Introduction to Treating Schizophrenia

Welcome! In the previous chapter, we looked at what schizophrenia is and why it happens. Now, we are going to look at the "how" — as in, how do we treat it? Because schizophrenia is a complex disorder with both biological and psychological roots, doctors and psychologists use a variety of methods to help people manage their symptoms. We will explore drug therapies, psychological therapies, and the "big picture" view known as the interactionist approach.

1. Biological Treatments: Drug Therapy

Drug therapy is the most common treatment for schizophrenia. These drugs are known as antipsychotics. They generally work by changing the balance of chemicals in the brain, particularly dopamine.

Typical Antipsychotics

These are the "first generation" of drugs, developed in the 1950s. They work as dopamine antagonists. This means they bind to dopamine receptors (specifically D2 receptors) and block them, preventing dopamine from over-stimulating the brain. This is based on the dopamine hypothesis, which suggests that too much dopamine causes positive symptoms like hallucinations.

  • Effect: They are very effective at reducing positive symptoms.
  • Side Effects: They can cause severe side effects, such as "tardive dyskinesia" (uncontrollable facial tics and movements).

Atypical Antipsychotics

These are the "second generation" drugs developed in the 1970s and 80s. They were designed to be just as effective as the older drugs but with fewer side effects.

  • How they work: Like typical drugs, they block dopamine, but they also act on other neurotransmitters like serotonin and glutamate.
  • Effect: They help with both positive symptoms (hallucinations) and negative symptoms (like avolition or lack of motivation). They are also often used for patients who don't respond well to typical antipsychotics.

Quick Summary: Drug therapy is fast-acting and can help a person stabilize so they can engage in other types of therapy. However, they don't "cure" schizophrenia; they manage the symptoms.

2. Psychological Treatments

While drugs treat the biology, psychological therapies help patients manage their thoughts and their environment.

Cognitive Behaviour Therapy (CBT)

In schizophrenia, CBT is used to help patients identify and change dysfunctional thought processing. The goal isn't to make the hallucinations go away entirely, but to help the patient make sense of them.

  • Challenging Irrational Thoughts: A therapist might ask a patient to look for evidence for their delusions. For example, if a patient believes the government is watching them through the TV, the therapist might ask, "If they are watching everyone, how do they have enough people to sit and watch your specific screen all day?"
  • Normalisation: Helping the patient understand that hallucinations are just "errors" in perception can reduce the anxiety and "voice-hearing" distress.

Family Therapy

This therapy involves the whole family, not just the patient. It is based on the idea that family dysfunction (like high levels of stress or criticism) can make schizophrenia worse or cause a relapse.

  • Reducing Stress: The therapy aims to reduce "Expressed Emotion" (EE) — which includes criticism and hostility.
  • Improving Communication: Families learn better ways to talk to each other and solve problems, creating a calmer environment for the patient to recover in.

Key Takeaway: Psychological therapies give patients coping mechanisms that drugs cannot provide. They empower the patient to take control of their own recovery.

3. The Interactionist Approach

Modern psychology rarely looks at just one cause or one treatment. Instead, it uses the interactionist approach. This approach recognizes that schizophrenia is the result of both biological and environmental factors working together.

The Diathesis-Stress Model

This is the "Golden Rule" of the interactionist approach. It suggests that people have a diathesis (a vulnerability) and a stressor (an environmental trigger).

  • Diathesis: This is usually biological, such as a genetic predisposition or brain structure issues. For example, a person might be born with a higher risk because of their genes.
  • Stress: This is a psychological or environmental experience that "triggers" the vulnerability, such as family dysfunction, trauma, or even drug use (like cannabis) during adolescence.

Analogy: Think of a glass of water. The diathesis is how much water is already in the glass (your genetic risk). The stress is the extra water being poured in. Schizophrenia only "overflows" when the combination of the two becomes too much.

Combined Treatments

If schizophrenia is caused by both biology and environment, then the best treatment is to address both! In the UK, it is very common to see patients prescribed antipsychotic drugs (to handle the biological side) alongside CBT (to handle the psychological side).

Did you know? Research shows that patients who receive a combination of drugs and psychological therapy often have lower relapse rates than those who only take drugs.

4. Evaluating Treatments (AO3)

When you are writing about these in an exam, you need to consider how appropriate (is it right for the person?) and effective (does it actually work?) they are.

  • Effectiveness: Drug therapy is highly effective at reducing symptoms quickly, but about \( 20\% \) to \( 30\% \) of patients are "treatment-resistant" (the drugs don't work for them). CBT is effective at reducing distress, but it requires the patient to be motivated and engaged.
  • Appropriateness: Family therapy is very appropriate for patients who live with their families and have high levels of conflict. However, for a patient with no family contact, it obviously isn't an option.
  • The "Symptom Overlap" Problem: Sometimes it is hard to know which treatment is working because schizophrenia symptoms often overlap with other disorders like Bipolar Disorder.
  • Ethics: Typical antipsychotics have been criticized as "chemical straitjackets" because they can make patients very lethargic and passive, which raises questions about the patient's quality of life.

Quick Review: Common Mistakes to Avoid

Mistake 1: Thinking CBT "cures" hallucinations. Correction: CBT helps the patient manage and interpret their symptoms so they are less distressing.

Mistake 2: Thinking the Diathesis-Stress model only refers to genes. Correction: While it often does, "diathesis" can also include early childhood trauma that changed how the brain developed.

Mistake 3: Ignoring side effects. Correction: In evaluation, always mention that side effects of drugs are a major reason why patients stop taking their medication (leading to relapse).

Summary Checklist:
1. Do you know the difference between Typical and Atypical drugs?
2. Can you explain how CBT and Family Therapy help?
3. Can you define the Diathesis-Stress model?
4. Can you explain why combining treatments is usually best?