Schizophrenic Model

The two most common treatments used for schizophrenic patients are cognitive behavioural therapy (CBT) and anti-psychotic drugs.
The Medical Model (MM) of treatment proposes that the causes of schizophrenia are physical (biochemistry/neuroanatomy) therefore, the treatment should also be physical. The MM recommends direct manipulation of biological process to treat schizophrenia. Anti-psychotic (AP) drugs are designed to reduce the effects of the neurotransmitters which are believed to be the cause. There are two forms of AP drugs: conventional and atypical. Conventional AP drugs, such as phenothiazine, can reduce the amount of available dopamine receptors by blocking them; drugs such as chlorpromazine reduce acute positive symptoms such as
The basic assumption of CBT is that people often have distorted beliefs that influence their behaviour in maladaptive ways. The learning of maladaptive responses to life’s problems is often the result of distorted thinking by the schizophrenic, or mistakes in assessing cause and effect. CBT aims to help the patient to identify and correct these faulty interpretations. During CBT, the therapist lets the patient develop their own alternatives to these previous maladaptive beliefs, ideally by looking for alternative explanations and coping strategies that are already present in the patient’s mind. The therapy usually takes place weekly or fortnightly with between 5 to 20 sessions. Patients are encouraged to trace back to the origins of their symptoms in order to get a better idea of how they may have developed; understanding where symptoms originate is crucial for some patients as it allows them to develop rational reasoning for these thoughts and feelings. Patients are also encouraged to evaluate the content of their delusions or auditory hallucinations, and to consider ways in which they might test the validity of their faulty beliefs. They may also be set behavioural assignments by their therapist in order to enable them to improve their general level of functioning. The therapist may draw diagrams for patients to show them the links
Outcome studies of CBT suggest patients who receive such treatment experience fewer hallucinations and delusions and recover their functioning to a greater extent than those who receive antipsychotic medication alone. Turkington et al. (2002) found that CBT has a significant effect on both positive and negative symptoms of schizophrenia and also said that it can be effectively delivered by brief intervention programmes delivered by community psychiatric nurses. Research conducted by Chadwick et al. (2000) showed that patients involved in CBT experienced a significant reduction in negative beliefs about the power of the voices and how much they were controlled by them.
However, not everyone with schizophrenia may benefit from CBT. Kingdon and Kirschen (2006) studied 142 schizophrenic patients and found many patients weren’t deemed suitable for CBT because psychiatrists believed they wouldn’t fully engage with therapy. In particular, they found older patients were deemed less suitable than younger patients. This could be due to a number of factors such as motivation, the elderly are less likely to be motivated to change as they used to living with the condition and have entered a ‘bubble’ in which they do not intend to