biological therapies for schizophrenia

Question 1

what’s the most common treatment for schiz

Answer 1

drug therapy antipsychotic drugs

Question 2

how are antipsychotic drugs taken

Answer 2

tablets or syrup.
those risk to not take medication avalibkle as injections every 2/4 weeks.

Question 3

how ling should antipsychotic drugs be taken for

Answer 3

may be required short or long term.
some patients can take short course then stop w/out return of symptoms.
other require for life or recurrence of schiz.

Question 4

what are the two types of antipsychotic drugs

Answer 4

typical (traditional)
newer atypical or second-generation drugs.

Question 5

what are the typical antipsychotic drugs

Answer 5

around 1950s & include chlorpromazine.
strong association between typical & chlorpromazine & dopamine hypothesis.

Question 6

how can chlorpromazine be taken and dosage

Answer 6

as tablets, syrup or injection.
orally - daily max 1000mg, initial doses much smaller gradually increase 400 to 800mg.
typical doses have declined over last 50yrs.

Question 7

how do the typical antipsychotics like chlorpromazine work

Answer 7

by acting as antagonists in the dopamine system.
antagonist r chemicals which reduce the action of a neurotransmitter.
dopamine antagonist work by blocking dopamine receptors in the synapses of the brain, reducing the action of dopamine.
initially when patient begins taking chlorpromazine dopamine levels build up, but then its production is reduced.

according to dopamine hypothesis - this dopamine-antagonist effect normalises neurotransmitter in key brain - reduces symptoms like hallucinations

Question 8

what do typical antipsychotics reduce

Answer 8

symptoms like hallucinations

Question 9

what is chlorpromazine also useful for

Answer 9

effective sedative
related to its effect on histamine receptors.
chlorpromazine often used to calm patients with other conditions.

Question 10

what are the atypical antipsychotics

Answer 10

used since 1970s.
aim in developing newer antipsychotics to improve effectiveness & reduce side effects.
antipsychotics don’t all work in same way.

Question 11

early clozapine
1970s/60

Answer 11

developed in 1960s, first trialed in 1970s.
withdrawn in 1970s bc of deaths from blood condition - agranulocytosis.

Question 12

later clozapine
1980s

Answer 12

in 1980s discovered to be more effective than typical antipsychotics.
clozapine remarked as treatment for schiz when all other failed.

Question 13

modern day clozapine

Answer 13

still used today, ppl take regular blood tests to prevent development of agranulocytosis .
bc of side effects not available as injection.
daily dosage is lower than chlorpromazine.
typically 300 - 450mg a day

Question 14

dosage of clozapine

Answer 14

300-450mg a day

Question 15

how does clozapine work ??

Answer 15

C binds to dopamine receptors in same way chlorproxamine does.
but in addition - acts on serotonin & glutamate receptors.

Question 16

what r the benefits of clozapine

Answer 16

this action helps improve mood & reduce depression/anxiety.
this may improve cognitive functioning.
so prescribed to patients w high risk of suicide. (30/50%)

Question 17

how many schiz sufferers attempt suicide

Answer 17

30 to 50%

Question 18

what was Risperidone aim

Answer 18

attempt to produce drug as effective as clozapine but w/out serious side effects.

Question 19

what is risperidone

Answer 19

more recently developed atypical antipsychotic
been around since 1990s.

Question 20

how can risperidone be taken

Answer 20

tablets, syrup or injection - lasts around 2 weeks.
small dose start, built up to 4-8mg max 12mg

Question 21

how does risperidone work

Answer 21

bind to dopamine & serotonin receptors. R binds more strongly to dopamine receptors than clozapine so is more effective in much smaller doses than most antispchotics.

evidence to suggest fewer side effects than is typical

Question 22

what are the 2 atypical antipsychotics

Answer 22

1. clozapine
2. risperidone

Question 23

all A02 points for biological therapies

Answer 23

+ evidence for effectiveness
- serious side effects
- use of antipsychotics depend on dopamine hypothesis
-problems for effectiveness

Question 24

A02
evidence for effectiveness

Answer 24

Thornley et al: reviewed a studies comparing effects of chlorpromazine to control conditions - patients received placebo.
13 trials. 1121 participants.
showed chlorpromazine better overall functioning & reduced symptoms severity.

++research supporting this^
Meltzer

Question 25

A02
Meltzer research support for the effectiveness

Answer 25

concluded that clozapine more effective than typical & atypical.
is effective in 30-50% of treatment resistant cases where typical have failed.

seems general antipsychotics r reasonably effective, strength

Question 26

A02
serious side effects

Answer 26

dizziness, agitation, sleepiness, stiff jaw, weight gain, itchy skin.
long term use - tardive dyslexia manifests as involuntary facial movements e.g. grimacing, blinking.

most serious - NMS neuroleptic malignant syndrome.
NMS results in high temp, delirium, coma can be fatal.
typical doses have declined NMS has become rarer. 0.1-2%

atypical developed to reduce side effects, worked (melzer)
but still exist clozapine - weakness

Question 27

what’s most serious side effect of typical antispychotics

Answer 27

NMS
neuroleptic malignant syndrome.
NMS results in high temp, delirium, coma can be fatal.

Question 28

how is NMS caused

Answer 28

drug blocks dopamine action in the hypothalamus, area in brain associated with the regulation of number of body systems.

Question 29

A02
use of antipsychotics depend on the dopamine hypothesis

Answer 29

theoretical issue not practical.
evidence showing original dopamine hypothesis not complete explanation for schiz.
instead - dope levels parts of the brain other than subcortext too low rather than too high.
so not clear how antipsychotic help w schiz when they reduce dope activity. = suggests antipsychotics shldnt work.
undermine effectiveness

Question 30

A02
problems with evidence for effectiveness Healy

Answer 30

HEALY suggested some successful trails had data published multiple X, exaggerated positive effects.

powerful calming effects-some positive effects. BUT not same as reducing severity of psychosis. & most published studies asses short term not long benefits.
& compare patients who keep taking them w those suffering withdrawal just stopped taking them.