biological therapies for schizophrenia

Question 1

Drug therapy

Answer 1

• most commonly used treatment
• called anti-psychotic drugs
• these can be taken as tablets, syrups or injections
• can be required to be taken for short or long-term use

Question 2

Typical Anti-psychotics

Answer 2

1st type of antipsychotic that has been around since the 50s

Question 3

Typical Anti-psychotics: Chlorpromazine

Answer 3

• it can be taken as a tablet, syrup or injection
• when taken orally it can go up to 1000mg
• does have declined over the years
• it blocks dopamine receptors reducing the amount of dopamine
• can reduce symptoms like hallucincations
• can also be a sedative as it affects the histamine receptors
• it can be used to calm patients down

Question 4

Atypical Anti-psychotics: Clozapine

Answer 4

• developed in the 60s to reduce the side effects of typical drugs and psychotic symptoms
• it was found to be more effective in relieving symptoms of schizophrenia
• used today but patients are checked against agranulocytosis
  not available as an injection
• a daily dose is lower to 300-450mg per day
• binds to dopamine receptors and also serotonin & glutamate receptors
• meant to improve mood & reduce depression, anxiety and improve cognitive functioning
• sometimes prescribed to those at risk of suicide

Question 5

Atypical Anti-psychotics: Risperidone

Answer 5

• developed in the 90s
• created to reduce effects but without as many side effects as Clozapine
• it can taken as a tablet, syrup or injection
• small doses given at the start to build up to a daily dose of 4-8mg
• binds to dopamine and serotonin receptors more strongly
• evidence to suggest that the smaller dose causes less side effect

Question 6

AO3: Evidence for effectiveness (S)

Answer 6

• Thornley et al (2003): reviewed studies comparing effects of Chlorpromazine to control conditions where patients received a placebo
  
  • results from 13 trials with 1121 ppts showed that Chlorpromazine was associated with better overall functioning & reduced symptom severity
  • data from 3 trials with 512 ppts showed that relapse rate was lower in the Chlorpromazine was taken
• Meltzer (2012): concluded that Clozapine is more effective than typical antipsychotics & other atypical antipsychotics
  
  • it is effective in 30-50% of treatment-resistant cases where typical antipsychotics failed
• other studies have compared the effectiveness if Clozapine & other atypical drugs like Risperidone
  
  • results have been inconclusive maybe as some respond better to one drug or the other
• evidence suggests that drugs are effective in reducing symptoms

Question 7

AO3: Serious side effects (W)

Answer 7

• typical antipsychotics are associated with side effects including dizziness, agitation, sleepiness, stiff jaw , weight gain & itchy skin
• long term use can lead to tardive dyskinesia
  
  • involuntary facial movements such as grimacing, blinking & lip smacking
  • caused by dopamine supersensitivity
• most serious side effect is neuroleptic malignant syndrome (NMS)
  
  • results in high temperature, delirium, coma and can be fatal
  • believed to be caused by the drug blocking dopamine action in the hypothalamus (area that regulates body systems)
• typical doses have decline and NMS has become rarer (0.1% to over 2%)
• atypical antipsychotics were designed to overcome the side effects of typical antipsychotics
  
  • side effects still exist & patients taking Clozapine have to be regularly tested for agranulocytosis

Question 8

AO3: chemical cosh arguement (W)

Answer 8

• widely believed that antipsychotics are used for the benefit of the medical staff rather than the patients
• the drugs make patients easier to work with
• it is for short-term use to calm patients is what is recommended and that this practice is seem as human rights abuse by some

Question 9

AO3: Use of antipsychotics depends on the dopamine hypothesis (W)

Answer 9

• original hypothesis suggests that high levels of dopamine activity in the sub-cortex of the brain (hyperdopaminergic)
• later hypothesis suggests that there are low levels of dopamine in other areas (hyperdopaminergic)
• not clear how antipsychotics work as they are dopamine antagonists
• some believe that antipsychotics don’t work

Question 10

AO3: problems with evidence for effectiveness (W)

Answer 10

• Healy (2012) suggested that some successful trials have had their evidence published multiple times exaggerating evidence for positive effects
  
  • since they have calming effects and it is easy to show positive effects which is not the same as saying they reduce the severity of psychotic symptoms
  • also states that studies assess short term benefits than long-term benefits and compare patients who keep taking antipsychotics with those suffering withdrawal having stopped taking them