produce the maximum benefit in the first six months of
use. More recently atypical drugs such as clozapine have been introduced which block
serotonin rather than dopamine receptors which have been found to be more effective than the
typical antipsychotic drugs (Julien 2005). Further research support of drug therapy comes
from research by David et al when reviewing relapse rates of 29 studies it was found that
there was a higher relapse rate of 55% using the placebo and of just 19% when using the drug.
However Ross et al pointed out that in the previous study, it doesn’t take into account the fact
that 45% of people did benefit from the placebo, therefore making the information misleading
and perhaps, points the findings in the direction of it being merely coincidental. However the
use of drug therapy has been found to produce a sedative effect and can significantly reduce
psychotic symptoms of hallucinations, which enables patients to live relatively normal lives,
however it is disputed as to what degree they are able to live normal lives. However the
conventional antipsychotic drugs have been found to produce very serious side effects, raising
doubts of their appropriateness as a treatment, with one development of symptoms as a result
of drugs being similar to those found in Parkinson’s disease and in it’s most serious form
leads to a condition called tardive dyskinesia which occurs in around 30% of the those taking
the drugs, with increased risks when use is prolonged (Gualtieri 1991).

Moreover before antipsychotic drugs 50% of patients diagnosed with schizophrenia and then
admitted to hospitals stayed there for life, in comparison to today where only 3% of
schizophrenics are in hospital and usually only stay for a few weeks if that. Therefore the
treatment of the mentally ill has changed radically for the better due to the hugely decreased
population of those diagnosed being admitted to hospital. Furthermore antipsychotic drugs
decreased many of the most disturbing symptoms, and in particular atypical drugs decreased
some of the negative symptoms as well. However with patients being prescribed
antipsychotics, the longer they are on these drugs, the higher their tolerance becomes,
therefore resulting in them needing more of the drug to get the same effect, therefore making
this treatment very expensive in the long run. However, coming off the drug can produce
symptoms which are far worse than the original ones. Furthermore some people have
criticized whether the widespread use of drugs in the treatment of mental disorders is
appropriate, referring to the treatment as pharmacological straitjackets, and that the drugs are
taking away patients sense of control or responsibility by keeping patients ‘zombied’ for the
benefit of the hospital and families.

Furthermore this treatment is deterministic as it suggests patients can’t help themselves and
must rely on drugs, with no implications of free will which contradicts evidence from cross
cultural studies where a strong support network of family and friends has proven to be a
successful treatment aid, where social stigma of the diagnosis it not attached, and furthermore
contradicts findings of those patients receiving CBT alone. Moreover reducing treatment to
blocking dopamine suggests that cause and treatment is biological only, although research has
shown that the cause is not just biological.

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