Biological treatment For Schizophrenia (drug treatments) Flashcards
Name one biological treatment for schizophrenia
drug treatments
drug treatments for schizophrenia
if schizophrenia is caused by an excess or a deficiency of a certain neurochemical, then medication can be used to correct this imbalance.
Typical or first-generation antipsychotics (FGAs)
Chlorpromazine, haloperidol
What is meant by a dopamine antagonist?
give an example.
what makes them effective?
What do they reduce?
What did Barlow and Durand 1995 find?
name a side effect
-chlorpromazine was the first antipsychotic medication in 1950s
Dampens the effects of dopamine, however motor side effects.
-haloperidol, higher potency, do smaller dose required, effective at stopping auditory hallucinations. Still motor effects.
However, dopamine was only too high in some parts of the brain and not all parts so areas involved in motor control were already working normal and reducing the dopamine there lead to symptoms similar to Parkinson’s.
-Dopamine antagonist - reduces positive symptoms by blocking postsynaptic dopamine receptors without activating them.
-Most effective FGAs bind to D2 receptors (one of the main receptors implicated in schizophrenia).
-FGAs reduce positive symptoms for many but up to 40% gain no relief at all and many still experience negative symptoms (Barlow and Durand 1995).
-Side effects, e.g tardive dyskinesia (uncontrollable stiff or slow, writhing movements of the face and body) leading to poor compliance and subsequent relapse.
who found that FGAs reduce positive symptoms for many but up to 40% gain no relief, still experiencing negative symptoms.
Barlow and Durand 1995
Atypical or second-generation antipsychotics (SGAs)
Clozapine, when was it developed?
and aripiprazole
what do they block?
what neurotransmitters do they act on?
what symptoms do they reduce?
name a side effect
what did Lally and MacCabe 2015 find?
what will clients have to avoid this side effect?
-clozapine was developed in the 1960s, blocks dopamine in the same way as FGAs.
-also acts on serotonin and glutamate receptors, e.g. blocking serotonin receptors (antagonist).
-reduces both positive and negative symptoms.
-side effects, e.g agranulocytosis (potentially fatal blood condition, decrease in white blood cells), which has led the drug to fall out of favour, but still used with treatment-resistant clients, providing relief for up to 60%. (Lally and MacCabe 2015).
-clients will have regular blood tests to help avoid arangulocytosis.
-aripiprazole, partial dopamine d2 receptor agonist, little adverse effect on motor functions.
protocol
what increases as the sooner medication is started?
what’s the aim for the first week after an episode?
what’s monitored carefully?
when will a maintenance dose be prescribed?
what does this encourage?
what percentage relapse when on this prescription?
what percentage relapse when not on it?
how long is dosage maintained?
-medication is started quickly for greatest effectiveness.
-In the first week after a psychotic episode, the aim is to decrease hostility and return client to normal functioning (e.g, sleeping and eating).
-Careful monitoring for changes in symptoms and side effects, once subsided, a maintenance dose is prescribed.
-this encourages socialisation, self-care and improves mood.
-combats relapse which occurs in 18-32% who take the medication, but in 60-80% who don’t.
-dosage maintained for at least 12 months after remission (absence of symptoms).
additional considerations
what can disrupt the effectiveness of antipsychotic medication?
What should be considered as a result?
What do drug treatments often fail to do?
What did Patel et al 2014 find?
-Amphetamines, alcohol, caffeine and nicotine can all disrupt the effectiveness of antipsychotic medication.
-consider support for substance abuse during treatment.
-Drug treatments often fail to bring relief to people who have experienced symptoms for many years - first five years following an acute episode can lead to the most significant changes in the brain (Patel et al 2014).
Who found that the first five years following an acute episode can lead to the most significant brain changes?
Patel et al. 2014
strengths
What did Zhao et al. 2016 compare?
what did they find?
what does this mean for people with schizophrenia?
good empirical evidence for drugs from a large meta-analysis.
Zhao et al. 2016 compared 18 antipsychotics using data from 56 randomised controlled trials (RCTS) with over 10,000 people.
They found that 17 of the antipsychotics tested had significantly lower relapse rates than placebo treatment.
This means that drug treatments for people with schizophrenia can help avoid the emotional and financial costs of hospital treatments.
who compared 18 antipsychotics using data from 56 RCTs with over 10000 people?
Zhao et al. 2016
counter argument
what percentage of people with schizophrenia show little improvement?
what percentage experiences partial or inadequate improvement?
what did Patel et al 2014 find?
what do people with schizophrenia taking drugs fail to do?
however, 20% of the people with schizophrenia show little improvement after multiple FGA trails and 45% experienced partial or inadequate improvement and unacceptable side effects (Patel et al 2014).
Many people with schizophrenia who are taking drugs fail to function well in everyday life (e.g, most are unemployed)
weaknesses
what did kapur et al. 2000 point out?
what can’t animal models show?
What does this therefore mean for lab research.
What did turner et al 2012 find?
what is much research funded by?
What does this therefore mean for drug effectiveness?
-Much of the data comes from research with animals
Kapur et al. 2000 point out that high doses of medication can be given to animals to block D2 receptors effectively (but these doses produce severe side effects in humans).
Animal models cannot show how such side effects would interfere with everyday life or whether this would lead to lack of compliance.
Therefore, lab research can’t always replicate the lived experienced of taking daily medication and coping with incapacitating side effects (which lead clients to stop taking medication).
-drug therapy can be selectively reported
There is a publication bias towards studies showing a positive outcome of antipsychotic drugs (turner et al. 2012).
much research is funded by drug companies who promote continuing success of drugs.
therefore, drug effectiveness is exaggerated, and doctors may make inappropriate treatment decisions.
who found that there is publication bias towards studies showing positive outcome of antipsychotic drugs?
Turner et al. 2012
who pointed out that high doses of medication can be given to animals to block D2 receptors effectively.
Kapur et al. 2000
application
what has drug treatment led to?
What has the advent of antipsychotics (1950s) meant?
What did people with schizophrenia have the chance to do?
Why is this important?
Drug treatment has led to de-industrialisation
The advent of antipsychotics (1950s) meant an enormous change in the way people with schizophrenia could live their lives.
People with a diagnosis of schizophrenia had the chance to remain in the community. (avoiding institutionalisation and inability to cope).
This is important because segregation of people with mental health problems in hospitals increases stigmatisation through lack of contact with the rest of the community.
