To read up on biological therapies for schizophrenia, refer to pages 409–414 of
Eysenck’s A2 Level Psychology.
Ask yourself
 If a biochemical imbalance is the cause of schizophrenia, what would be the
 treatment?
What do you think are the weaknesses of biological therapies?
 Should electroconvulsive therapy be used for schizophrenia?
What you need to know
DRUG THERAPY ELECTROCONVULSIVE THERAPY (ECT)
 Neuroleptic drugs
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Atypical antipsychotic drugs
General evaluation of drug therapy
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Research evidence
Evaluation and effectiveness and appropriateness of ECT
Drug therapy
There are two main categories of drug: (1) conventional or neuroleptic drugs; and
(2) the newer atypical drugs. Some drugs are more effective at reducing the positive symptoms (hallucination, delusions) than the negative ones (lack of motivation, lack of emotion, social withdrawal).
Neuroleptic drugs
Common neuroleptic drugs include Thorazine, Prolixin, and Haldol. These drugs block the activity of the neurotransmitter dopamine within 48 hours, and so it is their effect upon the dopamine system that is therapeutic, although it can take several weeks before there is any significant symptom reduction.
RESEARCH EVIDENCE FOR NEUROLEPTIC DRUGS
 Comer (2001, see A2 Level Psychology page 409) suggests that the drugs do work for the majority of patients and are the most successful treatment as they are more effective as a single treatment than any other therapy.
 Lower dosages of the drugs can reduce unpleasant side effects although this has to be carefully balanced against the fact that higher dosages offer the best outcome in terms of reducing the symptoms of schizophrenia (Barondes,
1993, see A2 Level Psychology page 410).
RESEARCH EVIDENCE AGAINST NEUROLEPTIC DRUGS
 Birchwood and Jackson (2001, see A2 Level Psychology page 409) concluded that there is no good evidence that neuroleptic drugs are effective in treating the negative symptoms of schizophrenia.

EVALUATION OF NEUROLEPTIC DRUGS
 Effectiveness. Research shows neuroleptics are effective in reducing the symptoms of schizophrenia, particularly the positive symptoms, such as hallucinations and delusions.
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Relapse rates. Patients tend to relapse in a relatively short period of coming off the drugs and so essentially need to remain on them for life. Sampath et al. (1992, see A2 Level Psychology page 409) found 75% of schizophrenics who had previously been on the neuroleptics for 5 years relapsed within a year when switched to a placebo compared to only 33% in the control group who continued on the neuroleptics.
Side effects. Patients report unpleasant and distressing side effects of neuroleptics such as sedation, grogginess, impaired concentration, and blurred vision. More seriously patients can develop a cluster of symptoms closely resembling those of Parkinson’s disease (e.g. muscle rigidity, tremors, foot shuffling). Furthermore, approximately 2% of patients develop neuroleptic malignant syndrome. This involves muscle rigidity, altered consciousness, and fever, and can be fatal. These symptoms normally develop within a few weeks of starting drug therapy.
 Tardive dyskinesia. More than 20% of patients who take neuroleptic drugs for over a year develop tardive dyskinesia. Symptoms include involuntary sucking and chewing, jerky movements of the limbs, and writhing movements of the mouth or face; these effects can be permanent.
Atypical antipsychotic drugs
Schizophrenia is increasingly treated with atypical antipsychotic drugs (e.g.
Clozaril?, Risperdal?, Zyprexa?). These drugs block activity of the neurotransmitter dopamine in the same way neuroleptics do but they also affect serotonin activity.
RESEARCH EVIDENCE FOR ATYPICAL DRUGS
 They benefit 85% of patients with schizophrenia, compared with 65% given neuroleptic drugs (Awad & Voruganti, 1999, see A2 Level Psychology page
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410).
Meltzer (1999, see A2 Level Psychology page 410) found that about one-third of patients who had shown no improvement with neuroleptic drugs responded well to the atypical drug clozapine.
 The atypical drugs do treat the negative symptoms (Remington & Kapur,
2000, see A2 Level Psychology page 410).
EVALUATION OF ATYPICAL DRUGS
 Compare favourably to the neuroleptics. The atypical drugs compare
 favourably because they are as effective, if not more so, than the neuroleptics but with fewer side effects. Plus they also treat the negative symptoms, which the neuroleptics do not.
Agranulocytosis. This is a serious potential side effect of the atypicals. There is a 1–2% risk of developing agranulocytosis, which involves a substantial

reduction in white blood cells, and can be life threatening. However, olanzapine (which is another atypical drug) does not seem to cause agranulocytosis.
GENERAL EVALUATION OF DRUG THERAPY
Effectiveness
 Better than other therapies. Drug therapy is probably more effective than
 any other form of therapy in the treatment of schizophrenia.
Rapid action. Drug therapy often reduces the symptoms of schizophrenia
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 more rapidly than psychological therapies.
Treats symptoms not causes. Drugs suppress the symptoms of schizophrenia without addressing the underlying processes responsible for the disorder. Drug therapy for schizophrenia is basically a palliative treatment in that it manages the disorder but does not cure it and so patients need to remain on the drugs indefinitely.
Does not work for everybody. Some patients are resistant to drugs, and so
 the drugs are not effective with everyone. Although more patients respond to the atypical drugs than to the neuroleptics, this is still not all patients.
Do not treat negative symptoms. The neuroleptics have little effect on the negative symptoms.
 Placebo effect. The placebo effect occurs when patients given an inactive substance or placebo (e.g. a salt tablet) show significant reductions in their symptoms. It is difficult to know how much any improvement is due to the drug and how much to the placebo effect, i.e. the patient improves because they expect the drug to work.
Appropriateness
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Schizophrenia has a biological basis. Drug therapy is appropriate because schizophrenia is partly biological. The drugs act on the dopamine system and this is appropriate because this biochemical is imbalanced in schizophrenics.
Side effects. These are detailed above and do question the appropriateness
 of the use of drugs.
Compliance. The side effects result in many schizophrenics refusing to take the drugs and so compliance is a real issue, which reduces the appropriateness of the drugs.
 Treats symptoms not causes. Again this issue is considered above and also questions the appropriateness of drugs as a treatment. We can question how appropriate it is to take something that just subdues the symptoms rather than cures the disorder, particularly when prolonged use of the drugs is
 likely to result in some form of unpleasant side effect.
Individual differences. Appropriateness is also questioned by the fact that the drugs do not work for all patients. Approximately 35% of patients do not
 respond to neuroleptics and 15% do not respond to the atypicals.
Reductionism. Drug therapy only focuses on one level, the biological, and so ignores the psychological approach to treatment.

Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT) was based on the observation that epileptics did not have schizophrenia and so it was concluded that the two disorders were antagonistic (cannot have one if have the other). This led to the deduction that inducing seizures could help treat schizophrenia, and this was done initially using drugs such as camphor and then cardiazol. It was then discovered that electric shocks could produce seizures and that ECT had better outcomes than cardiazol.
ECT involves passing an electric current through the head to produce brain seizures.
It used to result in patient terror as well as broken bones because the whole body would be in seizure; traditionally no anti-anxiety drugs were used and it was a dangerous process. The modern use of ECT has a number of improvements, including muscle relaxants to minimise the convulsions and the use of anaesthetics so that the patient is asleep during the treatment and so does not experience the same anxiety. In addition, bilateral ECT (administering ECT to both brain hemispheres) has been mainly replaced by unilateral ECT (applying it only to the non-dominant hemisphere) to reduce any memory loss.
RESEARCH EVIDENCE FOR ECT
 Tharyan and Adams (2005, see A2 Level Psychology page 412) concluded from their meta-analysis on the effects of ECT in treating schizophrenia that it had beneficial effects in the short term, but smaller than those obtained with drugs. Furthermore, it wasn’t clear that ECT produced long-term
 benefits to patients with schizophrenia. But it was successful where rapid symptom reduction was required and for patients who did not respond well to drugs.
Chanpattana (2007, see A2 Level Psychology page 413) considered the effects of ECT on positive and negative symptoms. ECT produced a marked reduction in positive symptoms, and significant improvements in quality of life and social functioning, especially when used in combination with drug therapy. However, ECT had no effect or led to a worsening of negative symptoms.
EVALUATION OF ECT
Effectiveness
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Moderate effectiveness. It can effect a rapid improvement in the symptoms of schizophrenia but such improvements tend to be short term and so it does not produce long-term improvement. The effectiveness of ECT is also limited because it is better combined with drug therapy than used on its own.
Less effective for negative symptoms. Recent evidence suggests that ECT is more effective in treating the positive symptoms of schizophrenia than the negative ones. It is not very effective at all in reducing the lack of motivation, lack of emotion, or social withdrawal.

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Treats symptoms not causes. ECT reduces the symptoms of schizophrenia; it does not produce a cure. Thus, it is a palliative rather than a curative treatment.
Appropriateness
 ECT is consistent with the biological basis of schizophrenia. Most of the symptoms of schizophrenia seem to involve deficient functioning within the
 brain, and so a form of treatment that alters brain functioning may well prove to be appropriate.
Schizophrenia is difficult to treat. Particularly historically, but even today, if you consider the side effects of drug therapy, schizophrenia is a difficult disorder to treat and so this means ECT is appropriate in spite of it being such a radical form of therapy.
Side effects. Memory loss, other cognitive impairments, and possible neurological damage do question the appropriateness of the treatment.
However, this must be balanced against the fact that most side effects are relatively short lasting.
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Memory loss is not permanent. The American Psychiatric Association and the British National Institute for Health and Clinical Excellence have both concluded that ECT does not cause permanent brain damage.
We do not understand how it works. Some would argue that because we
 do not understand how it works then we should not use the treatment.
Ethical issues. Issues of protection and informed consent are raised because most patients dislike receiving ECT, and some might be put under excessive
 pressure to become involved in this form of therapy. Historically it was used as a form of punishment and to exert control over patients.
Reductionism. ECT only focuses on one level—the biological, and so ignores the psychological approach to treatment.
So what does this mean?
We have considered two forms of biological therapy for schizophrenia, drugs and
ECT. Both have been assessed in terms of effectiveness and appropriateness and this leads to the conclusion that atypical drugs generally have the better outcomes in terms of long-term improvements and the range of symptoms treated than neuroleptics and ECT. However, all biological treatments raise issues of appropriateness such as side effects, individual differences, and the fact that they treat the symptoms not the causes. This last criticism is a key weakness as this makes biological treatments palliative because they manage the disorder rather than cure it and so we need to consider if psychological treatments offer more hope of a cure.
Over to you
(a) Outline one or more biological therapy(ies) for schizophrenia. (9 marks)
(b) Evaluate the therapy(ies) described in (a). (16 marks)