4.4. Biological Treatment of Sz

Question 1

What is the aim of antipsychotics?

Answer 1

To rebalance the neurotransmitters that appear to be causing sz.

Question 2

How can antipsychotics be taken?

Answer 2

• Tablet or syrup
• Can be given in a short course of treatment without symptoms returning for some whilst others may need them for life.

Question 3

What does drug therapy aim to do?

Answer 3

Aims to enable the person to function and improve their well-being. Antipsychotics all reduce dopaminergic transmission in particular areas.

Question 4

What time period was the development of typical antipsychotics?

Answer 4

1950s

Question 5

What are examples of typical antipsychotics?

Answer 5

• chlorpromazine
• pimozide

Question 6

What does chlorpromazine do?

Answer 6

• Combats the positive symptoms of sz.
• They’re dopamine antagonists and bind to dopamine receptors without stimulating them, blocking the action of dopamine receptors in the synapse. This reduces the action of dopamine.

Question 7

What happens to hallucinations and delusions when taking chlopromazine?

Answer 7

They diminish within a few days

Question 8

What does chlorpromazine have an effect on other than dopamine receptors?

Answer 8

Histamine receptors which lead to a sedation effect- used to calm anxious patients when they’re first admitted to hospital

Question 9

What does pimozide do?

Answer 9

Another typical antipsychotic that works by decreasing the activity of dopamine in the brain

Question 10

When were atypical antipsychotics developed?

Answer 10

1970s

Question 11

What is the aim of atypical antipsychotics?

Answer 11

To suppress psychosis and also minimise the side effects.

Question 12

What do atypical antipsychotics target?

Answer 12

dopamine and serotonin

Question 13

What does clozapine do?

Answer 13

• Binds to dopamine receptors but also acts on serotonin and glutamate receptors

Question 14

Why is clozapine more effective than typical antipsychotics?

Answer 14

Clozapine reduces depression and anxiety as well as improves cognitive function.

They also improve mood, which is important as up to 50% of people suffering from sz attempt suicide.

Question 15

Why was risperidone developed?

Answer 15

This developed due to clozapine being involved in the deaths of some patients from a blood condition

Question 16

What does risperidone do?

Answer 16

Binds to dopamine and serotonin but risperidone binds more strongly to dopamine receptors and is therefore more effective in smaller doses than most antipsychotics and has fewer side effects

Question 17

Weakness: side effects

Answer 17

• Typical antipsychotics are associated with dizziness, agitation, sleepiness, weight gain and in the long term, smacking and grimacing
• An extreme side effect is neuroleptic malignant syndrome, caused by blocking dopamine action in the hypothalamus.
• A typical antipsychotics were developed to reduce side effects but some still exist.

Question 17

Strength: anti-psychotic vs placebo

Answer 17

• A meta analysis of 65 studies including 6000 patients concluded that 64% of patients taken off antipsychotics and given a placebo relapsed within 12 months, compared to 27% of those who stayed on antipsychotics
• Thornley et al reviewed data from 13 trials (1121 ppts) and found the chlorpromazine was associated with better functioning and reduced symptom severity compared with a placebo.
• Meltzer concluded that clozapine is more effective than typical antipsychotics - it’s effective in 30-50% of treatment-resistant cases
• This shows the effectiveness of antipsychotic treatments

Question 18

Weakness: overestimated effectiveness of drug therapy

Answer 18

• Healy suggests that data from some successful trials have been published multiple times, exaggerating the positive effects
• Most studies only review short term effects, furthermore, they have a powerful calming effect which demonstrates that they have a positive effect on patients
• This means the effectiveness of drug therapy may have been overestimated

Question 19

Weakness: motivational deficits

Answer 19

Ross and Read: claim that prescribing medication reinforces a biological explanation of sz so people aren’t motivated to look for solutions to social or cognitive factors which may be contributing to their suffering - reductionist

Question 20

Weakness: ethical issues

Answer 20

Antipsychotics may have been used in hospitals to calm patients and make them easier to work with, rather than to benefit the patients.

This practice is seen by some as a human rights abuse.

This raises ethical issues in the use of antipsychotic drugs with sz patients.