Biological therapies for schizophrenia; drug therapy

Question 1

What can antipsychotics be in the form of?

Answer 1

Tablets, syrups or injections

Question 2

What are the two types of antipsychotics?

Answer 2

Typical

Atypical

Question 3

How often are antipsychotics generally taken?

Answer 3

every 2 weeks

Question 4

When were Typical antipsychotics developed?

Answer 4

1950’s

Question 5

What is Chlorpromazine?

Answer 5

Type of typical antipsychotic

Question 6

What are the dosages of chlorpromazine?

Answer 6

Start on 400mg and can go up to 1000mg

Question 7

What is the link to chlorpromazine?

Answer 7

The dopamine hypothesis

Question 8

How does chlorpromazine work?

Answer 8

• Acts as an antagonist in the dopamine system
• They block receptors in the synapse and reduce dopamine action
• Reduces hallucinations

Question 9

What are antagonists?

Answer 9

They are chemicals which reduce the action of neurotransmitters

Question 10

How is chlorpromazine a sedative?

Answer 10

It has an effect on histamine receptors but not sure exactly how they sedate patients but extremely fast and effective

Question 11

When were atypical antipsychotics developed?

Answer 11

1970’s

Question 12

What are the two types of atypical antipsychotics?

Answer 12

Risperidone

Clozapine

Question 13

Why was clozapine withdrawn in 1970’s?

Answer 13

Patients died from the drug causing blood condition agranulocytosis

Question 14

Why was clozapine reintroduced in 1980’s?

Answer 14

It was a better treatment than typical antipsychotics

Question 15

What measures are taken since clozapine was reintroduced?

Answer 15

Regular blood tests

Not injected

Question 16

How does clozapine work?

Answer 16

Binds to dopamine receptors and also acts on serotonin levels and glutamate receptors

Question 17

Who is clozapine prescribed to and why?

Answer 17

Those with high suicide risk

They improve mood and reduce anxiety and depression

Question 18

When was risperidone developed?

Answer 18

1990’s

Question 19

What does risperidone do?

Answer 19

Binds to dopamine and serotonin receptors more strongly than clozapine and therefore it is effective in much smaller doses and can reduce side effects

Question 20

What did Thornley et al (2003) find?

Answer 20

Reviewed studies into effects of chlorpromazine and compared to control group with placebo.
1121 patients over 13 trials
Overall, drug associated with better functioning and reduced severity
Relapse rates were lower

Question 21

What did Meltzer (2012) find?

Answer 21

Clozapine was more effective than typical, better than other atypical. Effective in 30-50% of treatments.
Inconclusive studies with risperidone, overall antipsychotic drugs are effective in schizophrenia

Question 22

What do the use of antipsychotics depend on?

Answer 22

The dopamine hypothesis
It is not a complete explanation
Unclear how dopamine antagonists can help if they reduce dopamine

Question 23

What did Healy (2012) find?

Answer 23

Some successful trials had data published multiple times, exaggerates the positive effects
Just because it is calming, doesn’t mean reduction in psychosis

Question 24

What are the side effects of using typical antipsychotics?

Answer 24

Dizziness
agitation
sleeplessness
weight gain
stiff jaw
itchy skin

Question 25

What can long term use of typical antipsychotics result in?

Answer 25

Tardive dyskinesia

Question 26

What does tardive dyskinesia manifest itself in?

Answer 26

Grimacing
Blinking
Lip smacking

Question 27

What is neuroleptic malignant syndrome?

Answer 27

Drugs block dopamine action in the hypothalamus
Very rare
0.1% of Sz patients

Question 28

Where are there less side effects seen? With typical or atypical antipsychotics?

Answer 28

Atypical

Question 29

What is the chemical kosh argument?

Answer 29

Making patients easier to deal with rather than airing them, helps staff more than patients and is a human rights abuse