Revise Treatment and management of schizophrenia for Cambridge 9990 (1.1.3)

Antipsychotics are the primary biochemical treatment for schizophrenia, working on the principle of the dopamine hypothesis. They are categorised into two main types: typical (first-generation) and atypical (second-generation). Typical antipsychotics, such as Chlorpromazine, primarily act as dopamine antagonists by blocking D2 receptors. They are effective in reducing positive symptoms like hallucinations and delusions. Atypical antipsychotics, such as Clozapine and Risperidone, block D2 receptors more transiently and also act on other neurotransmitters, notably serotonin. This dual action makes them effective against both positive and negative symptoms (e.g., avolition) and often results in fewer motor side effects. However, both types have significant side effects—tardive dyskinesia for typicals and metabolic syndrome for atypicals—which can impact patient adherence.

Cognitive Behavioural Therapy for psychosis (CBTp) is a talking therapy adapted to help individuals manage the symptoms of schizophrenia. It does not aim to eliminate symptoms but to reduce the distress they cause. The therapist and patient work collaboratively to identify and challenge irrational beliefs (delusions) and develop coping strategies for hallucinations. For instance, using a process of reality testing, a patient might be encouraged to find evidence for and against their delusional belief. For auditory hallucinations, patients learn to view the voices as part of their illness and develop techniques to manage them, such as focusing on external sounds or engaging in conversation. This process helps patients to re-evaluate their understanding of their psychotic experiences, granting them more control and improving their overall functioning.

Family therapy is a psychological intervention that views the family as a system and aims to improve its functioning to support the individual with schizophrenia. Its primary goal is to reduce high levels of Expressed Emotion (EE) – a family communication style involving criticism, hostility, and emotional over-involvement, which is a strong predictor of relapse. Sessions typically involve the patient and key family members. A therapist helps the family to understand the illness (psychoeducation), improve communication, learn problem-solving skills, and reduce feelings of guilt or anger. By creating a more stable and supportive home environment, family therapy reduces stress on the patient, which has been shown to significantly lower relapse rates compared to medication alone.

Care in the community represents a fundamental shift from long-term institutionalisation to providing support for individuals with schizophrenia within their own locality. This model aims to enhance quality of life, promote independence, and prevent social isolation. A key element is the Assertive Community Treatment (ACT) team, a multidisciplinary group of professionals (e.g., psychiatrists, social workers, nurses) who provide intensive, round-the-clock support. This includes medication management, psychological support, and practical help with housing, finances, and employment. By offering holistic and proactive care, community services aim to reduce hospital readmissions and help individuals integrate more fully into society. The success of this model, however, is heavily dependent on adequate funding and resource allocation.