Biological Treatments

Question 1

prefrontal cortex function and role in SZ

Answer 1

function: helps people think logically and organise their thoughts
role: many schizophrenics have lower activity in this area which could be linked to delusions and disorganised thoughts

Question 2

visual cortex & auditory cortex

Answer 2

function: process info received from the eyes and the ears
role: SZs have the same activity in these areas when they hallucinates as sane people do when they have genuine visual and auditory experiences

Question 3

basal ganglia

Answer 3

function: located deep inside the brain and affects movements and thinking skills
role: this structure is larger in SZ which could cause motor dysfunction

Question 4

amygdala

Answer 4

function: responsible for basic feelings such as fear, lust and hunger
role: smaller in SZ patients so can link to loss of emotion

Question 5

dopaminergic circuits

Answer 5

function: responsible for feelings of pleasure and also affects thinking and movement
role: LOW levels = linked to negative symptoms
HIGH levels = linked to positive symptomd

Question 6

what is the most common treatment for SZ

Answer 6

• antipsychotic drugs (syrups or tablets)

Question 7

how is medication administered to non-compliant patients

Answer 7

• if the patient is unwilling to have the medicine, they will get injections every 2-4 weeks
• they can be used to stop or prevent psychosis

Question 8

what are typical antipsychotics

Answer 8

drugs such as chlorpromazine
- around since 1950s
- strongly associated with the dopamine hypothesis

Question 9

how are typical antipsychotics thought to work

Answer 9

• act as dopamine antagonists
• blocks dopamine receptors
• ‘tightly bound’ to the dopamine receptors
• according to the dopamine hypothesis it should normalise neurotransmission in key areas
• reducing hallucinations

Question 10

what is the name of a common typical antipsychotic

Answer 10

chlorpromazine

Question 11

what effect does the typical antipsychotic chlorpromazine have

Answer 11

• sedative
• often used to calm patients
• can cause confusion, lethargy, dizziness and agitation

Question 12

what is commonly administered acutely as a syrup

Answer 12

• chlorpromazine
• often for when patients are first admitted to hospital and are anxious

Question 13

what is tardive dyskinesia

Answer 13

typical antipsychotics are liable to produce movement side effects sometimes resembling Parkinson’s disease

Question 14

whats the problem with typical antipsychotics

Answer 14

the symptoms of Parkinson’s disease are recreated due to tardive dyskinesia and low D2 levels
- this is not wanted or needed for someone with SZ

Question 15

why were atypical antipsychotics developed

Answer 15

• 1970’s
• to improve the effectiveness of treating negative symptoms and reduce the side effects of typical antipsychotic drugs

Question 16

name an atypical antipsychotic

Answer 16

clozapine

Question 17

in what way is the mechanism of atypical antipsychotics similar and dissimilar to typical antipsychotics

Answer 17

unlike typical antipsychotics atypical ones target a range of neurotransmitters
1. binds to and blocks dopamine receptors in the same ways
2. also acts on seretonin
3. acts on glutamate receptors
4. they are ‘loosely bound’ to a variety of receptors

Question 18

what are the possible side effects of atypical antipsychotics

Answer 18

• agranulocytosis (a blood disorder)
• weight gain
• cardiovascular problems

Question 19

how is risperidone different to clozapine

Answer 19

• risperidone was developed clozapine was involved in the deaths of some patients from a blood condition called agranulocytosis
• both bind to dopamine and serotonin receptors

Question 20

what is the key clinical advantage of atypical antipsychotics compared to typical antipsychotics

Answer 20

patients experience fewer side effects related to high D2 blockades

Question 21

what is a key challenge for the original dopamine hypothesis

Answer 21

D2 blockade cannot explain both subcortical hyperdopaminergia and cortical hypodominergia

Question 22

in the new dopamine hypothesis what is the role of dopamine in SZ

Answer 22

hypodopaminergia occurs in the prefrontal cortex

Question 23

AO3 - strength is that the
evidence shows
antipsychotics are
moderately effective

Answer 23

p - moderately effective
e - thornley et al (2003) reviewed data from 13 trials (1121ppts). found that chlorpromazine was associated with better functioning and reduced symptom severity compared to a placebo
e - Meltzer et al.(2012) concluded that clozapine is more effective than typical antipsychotics, and that it is 30-50% more effective in treatment resistant cases
l - antipsychotics are reasonably effective therapies for SZ

Question 24

PEEL - The effectiveness of antipsychotics has been vigorously challenged

Answer 24

p - vigorously challenged
e - Healy (2012) suggests that many published studies are of short duration only, published multiple times, implying there is more evidence than there is
e - powerful calming effects of antipsychotics may be effective in short term, btu that side effects may occur with more prolonged treatment
l - may not be as strong as it is sometimes reported

Question 25

PEEL - One limitation of biological
therapies is that
antipsychotics drugs have
side effects

Answer 25

p - side effects
e - associated with dizziness, agitation, sleepiness, stiff jaw, weight gain and itchy skin and tardive dyskineasia
e - most serious side effect is neuroleptic malignant syndrome (NMS) caused by dopaminergic blockade in the hypothalamus, and causes high temperature, delirium and coma, can be fatal
l - developed to reduce side effects but some still exist

Question 26

PEEL - The effectiveness of antipsychotics is based on the dopamine hypothesis which has mixed evidence

Answer 26

p - based on the dopamine hypothesis which has mixed evidence
e - original hypothesis states that symptoms result from high levels of subcortical dopaminergic activity
e - newer dopamine hypothesis argues that hypodopaminergia occurs in the prefrontal cortex
l - it is controversial as to whether drug treatments are an effective approach

Question 27

PEEL - The problems associated with the use of antipsychotic medication raise significant ethical issues

Answer 27

p - ethical issues
e - if side effects, deaths and psychosocial consequences were taken into account, a cost-benefit of antipsychotic’s advantages would most probably be negative
e - the cost drug treatments to the user with SZ does not outweigh the benefits of reduced symptoms
l - puts into question the effectiveness of such biological therapies

Question 28

PEEL - Atypical antipsychotics are claimed to have a number of advantages when compared to typical antipsychotics

Answer 28

p - number of advantages when compared to typical antipsychotics
e - patients experience fewer side effects
e - more recent newly developed atypical antipsychotic
less likely to produce extrapyramidal side effects associated with motor skills
l - patients are more likely to continue with their medication making biological therapies successful

Question 29

PEEL - How does the CATIE trial provide a counterpoint to the supposed superior
efficacy of atypical
antipsychotics?

Answer 29

• a double-blind investigation in over 1400 patients prescribed a typical or an atypical and followed for up to 18 months or until treatment was discounted for any reason
• only 26% of patients continued any drug for the 18 month period
• time to discontinuation was greater for olanzipine than the other atypicals
• clozapine was given to patients AFTER they had withdrawn from other antipsychotics, and this was the most effective overall