Biological Therapies: Drugs Flashcards
How are drugs administered?
Usually taken orally but can injected if patients unreliable - forms a depot which slowly releases into body
What are the typical antipsychotics?
major are chlorpromazine (and haloperidol), drugs pass blood/brain barrier and act on receptor sites in brain, block D2 dopamine receptors
How effective is chlorpromazine?
In trials when compared to placebo, reduced relapse rates and improved functioning, confirmed by meta analyses
What are the side effects of chlorpromazine?
extrapyramidal side effects: movement disorders like Parkinonianism and tardive dyskinesia (involuntary movement of tongue and jaw), loss of sexual function, weight gain
What are atypical anti psychotics?
many people resistant to typicals, not useful for negative symptoms, major is clozapine which act on dopamine and serotonin receptor sites
How effective is clozapine?
In trials and meta analyses when compared to typical drugs, symptoms were reduced, fewer relapses, reduction in positive and negative symptoms, benefits for those resistant to typicals
What are the side effects of clozapine?
Fewer side effects, major effect on white blood cell count (could kill) but is closely monitored, fewer motor effects, increased drowsiness, temperature and hypersalivation
What are the questionable research practices in trials sponsored by drug companies?
Bury data (file drawer problem with financial motivation), biased data collection (drug by company is likely to be one found to be more effective)
What are the questionable research practices in trials sponsored by drug companies?
Bury data (file drawer problem with financial motivation), biased data collection (drug by company is likely to be one found to be more effective)
Who conducted a Cochrane review of chlorpromazine against a placebo?
Adams 2007, 2012: 349 trials but 299 excluded due to flaws, all RCTs, drug reduces relapse of short/medium period but heterogeneous data, homogeneous data for long term, global improvement in symptoms and functioning, fewer people left trial when on drug
Who conducted a Cochrane review to compare clozapine to typical medication?
Essali 2009: all RCTs, clozapine for effective in general, clinical improvements more frequent, fewer relapses, more symptom reduction (varied data), 34% treatment-resistant Pps had clinical improvement with clozpine
What are the concerns with the research used?
Worries that study are moderately prone to bias favouring clozapine - better conduct and reporting of trails would increase confidence in results
What did NICE find about drugs used to treat schizophrenia?
up to 40% patients show poor response to conventional anti psychotics, serious long term affect is tardive dyskinesia = 20% receiving antipsychotics
What did NICE find about drugs used to treat schizophrenia?
up to 40% patients show poor response to conventional anti psychotics, serious long term affect is tardive dyskinesia = 20% receiving 1st generation antipsychotics
Who found major issues with the comparison of 2nd generation antipsychotics?
Davis 2006: abstracts of all studies funded by drug companies masked the names/doses of drugs, in 90% trials the drug sponsored was favoured = contradictory conclusions across studies
