The Role of Psychological Therapies in Treating Schizophrenia - Essay Example

Treating Schizophrenia: The role of psychological therapies Abstract Schizophrenia is a brain disorder that makes it hard to differentiate between real and unreal life experiences, to logically think and abnormal responses to changes in the environment. This paper looks at an overview of the schizophrenia illness, signs and diagnosis. The main part of the paper focuses on pharmacological treatment of schizophrenia and the role played by psychotherapy in treating schizophrenia. It was found out that pharmacological agents are the best in the treatment of schizophrenia but they are limited with their side effects. Psychotherapy is safer but cannot be used as the initial choice of treatment. It was concluded that pharmacological therapy complemented with psychotherapy helps to best treat schizophrenia. Introduction Schizophrenia is a chronic, disabling and severe mental disorder that affects people from all walks of life. It has been experienced by people around the globe throughout history. Approximately 1% of people in the USA have this disorder. A person suffering from schizophrenia might be hearing voices that people around them don’t. They have the feeling that other people control their thoughts, read their minds and plan to harm them. This makes them terrified causing them to be withdrawn and awfully agitated. Such people may not make much sense when they talk and might sit down for a very long time without making a single move. People with schizophrenia might appear perfectly well until they start talking of their actual thoughts. Schizophrenia might also affect families and societies, especially a society where people depend on other for help because they cannot hold onto their jobs or they cannot take care of themselves (Van Os and Kapur, 2009). Schizophrenia has a variety of symptoms including feeling tense, anorexia, lack of sleep and troubles in concentrating. A person may become isolated or withdrawn and making of keeping friends becomes a problem. Psychotic symptoms usually develop when as the illness continues. Such symptoms include flat effect which refers to an appearance without any noticeable emotions, catatonic behavior where the person shows less reaction to the changes in the environment, delusions where a person has false beliefs or has unrealistic thoughts, hallucinations where the person sees, hears or feels things that are not their and disordered thinking where someone’s thought are divided among unrelated issues. Though schizophrenia has been there throughout history, not laboratory test has been developed for it. The complicated range of its signs and symptoms cannot be measured with such methods as evaluation of the mental status. This is because the symptoms of psychosis may be caused by other diseases. A thorough diagnosis is usually made through a detailed interview of the patient and the family members. The factors that might assist in diagnosis of this illness are; Genetics, family history, developmental background, emotional history, development of the illness, how long the symptoms have been observed, the current symptoms and response to medication. Imaging techniques such as head CT scans may reveal changes that result from schizophrenia ruling out other illnesses (Schultz , North and Shields, 2007). The main purpose of this paper is to explore the role of psychological therapies in treating schizophrenia. However it will not rule out the current pharmacological approach to the illness, this paper will therefore discuss the pharmacological to the treatment of schizophrenia, and then discuss the role of psychological therapies. Pharmacological Approach to Treatment of Schizophrenia Pharmacological medication remains best approach in treatment and management of schizophrenia. This started with the discovery of chlorpromazine in the year 1952 opening a whole new era of pharmacological medication for Schizophrenia patients. After that, many drugs were developed and are now available for the treatment of schizophrenia. These drugs work by blocking a variety of postsynaptic receptors like the D2 dopamine receptors. The tendency of there pharmacological agents to block the D2 receptors located in the mesolimbic projections is said to be the concept underlying the therapeutic effects they have on the patients with positive symptoms. When these drugs work on the D2 receptors in the hypothalamus and the basal ganglia basically result in neurohormonal changes and extrapyramidal side effects. Because these changes and side effects are more or less similar to the effects of the older drugs, they are referred to as the ‘typical’ antipsychotics (Lieberman, 2007). Although these pharmacological agents are the best for treating schizophrenia, they have major limitations as far as patient response is concerned. Between 30% to 50% of patients showing positive symptoms usually don’t respond or partially respond to the pharmacotherapeutic drugs. Those with negative schizophrenia symptoms and showing neurocognitive deficits show poor response to the typical antipsychoticdrugs or are worsened by them (Lambert and Pantelis, 2003, pg 63). There are also many side effects related with the use of pharmacological drugs to treat schizophrenia including cognitive impairment, sedation, diabetes, weight gain, hyperprolactinemia, seizures, heart problems and antimuscarinic side effects like constipation (Marx J, et al, 2002), dry mouth and urine retention. These drugs are currently available in Australia and they include risperidone, quentiapine, amisulpride, olanzapine and clozapine. For these limitations and side effects listed above, the pharmacological agents (drugs) are increasingly being replaced by psychotherapies because of they are safer. The Role of Psychotherapy in Treating Schizophrenia People with schizophrenia do not use psychotherapy (Cognitive Behavioral Therapy, CBT) as the treatment of choice. Most of the time, psychotherapy is used as a compliment to a good medication plan where neuroleptics are in a good medication plan (Addington, et al, 2005). However, they play the role of helping a patient to maintain is or her medication plan. In addition, it allows the patients to learn the required social skills by helping them to achieve their personal weekly or monthly set goals and objectives in improving their situation and making them acceptable in the society. Psychotherapy usually comes in form of reassurance, advice, education, reality testing, modeling and limit setting with the therapist (Tarrier, N., et al. (2001). They are encouraged by the therapists to set small goals and achieving them is said to be helpful and as a result, they are guided on setting bigger goals and when they achieve these goals, they help themselves. The schizophrenia patients usually have a hard time mastering and performing the basic life skills such as personal grooming, cleaning, cooking and communication with family members, friends and colleagues at work. Psychotherapy also plays a role in helping the patient to gain self confidence and trusting themselves to take care of themselves and live their lives to the fullest. This therapy is called self help. It is important to note that most therapists and medical professional usually overlook the role played by the self-help kind of therapy. Very few of them recognize it as a form of psychotherapy which needs very little guidance from the medical professionals and the therapists. The best way this happened is in adjunctive support groups in the community in parallel with psychotherapy. However, caution must me taken especially when the patient’s symptoms are under the control of pharmacological medication. This is because, people with schizophrenia usually have a difficulty in socializing with others and therefore, self help in a support group should not be used as the initial choice of treatment. Self help in a support group should be used as the patient goes further into treatment helping the patient to trace their tracks back to their social life. Self-help also works for the patient’s family since the difficulties and the tress that family members go through when one of their loved ones is affected with this condition is usually overwhelming and hard to cope with, especially for the family. The self-help is therefore for the family which should join a support group in their community. This therapy play a role of making the family share their experiences and learn more about better ways to deal with their feelings, frustrations, hardships and anger toward the patient. Family therapy also helps in significantly deceasing rates of relapsing for the person with schizophrenia in that particular family. In families with high stress levels, 50-60% of schizophrenic patients who have undergone standard aftercare will undergo a relapse. A family undergoing therapy should always have meetings every time an issue comes so that it ca be discussed and study the nature of the problems, come up with solutions and to finally agree on the best solution (Rakel, 2005) Group therapy is therefore a very important aspect of psychotherapy for both the patients and their families in schizophrenia treatment. When group therapy is complimented with pharmacological drugs, better results are obtained that when either psychotherapy or neuroleptics are used alone for treatment. The therapy is likely to be more successful when the support groups deal with real-life issues, relationships and problems, work and social roles and interpersonal interactions when taking the patient through psychotherapy. The cooperation with drug treatment, focused discussions on the side effects and involvement in work activities and practical recreational actions helps the patients to cope with real life issues and to even understand what happened with them once they start noticing the drug side effects. Support group therapy plays a significant role in decreasing social isolation while increasing the real-life testing by the therapists (Wykes, et al, 2008). Conclusion In a nutshell, it cannot be said that cognitive behavioral therapy is the best for the treatment of Schizophrenia as compared to neuroleptic drugs. It has been judged that pharmacotherapy and psychotherapy should be used in complement with each other. The patient should be put on the best medical plan and then made to under go psychotherapy that will help to accept and cope with the side effects of the drugs and help them to cope with the real life issues that can make them blend again with the society. Psychotherapy should be further examined and evaluated in various clinical cases and the effects compared for both the less skilled and expert practitioners to find out if it can fully replace pharmacological therapy because they are safe and have few or no side effects. After medication and psychotherapy, prevention of the reoccurrence of the symptoms should be done by fully following the medication plan laid out by the doctor. Side effects are one of the major causes of patients not sticking to the medication plan. Therefore, medication to control the symptoms without causing the side effects should be taken with collaboration with psychotherapy. References Addington D, Bouchard RH, Goldberg J, Honer B, Malla A, Norman R, Tempier R. (2005) Clinical practice guidelines: treatment of schizophrenia. Can J Psychiatry.;50:7s-57s. Lambert T, Velakoulis D, Pantelis C. (2003) Medical comorbidity in schizophrenia. Med J Aust; 178  Lieberman JA. (2007), Effectiveness of antipsychotic drugs in patients with chronic schizophrenia: efficacy, safety and cost outcomes of CATIE and other trials. J Clin Psychiatry.;68:e04. Marx J, et al, (2002), Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby;:1541-1548. Rakel RE. (2005), Textbook of Family Practice. 6th ed. Philadelphia, Pa: WB Saunders;115-124. Schultz SH, North SW, Shields CG. (2007), Schizophrenia: a review. Am Fam Physician.;75:1821-1829. Van Os, J., & Kapur, S. (2009). Schizophrenia. Lancet, 374, 635-645. Wykes, T., Steel, C., Everitt, B., & Tarrier, N. (2008) Cognitive behaviour therapy for Schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin, 34, 523-537. doi: 10.1093/schbul/sbm114 Tarrier, N., et al. (2001). Are some types of psychotic symptoms more responsive to cognitive behaviour therapy? Behavioural and Cognitive Psychotherapy, 29, 45-55. doi: 10.1017/S1352465801001060 Read More

The factors that might assist in diagnosis of this illness are; Genetics, family history, developmental background, emotional history, development of the illness, how long the symptoms have been observed, the current symptoms and response to medication. Imaging techniques such as head CT scans may reveal changes that result from schizophrenia ruling out other illnesses (Schultz , North and Shields, 2007). The main purpose of this paper is to explore the role of psychological therapies in treating schizophrenia.

However it will not rule out the current pharmacological approach to the illness, this paper will therefore discuss the pharmacological to the treatment of schizophrenia, and then discuss the role of psychological therapies. Pharmacological Approach to Treatment of Schizophrenia Pharmacological medication remains best approach in treatment and management of schizophrenia. This started with the discovery of chlorpromazine in the year 1952 opening a whole new era of pharmacological medication for Schizophrenia patients.

After that, many drugs were developed and are now available for the treatment of schizophrenia. These drugs work by blocking a variety of postsynaptic receptors like the D2 dopamine receptors. The tendency of there pharmacological agents to block the D2 receptors located in the mesolimbic projections is said to be the concept underlying the therapeutic effects they have on the patients with positive symptoms. When these drugs work on the D2 receptors in the hypothalamus and the basal ganglia basically result in neurohormonal changes and extrapyramidal side effects.

Because these changes and side effects are more or less similar to the effects of the older drugs, they are referred to as the ‘typical’ antipsychotics (Lieberman, 2007). Although these pharmacological agents are the best for treating schizophrenia, they have major limitations as far as patient response is concerned. Between 30% to 50% of patients showing positive symptoms usually don’t respond or partially respond to the pharmacotherapeutic drugs. Those with negative schizophrenia symptoms and showing neurocognitive deficits show poor response to the typical antipsychoticdrugs or are worsened by them (Lambert and Pantelis, 2003, pg 63).

There are also many side effects related with the use of pharmacological drugs to treat schizophrenia including cognitive impairment, sedation, diabetes, weight gain, hyperprolactinemia, seizures, heart problems and antimuscarinic side effects like constipation (Marx J, et al, 2002), dry mouth and urine retention. These drugs are currently available in Australia and they include risperidone, quentiapine, amisulpride, olanzapine and clozapine. For these limitations and side effects listed above, the pharmacological agents (drugs) are increasingly being replaced by psychotherapies because of they are safer.

The Role of Psychotherapy in Treating Schizophrenia People with schizophrenia do not use psychotherapy (Cognitive Behavioral Therapy, CBT) as the treatment of choice. Most of the time, psychotherapy is used as a compliment to a good medication plan where neuroleptics are in a good medication plan (Addington, et al, 2005). However, they play the role of helping a patient to maintain is or her medication plan. In addition, it allows the patients to learn the required social skills by helping them to achieve their personal weekly or monthly set goals and objectives in improving their situation and making them acceptable in the society.

Psychotherapy usually comes in form of reassurance, advice, education, reality testing, modeling and limit setting with the therapist (Tarrier, N., et al. (2001). They are encouraged by the therapists to set small goals and achieving them is said to be helpful and as a result, they are guided on setting bigger goals and when they achieve these goals, they help themselves. The schizophrenia patients usually have a hard time mastering and performing the basic life skills such as personal grooming, cleaning, cooking and communication with family members, friends and colleagues at work.

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