For Section B

• Describe
• Tricyclic e.g. Amytriptyline - sedative
• SSRI e.g. Prozac
• Theory - Serotonin
• Link to cause – biochemical
• Who is involved and how – GP, Psychiatrist, RMN, CPN
• Accessed by ....... Self, professional
For Section C
• Effective/Ineffective – research x 3
• Advantages
• Disadvantages
• Put references in text
• Check it’s OK for reader

For Section B
• Describe
• Major Tranquiliser e.g. Chlorpromazine –works on positive symptoms
• Atypical e.g. Olanzipine – works on positive and negative symptoms
• Intra-muscular – Depot e.g. depixol
• Theory - dopamine
• Link to cause – biochemical
• Who is involved and how – GP, Psychiatrist, RMN, CPN
• Accessed by - Self, professional
For Section C
• Effective/Ineffective – research x 3
• Advantages
• Disadvantages - side effects and others
• Put references in text
• Check it’s OK for reader

For Section B
• Explain – What is family therapy – education , increase self awareness discussion
• Theory/assumption – improving communication to support family and reduce relapse
• Procedure – varies depending on family : 1:1, group ,therapist involved or observer
• Will use different models of cognitive therapy dependent on their preference
• Link to cause – learned, life events
• Access – professional
• Who is involved – various, need trainin
•

ECT - applied to Depression in the main but do apply to Schizophrenia ( NICE, not used much)
For Section B
• Describe procedure
• Theory – brain chemicals changed - serotonin
• Link to cause - biochemical
• Who is involved and how – psychiatrist, junior doctors, RMN
• Accessed by ....... – emergency, professional, self (rarely)
For Section C
• Effective/Ineffective x3 sources
• Advantages
• Disadvantages
• Put references in text
• Check it’s OK for reader
ECT
ECT – Electro convulsive therapy is the process of sending and electric current through the brain
to artificially bring on a seizure. General anestetic is used throughout the procedure alongside
muscle relaxants.

What is ECT and why is it controversial?

ECT involves sending an electric current through the brain to trigger a seizure, or fit, with the aim,
in most cases, of relieving severe depression. The treatment is given under a general anaesthetic
and uses muscle relaxants, so that the muscles do not contract, and the body does not convulse
during the fit.
Currently, there is no clear explanation of how ECT works, and this is a cause of controversy. On
the one hand, its critics describe it as a crude treatment that causes brain damage; on the other
hand, its supporters defend it as an effective and life-saving technique. (See How does it work?)
People’s experience of ECT varies enormously. It’s a short-term treatment, which can’t directly
address underlying despair or practical problems, and does not prevent future depression.
Memory problems are widely reported, though for some people they are only temporary. Some
people feel violated by ECT.
Mind conducted a survey, in 2001, of mental health service users who had received ECT. It found
that as many people found it unhelpful as helpful:

‘I would happily die rather than have ECT again.’ (Woman, Yorkshire.)
‘If I had not received ECT I would be dead by now.’ (Woman, Staffordshire.)
In a survey conducted by the ECT Accreditation Service (ECTAS – also see below) between
September 2004 and February 2006, 72 percent of service users said that ECT had been helpful,
20 per cent said that it had had no effect, and 5 per cent said they would not want it again. 14 per
cent believed that it had changed or saved their lives.
Many psychiatrists are convinced that it is an effective treatment for seriously depressed people,
when no other treatment has been effective or available. They would argue that it is a suitable
treatment when it is important to have an immediate effect; for example, because a person is so
depressed that they are refusing to eat or drink, and are in danger of kidney failure.
Back to top
What is it used for?
ECT has been used to treat all types of mental distress in the past. It is now most commonly used
to treat severe depression and, occasionally, mania, schizophrenia and catatonia.
In 2003, NICE (National Institute for Health and Clinical Excellence) published guidance
recommending that ECT is used ‘only to achieve rapid and short-term improvement of severe
symptoms after an adequate trial of other treatment options has proven ineffective and/or when
the condition is considered to be potentially life-threatening, in individuals with severe depressive
illness; catatonia; a prolonged or severe manic episode’.
In treating schizophrenia, the ECT Handbook (published by the Royal College of Psychiatrists)
recommends that ECT should be limited to patients who are unable to take clozapine (an
antipsychotic drug given to those who are not helped by other antipsychotics), or who respond
poorly to it, when psychotic symptoms (such as hallucinations) accompany a mood disorder (such
as depression) or great agitation or immobility, and treatment recommendations for severe
depression or mania would apply.
Because, when it works, ECT usually works very quickly, some psychiatrists think it is the best
treatment for severe postnatal depression. It can minimise the time that the new mother is not
able to care for and bond well with her baby. (See Understanding postnatal depression.)
Side effects

Medicines and their possible side effects can affect individual people in different ways. The
following are some of the side effects that are known to be associated with this medicine. Just
because a side effect is stated here does not mean that all people using this medicine will
experience that or any side effect.

· Dry mouth.

· Drowsiness.

· Blurred vision.

· Constipation.

· Nausea.

· Difficulty in passing urine.

· Drop in blood pressure when moving from a lying or sitting position to sitting or standing,
causing dizziness and lightheadedness (postural hypotension).

· Sweating.

· Involuntary muscle movements such as tremors or twitching.

· Rashes.

· Confusion or delirium.

· Headache.

· Sexual problems.

· Changes in behaviour.

· Increased appetite and weight gain.

· Taste disturbances.

· Low blood pressure (hypotension).

· Disturbances in the normal numbers of blood cells in the blood.

· Abnormal heart beats.

· Faster than normal heart beat (tachycardia).

· Convulsions (fits).
The side effects listed above may not include all of the side effects reported by the drug's
manufacturer.

Netdoctor.co.uk

Amytriptyline
This drug is a type of medicine called a tricyclic antidepressant. In the brain there are
many neurotransmitters and serotonin and noradrenaline are 2 that are linked to depression.
When serotonin and nordrenaline are released they change the mood a person is feeling for the
better, and this is why it is believed that peopole that suffer from depression that they have a
decreased level of both of the neurotransmitters realeased from the nerve cells, alongside for
depression amytriptyline helps with other treatments.

The way that the drug is prescribed is the way that the patient should take the drug, as it will have
been set for the individual, and although symptoms of depression may not disappear immediately
it can take upto 4 weeks to feel better and at no point should the person decide to take themself
off the drug as the side effects can be unpleasant.

Some side effects of the drug include sudden numbness or weakness, headaches,
halluncinations and seizures, rashes, restlessness, thirstyness and some less serious side effects
could include drowsyness, tiredness, blurred vision and decreased sex drive.

How does it work?

The way this drug works is that it stops the serotonon and noradrenaline being reabsorbed in the
brain, which is usually the cause of the depression due to chemical imbalances in the brain.
Because the neurotransmitters are not being reabsorbed the mood of the person will be lightened
and the amitripyline will help to lighten the person with depression in turn.

Who is involved?
Practitioners involved in accessing drugs are a GP as they are the people that will firstly diagnose
and provide a short term treatment such as anti-depressants until they refer the patient on to a
specialist. This specialist could be a psychiatrist that will confirm a diagnosis on the condition the
person has and then go on to access the drugs that they need to get a better balance in the brain
to help the person feel better. Also involved in the access to drugs can be registered mental
health nurse that can administer the drugs/treatment in the hospital and can help to monitor the
drugs the patient is on and if they are the ones for the patient, if they are helping to reduce the
symptoms and making the patient feel any better. A community psychiatric nurse can be involved
aswel if the person is managing from home and they can, similarly to nurses in the hospital
monitor the treatment plan and how it is effecting the patient as they go round to the persons
house and ensure they are taking their prescribed medication when they need to and how much
they need to.

How are they accessed?

Drugs can be accessed by self referral, by professional referral or by 3rd party referal. This is
because if a person goes to the GP to get help they will be prescribed some treatment for their
condition which is self referral, secondly professional referral could access drugs as the patient
could be referred to a psychiatrist and they could prescribe a drug or course of treatment that is
best for that person and suits them. Lastly, it could be 3rd party referral for access to drugs if a
parent was worried about their child and they then get prescribed something for their problem.

For Section B
• Describe
 • Tricyclic e.g. Amytriptyline - sedative
• SSRI e.g. Prozac
• Theory - Serotonin
• Link to cause – biochemical
• Who is involved and how – GP, Psychiatrist, RMN, CPN
• Accessed by ....... Self, professional
For Section C
• Effective/Ineffective – research x 3
• Advantages
• Disadvantages
• Put references in text
• Check it’s OK for reader

Prozac
Prozac is an anti-depresant also known as a selective seotonon reuptake inhibitor, in prozac is
the ingrediant Fluoxetine. In teh brain there are many neurotransmitters and there is one called
Serotonin, when this is released within the brain this lightens the persons mood,

With lots of drugs there are certain side effects, although these will not all effect the patient - if
any. Some include; Headache, sweating, seizures, dizziness, abdominal pains, hair loss and
sexual problems also pain in the joints or muscle.

Drugs tend not to work immediately and it is crucial to maintain the dose that the doctor has
prescribed as after a while of the body getting used tothe drug it will start to take effect and
relieve the depressive symptoms. It is important not to change the dose to suit yourself and to
keep up the course the doctor prescribed and the way it was given.

How does it work?

As the serotonin lightens a peersons mood it is vital to keep a certain amount of this within the
brain and so that it does not get reabsorbed to darken a persons mood, prozac is taken. The
serotonon levels within the brain are thought to be the reason behind a persons depression and
by taking this it should help to relieve the depression and stop reabsorbtion.

Who is involved?

How are they accessed?

Drugs such as prozac can by accessed by all types of referral, including self referral, professional
referral and 3rd party referral. Prozac would be prescribed if it is thought that this drug would be
the best for he patient and their symptoms, as the only neurotransmitter it affects is Serotonin,
unlike amitripyline which effects serotonin and noradrenaline. Self referral access would be
gained by going to the local GP and going through the diagnosis process and then on a course of
treatment. This would be more likely to be prescribed however by professional referral as the
referral by GP would be usually to a psychiatrist or specialist i mental health that will find a course
of medication suitable dependant upon the symptoms shown. Lastly, 3rd party would be referring
somebody to either a GP or specialist in the hope that they will gain some help and this is when
mdication/treatment including Prozac would come about.

For Section B
• Describe
• Major Tranquiliser e.g. Chlorpromazine –works on positive symptoms
• Atypical e.g. Olanzipine – works on positive and negative symptoms
• Intra-muscular – Depot e.g. depixol
• Theory - dopamine
• Link to cause – biochemical
 • Who is involved and how – GP, Psychiatrist, RMN, CPN
• Accessed by - Self, professional

Chlorpromazine
This is known as a 'Major tranquiliser' and used to treat people with what is referred to as a
psychotic illness, this would cover the illness of Schizophrenia. The ingrediant inside this
tranquiliser is chlorpromazine hydrochloride, and is not just a tranquiliser as the function of this
drug is to work on a wide amount of things in the brain.

Chlorpromazine trys to get a control of the unreal thoughts sufferers are having and help with the
behaviour that they are showing and also what they feel which are the positive symptoms or
schizophrenia . This drug is not a light drug and without doctors permission cannot suddenly stop
being taken.

Side effects of this drug include such things as drowsiness, agitation, abnormal movemens of the
hands, legs and other limbs, insomnia and twitching. These are possible side effects and the
most likely would be the twitching or involuntary movements which people may find odd but is a
side effect to stop the disturbed thoughts.

How does it work?

Dopamine, is a neurotransmitter in the brain like many others such as serotonin or nordrenaline.
This drug blocks the neurotransmitter dopamine as it is thought to be linked to the cause of the
condition scizophrenia by overactivity of this neurotransmitter or too much of it. It is important to
ensure there is not too much overactivity of this neurotransmitter and this is because messages
are sent from brain cells in connection with this neurotransmitter and too much could interupt or
disturb these messages.

Who is involved?

How is it accessed?
The two most probable referral routes in prescribing this type of drug known as a tranquiliser
would intially be professional referral and 3rd party referral. This is because professional referral
may be by a doctor if they notice unusual things about behaviour or things that are dicussed with
the doctor. Alongside this if somebody else is worried by behaviour maybe hallucinations or
delusions it is likely they will want to help and tell a doctor. It is unlikely that with a condition such
as shizophrenia or any psychotic illness that the patient would refer themselves as they don't tend
to have insight and don't see a problem with their behaviour or with thoughts or actions they are
having or doing.

Olanzipine
Olanzipine can also be known as an atypical antipsychotic drug, and this can be administered
through either tablets or injection. It is usually only taken by injection when a quick dose needs to
be given to patients maybe in emergency situations but is usually found in tablet form and
dissolve. Serotonin and dopamine are neurotransmitters in the brain that help to regulate moods.
And it is believed that illnesses like schizophrenia are caused due to distubances in the
neurotransmitters.

Possible common side effects from the drug Olanzipine include weight gain, feeling tired,
increasde in apitite, dizziness, rashes and a dry mouth. This drug has a number of side effecyts
linked to it which vary from common to uncommon but the less worrying ones are the ones which
people wil most likely suffer from.

How does it work?

Olanzapine works by blocking the neurotransmitters to make sure that there is not too much of
them produced and by doing this it will relieve the symptoms in the sufferer.
Other drugs that are used to help relieve symptoms are not usually like this drug in terms of
treating both types of symptoms which are positive and negative. Drugs such as Chlorpromazine
only treat the positive symptoms, and this means not only hallucinations and delusions can be
helped but also help the patient socially and emotionally.

Who is involved?

How is it accessed?
Depixol
The depixol injection is referred to as a 'depot' injection alongside being a major
tranquiliser and it is injecting into a muscle such as the thigh so that the flupentixol
ingredient inside can be released into the blood slowly for around 2-4 weeks. Like other
drugs it does not just have one function but acts to relieve symptoms in psychotic
illnesses like schizophrenia.
Side effects of the injection include fits, rashes, incontinence, drowsiness and impotence.
Although there are many side effects they are not always experienced but are possible
with such a drug as this one.
How does it work?
Flupentixol blocks dopamine receptors in the brain, which is a neurotransmitter, this
neurotransmitter's function is to regulate moods and too much causes over-stimulationin
the brain and is believed to be the reason for psychotic illnesses such as schizophrenia.
Who