Biological therapy for schizophrenia Flashcards
What does the most common treatment for schizophrenia involve?
The use of antipsychotic drugs
What does the term ‘antipsychotic’ refer to?
Psychosic
What does a person with psychosis experience?
Some loss of contact with reality
Give an example of how a person with psychosis may experience some loss of contact with reality
Through hallucinations or delusions
Psychosis is a defining characteristic of what?
Schizophrenia and related disorders
True/False: Antipsychotics are always required in the long term when treating schizophrenia
False, they can be required in the short or long term
True/False: Some people with schizophrenia can take a short course of antipsychotics then stop their use without the return of symptoms
True
Why may some people with schizophrenia require antipsychotics for life?
Otherwise they face the likelihood of a recurrence of schizophrenia’
Antipsychotics can be divided into how many types of drugs?
2
What are the two types of antipsychotic drugs called?
Typical and atypical
Typical antipsychotics have been around for how long?
Since the 1950s
Chlorpromazine is a(n) typical/atypical antipsychotic
typical
How is chlorpromazine taken?
As tablets, syrup or by injection
If taken orally, chlorpromazine is administered daily up to a maximum of how many milligrams?
1000
If taken orally, chlorpromazine is administered how frequently up to a maximum of 1000mg?
daily
When prescribed chlorpromazine to treat schizophrenia, initially doses are larger/smaller
smaller
When prescribed chlorpromazine to treat schizophrenia, for most people the dosage is gradually increased to a maximum of ___ to ___mg
400 to 800
According to Liu and Haan (2009), the typical prescribed doses of chlorpromazine to treat schizophrenia have increased/declined over the last 50 years
declined
As well as having antipsychotic properties, chlorpromazine is also an effective what?
Sedative
Which effect are typical antipsychotics such as chlorpromazine often associated with?
A sedative effect
The sedative effect of chlorpromazine is believed to be related to what?
Its effect on histamine receptors
True/False: It isn’t fully understood how chlorpromazine leads to sedation
True
True/False: Chlorpromazine is often used to calm individuals not only with schizophrenia but also with other conditions
True
Why is chlorpromazine often used to calm individuals not only with schizophrenia but also with other conditions?
Its sedative effect
Chlorpromazine has often been used to calm individuals not only with schizophrenia but also with other conditions, for example when patients are first admitted to hospitals and are…
very anxious
When is chlorpromazine usually given in a syrup form?
When being used for its sedative properties
Why is chlorpromazine often given in a syrup form when being used for its sedative properties?
Syrup is absorbed faster than tablets
There is a strong association between the use of typical antipsychotics and what?
The dopamine hypothesis
Chlorpromazine works by acting as what in the dopamine system?
Antagonists
Antagonists
Chemicals which reduce the action of a neurotransmitter
How do dopamine antagonists work?
By blocking dopamine receptors in the synapses of the brain, reducing the action of dopamine
Initially when an individual begins taking chlorpromazine are dopamine levels built up or broken down?
Built up
When an individual begins taking chlorpromazine, dopamine levels build up. After this, what happens to its production?
It is reduced
According to the dopamine hypothesis, the dopamine-antagonist effect does what?
Normalises neurotransmission in key areas of the brain
According to the dopamine hypothesis, the dopamine-antagonist effect normalises neurotransmission in key areas of the brain which reduces what?
Symptoms like hallucinations
Atypical antipsychotics are first/second-generation drugs
second
How long have atypical antipsychotics been used for?
Since the 1970s
What was the aim in developing newer antipsychotics?
To maintain and improve upon the effectiveness of drugs
The aim in developing newer antipsychotics was to improve upon the effectiveness of drugs in doing what?
Supressing the symptoms of psychosis and minimising the side effects of the drugs used
True/False: Atypical antipsychotics all work in the same way
False, not all do and we don’t know how some of them work
True/False: We know how atypical antipsychotics work
False, we don’t know how some of them work
Atypical antipsychotics were developed in the 19__s
1960s
When were atypical antipsychotics first trialled?
The 1970s
Why were atypical antipsychotics withdrawn for a while in the 1970s?
Following the deaths of some patients from a blood condition called agranulocytosis
Typical/atypical antipsychotics were withdrawn for a while in the 1970s following the deaths of some patients from a blood condition called agranulocytosis
Atypical
In the 1980s which type of antipsychotics were discovered to be more effective than the other?
Atypical
In the 1980s what were atypical antipsychotics remarketed as?
Treatment for schizophrenia to be used when other treatments failed
Clozapine is a(n) typical/atypical antipsychotic
atypical
To this day, clozapine is still only used when…
other treatments fail
Why do people taking clozapine have regular blood tests?
To ensure they are not developing agranulocytosis
Why is clozapine not available as an injection?
Because of its potentially fatal side effects
Daily dosage for clozapine is a little higher/lower than chlorpromazine
Lower
What is the typical daily dosage of clozapine for someone with schizophrenia?
Typically 300 to 450mg a day
True/False: Clozapine binds to dopamine receptors in the same way that chlorpromazine does
True
Which receptors does clozapine act on in addition to the ones that chlorpromazine acts on?
Serotonin and glutamate receptors
It is believed that what action helps clozapine improve mood and reduce depression and anxiety patterns?
It acting on serotonin and glutamate receptors
The fact that clozapine is believed to help improve mood and reduce depression and anxiety patterns means it may improve what?
Cognitive functioning
The mood-enhancing effects of clozapine mean that it is sometimes prescribed when an individual is considered at high risk of what?
Suicide
Why is it important that the mood-enhancing effects of clozapine mean it is sometimes prescribed when an individual is considered at high risk of suicide?
30 to 50% of people with schizophrenia attempt suicide at some point
__-__% of people with schizophrenia attempt suicide at some point
30-50%
Which atypical antipsychotic has been around since the 1990s?
Risperidone
Risperidone is a(n) typical/atypical antipsychotic
atypical
Risperidone was developed in an attempt to produce what?
A drug as effective as clozapine but without its serious side effects
In which forms can risperidone be taken?
Tablets, syrup or an injection that lasts for around two weeks
Risperidone is usually given in a small/large initial dose
small
Risperidone is usually given in a small initial dose and this is built up to a typical daily dose of_-_mg, and a maximum of __mg
4-8, 12
Like clozapine, risperidone is believed to bind to which receptors?
Dopamine and serotonin recrptors
Which atypical antipsychotic binds more strongly with dopamine receptors?
Risperidone
Why is risperidone much more effective in much smaller doses than most antipsychotics?
It binds more strongly to dopamine receptors than clozapine
Evidence suggests that the fact that risperidone is much more effective in smaller doses due to its stronger binds to dopamine receptors suggests this leads to…
Fewer side effects than other antipsychotics
True/False: There is a large body of evidence to support the idea that both typical and atypical antipsychotics are moderately effective in tackling symptoms of schizophrenia
True
Thornley et al. (2003) reviewed studies comparing the effects of what?
Chlorpromazine to control conditions
Thornley et al. (2003)’s review included data from how many trials and how many participants?
13 trials, 1121 participants
What did Thornley et al. (2003)’s review show about chlorpromazine?
Associated with better overall functioning - reduced symptom severity compared to placebo
How did Thornley et al. (2003)’s ‘s review show chlorpromazine is associated with better overall functioning?
Reduced symptom severity compared to placebo
Meltzer (2012) concluded that clozapine is…
more effective than typical antipsychotics and other atypical antipsychotics
Meltzer (2012) concluded that clozapine is effective in __-__% of treatment-resistant cases where antipsychotics have failed
30-50
What do Meltzer (2012)’s findings mean about the effectiveness of antipsychotics?
As far as we can tell, antipsychotics work
What did Healy (2012) suggest about the evidence for effectiveness of antipsychotics?
There are serious flaws
Healy (2012) said that most studies of the effectiveness of antipsychotics are of what?
Short-term effects only
Healy (2012) found that some successful trials of antipsychotics have had their data published multiple times. What effect does this have?
Exaggerates the size of the evidence base for positive effects
Healy (2012) said that because antipsychotics have powerful calming effects, it is easy to demonstrate that they have…
some positive effect on people experiencing the symptoms of schizophrenia
Healy (2012) said that because antipsychotics have powerful calming effects, it is easy to demonstrate that they have some positive effect on people experiencing the symptoms of schizophrenia. This is not the same as…
saying they really reduce the severity of psychosis
The flaws Healy (2012) found in evidence supporting the effectiveness of antipsychotics in treating schizophrenia mean what?
The evidence base for antipsychotic effectiveness is less impressive than it first appears
The limitation of antipsychotic drugs is the likelihood of what?
Side effects
Give 2 examples of side effects typical antipsychotics are associated with
Any 2 from dizziness, agitation, sleepiness, stiff jaw, weight gain, itchy skin, NMS and tardive dyskinesia (grimacing, blinking, lip-smacking)
What is tardive dyskinesia caused by?
Dopamine supersensitivity
What does tardive dyskinesia cause?
Involuntary facial movements such as grimacing, blinking and lip-smacking
NMS is a serious side effect of antipsychotics, particularly typical/atypical antipsychotics
typical
NMS is believed to be caused when what happens?
The drug blocks dopamine action in the hypothalamus
The hypothalamus is an area in the brain associated with the regulation of a number of…
body systems
What does NMS result in?
High temperature, delirium and coma, and can be fatal
Estimates of the frequency of NMS as a result of antipsychotics range from less than .% to just over _%
0.1, 2%
True/False: Antipsychotics can do harm as well as good
True
Why may some people with schizophrenia avoid antipsychotics?
They can do harm as well as good - some people may experience severe side effects and therefore avoid such treatments
We don’t know how some antipsychotics work - which ones?
Typical and at least some atypical
Our understanding of the mechanism by which antipsychotic drugs work is strongly tied up with what?
The original dopamine hypothesis
The original dopamine hypothesis includes the idea that symptoms of schizophrenia are linked to high levels of what, where?
Dopamine activity in the subcortex of the brain
True/False: We now know that the original dopamine hypothesis is not a complete explanation for schizophrenia
True
The original dopamine hypothesis suggests that dopamine levels in other parts of the brain are too low/high rather than too low/high
low rather than too high
If the original dopamine hypothesis’ suggestion that dopamine levels in other parts of the brain are too low is true, what shouldn’t work?
Most antipsychotics
Given that there are questions over the effectiveness of antipsychotics anyway, the fact that our understanding is strongly based on the original dopamine hypothesis adds to…
the argument that they are ineffective
The argument that antipsychotics may be ineffective means that at least some antipsychotics may not be the best what?
Treatment to opt for
The fact that our understanding of the mechanism by which antipsychotic drugs work is strongly tied up with the original dopamine hypothesis yet we now know that this isn’t a complete explanation for schizophrenia means that perhaps some other factor is involved in…
their apparent success
