Most Preferred Intervention for Schizophrenia Research Paper

Excerpt from Research Paper :

Schizophrenia Treatments

Schizophrenia is a brain disorder that results in hallucinations, paranoid delusions, confused or disordered thinking and/or speech, difficulty concentrating and functioning, and other negative symptoms. It is diagnosed according to criteria described by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V, 2013): the individual should show signs of hallucinations, delusions or disorganized speech in a continuous manner for at least 6 months, with 1 at least one month of active symptoms occurring that negatively impacts the person’s ability to work or socialize consistently. The World Health Organization (2017) states that roughly 21 million people throughout the world suffer from schizophrenia. Schizophrenia is a treatable disease, however, and as Saks (2009) shows, an individual can lead a normal life while having schizophrenia because there are a number of treatments available to help control the symptoms.

Treatments

Treatments available for individuals who suffer from schizophrenia typically include a combination of pharmacological approaches and therapeutic approaches. Pharmacological treatments include antipsychotic mood stabilizers called neuroleptics. Therapeutic interventions include a wide range of methods, such as support group therapy or psychosocial therapy. Dietary supplements like Glycine are also utilized along with mood stabilizers or anti-depressants. In extreme cases, electroconvulsive therapy has been used to stabilize individuals who suffer from schizophrenia (Kates, Dequardo & Tandon, 1999).

Antipsychotics or neuroleptics are commonly used to treat schizophrenia and typically result in a reduction of the positive symptoms of the disease. There are a variety of drug choices available as Leucht, Cipriani, Spineli et al. (2013) showed in their comparative study of 15 antipsychotic drugs used to treat schizophrenia. Their meta-analysis of 212 suitable trials including data from over 43,000 patients showed that all fifteen of the drugs “were significantly more effective than placebo” (Leucht et al., 2013, p. 951). Drugs can differ in terms of the side effects they cause, so finding the right drug for the patient can sometimes be a process of trial and error, as a lot of the pharmacological success of this treatment depends on how the individual responds to the drug. Nonetheless, neuroleptics are viewed as an important treatment method in the stabilization of the subject.

Other psychotropic drugs are often prescribed and polypharmacy is common method of treatment, as Zink, Englisch and Meyer-Lindenberg (2010) show in their review of treatment options for schizophrenic patients. The purpose of polypharmacy is to address issues of cognitive disturbance, comorbidity, obsessive-compulsive syndromes, and other side effects that stem from antipsychotic treatment. As their study shows, “the add-on of lithium and mood stabilizers lacks compelling evidence, but might be beneficial for specific subgroups” and “for treatment-resistant cognitive symptoms, antipsychotic medication should be combined with cognitive remediation, as no pharmacological add-on strategy has gained convincing evidence so far” (Zink et al., 2010, p. 103).

In the early stages of the treatment, the patient may require to be hospitalized and even restrained to prevent self-injury or injury to others. As Saks (2009) has shown, this type of treatment, while necessary in the short-term, can cause long-term negative consequences and prevent the patient from wanting to seek treatment later on as the memories of being restrained against one’s will can be very traumatic for the patient and cause the patient to want to avoid hospitals and doctors. Saks (2009) recommends that patients be consulted once stabilized regarding how they would like to be treated in the future should they ever present themselves in a condition where they are unable to function or respond clearly to questions or commands. By giving patients a say when they are stable as to whether they would like to be forcefully restrained as a precautionary measure in the future, schizophrenic individuals can feel more confident about having their rights and personhood respected. This can be an important point to remember when it comes to treating individuals suffering from this disease.

Therapies that are often used in treating schizophrenic patients include cognitive behavioral therapy (CBT), support group therapy, psychoanalysis, and psychosocial therapy. Studies by Turkington, Kingdon and Turner (2002) show that CBT is an effective way to help stabilize schizophrenic patients in a brief amount of time and can be given safely by psychiatric nurses to help improve the lives of schizophrenic patients. CBT works effectively because it focuses the patient on adopting behaviors that will counteract the onset of a schizophrenic attack such as delusional thoughts or hallucinations. It also helps to act in a preventive manner by assisting the patient in directing his or her life in a manner that is more conducive to dealing with the reality of the schizophrenia.

Preferred Treatment

The American Psychiatric Association (2004) has published a guide for treating schizophrenia that offers recommendations for stabilizing the patient by working with the individual through an Acute Phase and into the Stable Phase, where the patient is able to control the symptoms of schizophrenia using the prescribed treatments. The preferred treatment would be to combine antipsychotic medication with CBT to stabilize the patient and reduce the effect of the symptoms significantly.

The first step in the treatment of schizophrenia in the Acute Phase is to give the patient a broad goal—which is to keep the individual from committing harm to him or herself or to others. This goal is important because it shows the patient that the aim is to restore functionality on a consistent and long-term basis by forming an alliance between the patient, his or her family, and the treatment provider. It is important because it helps the patient establish a connection to others based in trust. Since the patient is likely to suffer from paranoia or other negative thoughts, this trust is important to build and neuroleptics are the best option in decreasing the mental symptoms of schizophrenia and allowing the patient to get a handle on confused or disordered thinking.

Along with the application of neuroleptics it is important to also implement a therapeutic intervention, and the preferred method of therapy would be CBT since it identifies behavioral goals that the patient can work towards adopting in order to more fully deal with the effects of schizophrenia. CBT is a preferred therapeutic approach because it focuses on the behavior of the patient instead of trying to identify a cause of the schizophrenia through an exploration of the patient’s mind, past, thoughts, beliefs, ideas, and so on. While the psychoanalytic approach might be preferable to some who want to identify the source or cause of their condition, it is widely held that there is no known cause of schizophrenia and the best that treatment providers can do is to facilitate the patient in simply learning to live with the disorder, to fully cope with the symptoms and thereby take back control of one’s life, as Saks (2009) has shown is fully possible through her own story of dealing with the disorder. Being a full-time academic, a teacher, and a researcher, Saks’ (2009) story illustrates the extent to which schizophrenia can actually be moderated and controlled through the help of a strong support system consisting of friends and family, the use of neuroleptics or atypical neuroleptics (so as to reduce the number of side effects) and behavioral therapy.

Thus combing neuroleptics with behavioral therapy is the most preferred treatment as based on evidence provided by academics, professionals, researchers and even patients themselves like Saks (2009) who fills a duel role as patient and mental health scholar. This preferred treatment is also supported by the research of Leucht et al. (2013), Turkington et al. (2002), Zink et al. (2010) and many others. However, it is not the only effective method and the most preferred method is really the one that the patient is most comfortable with. So it might turn out that the patient does not prefer the CBT method for him or herself and would rather utilize support group therapy or another psychosocial therapy. The patient might also prefer one neuroleptic over another, or the patient might show a preference for no neuroleptics (though this is not recommended as the rate of relapse is higher when patients do not take neuroleptics). Nonetheless, these are issues that should be discussed with the patient, the patient’s family, and the provider so that everyone is on the same page, is informed and is committed to adopting the best course of action for the individual.

Limitations of the Preferred Treatment if It Were the Only Option

With that said there are clear limitations to the preferred method of treatment and the first one is that in extreme cases of schizophrenia it may not be possible to stabilize the patient through the use of neuroleptics or therapy. In these cases, electroconvulsive therapy may be the only option that works to get the patient under control so that he or she is no longer a threat to him or herself or others. While this type of therapy may be controversial and used as a last resort, it is…

Sources Used in Document:

References

American Psychiatric Association. (2004). Treating schizophrenia. Retrieved from http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/schizophrenia-guide.pdf

DSM-V. (2013). American Psychiatric Association. Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm

Kales, H. C., Dequardo, J. R., & Tandon, R. (1999). Combined electroconvulsive therapy and clozapine in treatment-resistant schizophrenia. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 23(3), 547-556.

Leucht, S., Cipriani, A., Spineli, L., Mavridis, D., Örey, D., Richter, F., Samara, M., Barbui, C., Engel, R.R., Geddes, J.R. and Kissling, W. (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. The Lancet, 382(9896), 951-962.

Saks, E. (2009). Diary of a High-Functioning Person with Schizophrenia. Scientific American. Retrieved from http://www.scientificamerican.com/article/diary-of-a-high-function/.

Turkington, D., Kingdon, D., & Turner, T. (2002). Effectiveness of a brief cognitive—behavioural therapy intervention in the treatment of schizophrenia. The British Journal of Psychiatry, 180(6), 523-527.

World Health Organization. (2017). Schizophrenia. Retrieved from http://www.who.int/mental_health/management/schizophrenia/en/

Zink, M., Englisch, S., & Meyer-Lindenberg, A. (2010). Polypharmacy in schizophrenia. Current Opinion in Psychiatry, 23(2), 103-111.

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