Treating Schizophrenia: Biologically

As I mentioned in the biological explanations Hub, it is believed that if schizophrenia has a biological cause it should be treated biologically, so this will be the subject of this particular Hub. There are going to be two main sections: historical treatments and anti-psychotic medication.

As the title suggests these treatments are not really used anymore as they are no longer considered appropriate but for the sake of this Hub I thought they deserved a mention. There are two types of historical treatment that I will be discussing: psychosurgery and electro convulsive therapy (ECT.)

Psychosurgery

This original procedure was first conducted by Moniz in 1935 and involved lesioning (cutting) the connections between the frontal lobes and the sub-cortical regions to produce a tranquilising effect. When moved to the US the procedure was updated by Walter Freeman who turned the lobotomy into the transorbital lobotomy. With this update the procedure involved inserting a scalpel through/behind the eye socket and then completing the lesions this way. Despite there being no real standardised procedure, a lack of evidence for its effectiveness and a long list of side effects the procedure was very common for schizophrenic patients up until around 1960.

However, now in the UK the use of psychosurgery to treat schizophrenia and other conditions is only ever to be used as a last resort owing to the 1983 Mental Health Act. After this law was brought in, the use of psychosurgery has drastically declined, for example in 1970, 500 operations were performed comp[ared to only 18 in 1991.

Electro Convulsive Therapy (ECT)

With this treatment an electrical current is passed through the brain of patients with the hope of alleviating schizophrenia symptoms, although researchers do not know exactly how this works, it has been proved relatively successful with some patients. First the patient will be given a barbiturate (anaesthetic) to render them unconscious and a muscle relaxant to paralyse their muscles. The electrical current of approximately 0.6amps is passed through two electrodes on the patients head. These electrodes can either be placed on either temple (bilateral ECT) or one on the temple and one in the middle of the forehead (unilateral ECT.) The current is passed through the brain for approximately half a second causing a seizure which can last up to a minute and affects the entire brain. For this to be successful around 3-15 treatments are usually required.

However, there are many side effects of ECT such as brain damage, memory dysfunction and possibly even death so for this reason, ECT is considered very extreme and as such not as widely practised anymore. Furthermore, evidence has shown that ECT may not even be effective or appropriate in treating schizophrenia.

Tharyan and Adams 2005: This study showed that ECT may not be effective in treating schizophrenia and involved reviewing 26 studies with 798 participants in total. The aim of the study was to discover whether ECT actually resulted in any meaningful benefit for schizophrenia patients. To do this they compared ECT with a placebo condition, with stimulated or 'sham' ECT and with anti-psychotic medication. Although results did favour the real ECT in the ECT vs. simulated ECT condition there was no indication that the advantage was maintained in the long term. In the ECT vs. medication condition, results favoured the medication groups but there was little evidence to suggest that there was a greater improvement in mental state when ECT and medication was used together.

Gagne et al 2000: This study involved following up 58 depressed patients. It was found that 93% of patients who continued treatments of ECT and antidepressents were free from symptoms for over 2 years compared to 52% of patients who solely took antidepressents. This therefore shows that ECT may be more appropriate in treating depression and not schizophrenia.

Anti-psychotic medication was first introduced in the 1950s due to advances in pharmacology and is a form of chemotherapy as it is a chemical based therapy. There are two main types of anti-psychotic medication: typical (first generation) and atypical (second generation). Originally, first generation drugs targeted D2 (dopamine) receptor sites while newer second generation drugs had a more widespread effect on key neurotransmitters. Hence this form of treatment is based on the belief that schizophrenia is caused by an excess of dopamine. Therefore the aim of anti-psychotics is to reduce and stabilise the balance of dopamine and alleviate some of the symptoms of schizophrenia.

Typical anti-psychotics e.g. chlorpromazine are primarily used to combat positive symptoms such as hallucinations which are a result of an overactive dopamine system. This type of anti-psychotic bind to dopamine receptos sites and are therefore aiding post synaptic action.

On the other hand atypical anti-psychotics e.g.clozapine also combat positive symptoms but there are claims that they also have some beneficial effects on negative symptoms too so therefore must also target serotonin. These types of anti-psychotics are responsible for lower levels of side effects e.g. lower levels of tardive dyskinesia compared to typical anti-psychotics. Finally, atypical anti-psychotics temporarily block dopamine receptor sites and disassociate themselves.

How effective are anti-psychotics?

Elesser et al 1996 found that typical anti-psychotics help up to 65% of those treated whereas atypical anti-psychotics help up to 85% of patients. Although they can decrease the severity of symptoms there is no cure.

What are the possible side effects?

There are many side effects but I will just write about three. One irreversible side effect is the condition tardive dyskinesia which effects around 20-30% of patients taking anti-psychotics. This is a deliberating condition that is characterized by abnormal involuntary bodily and facial movements e.g. lip smacking and tongue thrushing.

Another side effect is dystonia which is where muscle contractions produce uncontrollable movements of the neck, face, tongue and back.

And finally a side effect is akathisia which is restlessness, agitation and discomfort of the limbs resulting in constant fidgeting