Biological treatments Flashcards
What did Davis et al. do?
Davis et al performed a meta-analysis of over 100 studies that compared antipsychotics with placebos finding drugs to be more effective, with over 70% of sufferers treated with antipsychotics improving in condition after 6 weeks while fewer than 25% percent improved with placebos, suggesting antipsychotics have a beneficial effect.
What is the main treatment for schizophrenia?
The prime treatment for Schizophrenia is the use of anti-psychotic drugs; the first anti-psychotic was Chlorpromazine which was introduced in the 1950s and very quickly had a major effect by enabling many schizophrenics to live normal lives outside of mental institutions.
How do conventional anti-psychotic drugs work?
Conventional anti-psychotic drugs such as Chlorpromazine are dopamine antagonists and work by arresting dopamine production through blocking the D2 receptors in synapses that absorb dopamine and thus reducing the positive symptoms of the disorder. Chlorpromazine does not cure the patient of schizophrenia but instead dampens the positive symptoms such as hallucinations and thought disturbances down to a level where a regular degree of functioning becomes possible. Antipsychotics can be taken in tablet form, syrup or injection and can be divided into first generation (typical) and second generation (atypical) varieties.
How do atypical psychotic drugs work?
Atypical anti-psychotics introduced in the 1990s such as Clozapine work by acting upon serotonin as well as dopamine production systems and affect negative symptoms of the disorder such as reduced emotional expression. Although atypical drugs are perceived as having fewer side-effects, it is not always known specifically how they affect the brain to alleviate symptoms. Some sufferers only have to take a course of anti-psychotics once, while others have to take regular doses in order to prevent schizophrenic symptoms reappearing. There is also a sizeable minority of people who do not respond to drug treatment at all.
What did Vaughn and Leff do and what are the implications of their findings?
One of the studies in Davis et als review was by Vaughn and Leff, who found that antipsychotic medication did make a significant difference but only for those living with hostility and criticism in their home environment. In such conditions, the relapse rate for those on medication was 53% but for those in the placebo condition the relapse rate was 92%. For individuals living in more supportive environments however there was no significant difference between those on medication and placebos (12% relapse and 15% relapse). This shows that the environment people are surrounded by is very important and high amounts of hostility and criticism appears to be linked with higher relapse rates and environmental factors need to also be considered when deciding on the appropriateness of drug therapies. Supportive home environments yielded the best results regardless of being on medication or placebos which suggest drug therapies are most effective when certain environmental conditions are not always ideally suited.
What did Hill et al. find and what are the implications of their findings?
Hill et al highlighted another concern for conventional anti-psychotics; the sideeffects, one of which is Tardive dyskinesia which results in uncontrollable movements of the lips, face, hands and feet. About 30% of people taking antipsychotic drugs develop Tardive Dyskinesia and it is irreversible in 75% of cases therefore this needs to be considered when considering the appropriateness of drug therapies. Therefore ethical concerns arise and in one particular case in the US; a Tardive Dyskinesia sufferer sued on the grounds of inhumane treatment due to the sideeffects of the drugs. Some argue a cost/ benefit analysis of conventional drugs would likely result in more negatives.
What did Ross and Read find?
Ross & Read also argue that being prescribed medication reinforces the view that there is “something wrong with you” with patients. This, they argue prevents the individual from thinking about possible stressors that might be a trigger for their condition in turn reducing their motivation to look for possible other solutions beyond drug therapies that might alleviate stressors and suffering.
Outline the research by Leucht et al.
The introduction of the new atypical antipsychotics raised expectations for the outcomes possible with medication. A meta-analysis of studies by Leucht et al revealed however that the superiority of atypical drugs over conventional antipsychotics was only marginal and only slightly more effective. The claim the atypical antipsychotics are more effective in dealing with negative symptoms of Schizophrenia was also found to only be slightly more effective in Leuchts study.
Outline the research by Jeste et al.
One of the main claims of atypical drugs was that side effects such as Tardive Dyskinesia was less likely. This claim was supported by a study by JESTE et al which found people on conventional anti-psychotics had rates of 30% for Tardive Dyskinesia after 9 months while those on atypical antipsychotics had only 5%. Therefore Atypical anti-psychotics may be more appropriate in the treatment of schizophrenia because of the fewer risks of side effects which means patients are more likely to continue their medications and therefore see more benefits.
Explain Liberman’s research.
Liberman also conducted a study comparing conventional anti-psychotic use and atypical anti-psychotics and found from a study of over 1400 people; 74% discontinued their treatments due to the side effects from both drugs however for different reasons. First generation drugs were given up due to muscular disorders while atypical second generation drugs given up due to weight gain and metabolic effects. This suggests if atypical drugs are to be prescribed more due to lower side-effects; other aspects of life would also need to be recommended to be changed such as diets and levels of exercise to better manage the side effects to allow patients to continue treatment increasing the benefits of use.
What is the benefit of using anti-psychotic drugs?
The benefit of anti-psychotics in the treatment of Schizophrenia is that they are relatively cheap to produce and easy to administer. They have found to have hugely beneficial effects on sufferers allowing many to live normal lives outside of mental institutions. In the UK, through the use of drugs less than 3% of people live in hospitals on a permanent basis when previously this was much higher for those with Schizophrenia.
Weakness of using anti-psychotic drugs?
There is also recent evidence however that even second generation atypical drugs incur serious other side-effects such as the eduction in white blood cells which can lead to infection and even death.
