Schizophrenia is a disorder characterised by abnormalities involving distortions of thought,
perception and emotion; and social withdrawal. There are two types of treatments: drug therapy
and family therapy.
Drug therapy views schizophrenia through biological lenses and involves the use of antipsychotic
drugs, which reduce the intensity of symptoms. The rst generation antipsychotics (conventional
antipsychotics), such as Chlorpromazine, block D2 receptors in synapses that absorb dopamine
in the mesolimbic pathway. As a result of reduction in action of dopamine, positive symptoms
such as auditory hallucinations are reduced. The newer antipsychotics (atypical antipsychotics),
on the other hand, target D2 dopamine activity in the limbic system but not D3 receptors in other
parts of the brain. Atypical antipsychotics such as Clozapine bind to dopamine, serotonin and
glutamate receptors. Additionally, they have a signi cant e ect not only on positive but also on
negative symptoms, improving mood, cognitive functions and reducing depression and anxiety.
Nowadays, the latter is preferred more as it seems to have some improvements compared to the
rst generation drugs.
Family therapy adopts a rather di erent approach. Family therapy aims to reduce levels of
expressed emotion, i.e. an adverse family environment, in order to decrease the likelihood of
relapse. Families have weekly meetings, where they deal with an array of issues. For example,
they are taught the facts about the illness, its causes, the in uence of drug abuse, and the e ect
of stress and guilt. This allows changing any negative ideas of family members that might not
necessarily be valid. It also involves communication skills training - members learn to listen, to
express emotions and to discuss issues, emphasising aspects, such as compromise, negotiation,
requesting a “time out”, etc. Family therapies underline the importance of achieving a balance
between caring and maintaining their own lives - such disorders are not easy to accept on behalf
of the family, thus it reduces anger and guilt and improves their ability to anticipate and solve
problems.
Davis analysed 29 studies with 3519 people who received either conventional antipsychotics or
placebo. He found a signi cant di erence in relapse rates: 55% of patients in placebo condition
compared to 19% of those receiving treatment. This demonstrates the e cacy of drug therapy.
However, Ross and Read underlined that 45% of the placebo group did bene t. Likewise, the
data suggests a large proportion would also have bene ted from a placebo. The gures are
misleading and do not indicate the quality of these drugs. Additionally, they argued all studies
under placebo conditions are not a fair comparison, as patients under placebo conditions took an
appropriate treatment before, which leads to a drug withdrawal state. This explains relapses in the
placebo condition. Consequently, it is better to compare conventional antipsychotics to atypical
antipsychotics instead.
Whilst atypical drugs seem to surpass conventional drugs, Leucht’s research suggests otherwise.
A meta-analysis of studies on atypical VS conventional antipsychotics indicated the new drugs
were only “slightly” more e ective than conventional, whilst some were no more e ective at all -
the superiority of atypical drugs compared to conventional ones is only moderate. Nevertheless,
conventional antipsychotics block all types of dopamine activity, essentially causing side e ects.
Hill found 30% of patients undertaking conventional antipsychotics develop tardive dyskinesia,
i.e. a severe neurological state characterised by unintentional body movement. In contrast,
atypical drugs have lower likelihood of side e ects, as Jeste found only 5% had them. Therefore,
drug therapy consisting of atypical antipsychotics can be considered appropriate.
However, despite the improvement of medication, there are still side e ects due to its longevity.
This raises issues taking into account mental state of patients with schizophrenia. If one is deeply
paranoid and constantly senses danger, it is likely he/she will start building conspiracy theories
and refuse to follow medical professional’s instructions. In fact, the doctor will prescribe even
more medication that reduces side e ects. Therefore, from this perspective, drug therapies are
both inappropriate and ine ective due to lower compliance rate.
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perception and emotion; and social withdrawal. There are two types of treatments: drug therapy
and family therapy.
Drug therapy views schizophrenia through biological lenses and involves the use of antipsychotic
drugs, which reduce the intensity of symptoms. The rst generation antipsychotics (conventional
antipsychotics), such as Chlorpromazine, block D2 receptors in synapses that absorb dopamine
in the mesolimbic pathway. As a result of reduction in action of dopamine, positive symptoms
such as auditory hallucinations are reduced. The newer antipsychotics (atypical antipsychotics),
on the other hand, target D2 dopamine activity in the limbic system but not D3 receptors in other
parts of the brain. Atypical antipsychotics such as Clozapine bind to dopamine, serotonin and
glutamate receptors. Additionally, they have a signi cant e ect not only on positive but also on
negative symptoms, improving mood, cognitive functions and reducing depression and anxiety.
Nowadays, the latter is preferred more as it seems to have some improvements compared to the
rst generation drugs.
Family therapy adopts a rather di erent approach. Family therapy aims to reduce levels of
expressed emotion, i.e. an adverse family environment, in order to decrease the likelihood of
relapse. Families have weekly meetings, where they deal with an array of issues. For example,
they are taught the facts about the illness, its causes, the in uence of drug abuse, and the e ect
of stress and guilt. This allows changing any negative ideas of family members that might not
necessarily be valid. It also involves communication skills training - members learn to listen, to
express emotions and to discuss issues, emphasising aspects, such as compromise, negotiation,
requesting a “time out”, etc. Family therapies underline the importance of achieving a balance
between caring and maintaining their own lives - such disorders are not easy to accept on behalf
of the family, thus it reduces anger and guilt and improves their ability to anticipate and solve
problems.
Davis analysed 29 studies with 3519 people who received either conventional antipsychotics or
placebo. He found a signi cant di erence in relapse rates: 55% of patients in placebo condition
compared to 19% of those receiving treatment. This demonstrates the e cacy of drug therapy.
However, Ross and Read underlined that 45% of the placebo group did bene t. Likewise, the
data suggests a large proportion would also have bene ted from a placebo. The gures are
misleading and do not indicate the quality of these drugs. Additionally, they argued all studies
under placebo conditions are not a fair comparison, as patients under placebo conditions took an
appropriate treatment before, which leads to a drug withdrawal state. This explains relapses in the
placebo condition. Consequently, it is better to compare conventional antipsychotics to atypical
antipsychotics instead.
Whilst atypical drugs seem to surpass conventional drugs, Leucht’s research suggests otherwise.
A meta-analysis of studies on atypical VS conventional antipsychotics indicated the new drugs
were only “slightly” more e ective than conventional, whilst some were no more e ective at all -
the superiority of atypical drugs compared to conventional ones is only moderate. Nevertheless,
conventional antipsychotics block all types of dopamine activity, essentially causing side e ects.
Hill found 30% of patients undertaking conventional antipsychotics develop tardive dyskinesia,
i.e. a severe neurological state characterised by unintentional body movement. In contrast,
atypical drugs have lower likelihood of side e ects, as Jeste found only 5% had them. Therefore,
drug therapy consisting of atypical antipsychotics can be considered appropriate.
However, despite the improvement of medication, there are still side e ects due to its longevity.
This raises issues taking into account mental state of patients with schizophrenia. If one is deeply
paranoid and constantly senses danger, it is likely he/she will start building conspiracy theories
and refuse to follow medical professional’s instructions. In fact, the doctor will prescribe even
more medication that reduces side e ects. Therefore, from this perspective, drug therapies are
both inappropriate and ine ective due to lower compliance rate.
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