Biological treatments

Question 1

What are typical antipsychotic drugs?

Answer 1

Eg. Phenothiazine (oldest type of antipsychotic)

• works by binding to dopamine receptors in the brain and thus preventing dopamine from binding to the receptors.
• by blocking dopamine the positive symptoms seem to be contained and there is a marked cognitive and behavioural improvement.

Question 2

Example of a strong association between the use of typical antipsychotics like chlorpromazine and the dopamine hypothesis:

Answer 2

• chlorpromazine work by acting as antagonist in the dopamine system.
• antagonist are chemicals which reduce the action of a neurotransmitter.
• dopamine antagonist work by blocking dopamine receptors in the synapses of the brain.
• this dopamine antagonist effect normalise neurotransmitters in key areas of the brain, reducing symptoms like hallucinations.

Question 3

What have numerous studies shown about the effectiveness of the typical antipsychotic drugs?(AO3)

Answer 3

• They have shown that the neuroleptic are effective in controlling positive symptoms and have allowed patients to live outside institutional care.
• continued use of the drugs at a low dose has also been helpful in preventing relapse.

Question 4

Evaluation of typical antipsychotic drugs:

Answer 4

• they do not seem effective against negative symptoms such as apathy, withdrawal or impaired personal hygiene.
• they usually reduce symptoms within 6 months, but symptoms often return if medication is stopped.
• not effective for everyone with schizophrenia (about 30% of patients either do not respond or are intolerant to them)
• clozapine can sometimes be effective with treatment resistant patients, but only about half respond favourably.
• this means a minority of people with schizophrenia cannot be helped with antipsychotic medication.

-they produce some distressing and irreversible side effects, like drowsiness, visual disturbance, depression, uncontrollable lip and knife movements and facial tics.
24% of people develop this after taking typical antipsychotic drugs for 7 years.

Question 5

What happens when adverse side effects of the medication cause patients to stop taking their medication?

Answer 5

• Leads to the revolving door phenomenon, where patients relapse and have to return to hospital.
• to tackle this, patients are sometimes given injections of long last neuroleptics which take away their option to stop taking medication (however this is criticised for removing control from individuals).

Question 6

Why is the regulation and monitoring of antipsychotic drugs very important?

Answer 6

• it has been found that doses of antipsychotic medication are sometimes too high because they have not been reduced to a maintenance level after the acute stage is over.
• this exposes patients unnecessarily to risk of side effects.

Question 7

Atypical neuroleptics: introduced which avoid some of the problems of older drugs.

Answer 7

For example, clozapine appears to be effective in controlling symptoms in those who have proved resistant to other neuroleptics and have less side effects.

Question 8

What was the problem with clozapine?

Answer 8

It was withdrawn for a while following the deaths of some patients from a blood condition that increased vulnerability to infection.
This can be counteracted by the use of other drugs and regular blood monitoring - expensive and time consuming!

Also patients who take these drugs become dependent, but currently there is no cure which means treatment will be for their lifetime.

Question 9

How do atypical antipsychotics work?

Answer 9

They block the dopamine receptors and they also block the serotonin receptors, whereas the first generation antipsychotics (typical antipsychotics) only block dopamine receptors.

Question 10

Evaluation of atypical antipsychotics:

Answer 10

Strengths:

• they seem to be more effective against the negative symptoms.
• they are reported to be more effective for the 25% of patients who were not helped by the first generation of antipsychotics.

Weaknesses:

• clozapine can cause a blood disorder, which can be fatal.
• monitoring by regular blood tests is necessary
• weight gain of 5kg or more

Question 11

Evaluation of drug therapy: neuroleptic anti-psychotic drugs

Answer 11

Strengths:

• most effective treatment for schizophrenia, reduces positive symptoms.
• a minority of people with chronic schizophrenia cannot be helped with any antipsychotic medication.

Weaknesses:

• taking these drugs can cause severe problems eg. between 2000 & 2004 there were 45 reporter deaths in which atypical antipsychotics were listed as the primary suspect.
• there were 1328 reports of serious side effects
• patient responses are variable and patients that don’t respond to typical drugs may be prescribed clozapine (atypical)

Question 12

Evaluation of drug therapy:

Answer 12

• drug treatments only offer relief from symptoms and do not tackle the underlying cause- so drug treatments are an example of the reductionist approach.
• however drugs enable a patient to live a relatively normal life and has transformed schizophrenia from hospital long stay to hospital short stay.

Question 13

AO3 ethical issues with drug therapy:

Answer 13

• some people say the spread use of drugs in treatment of mental disorder is inappropriate, referring to them as ‘chemical straight jackets’
• drugs take away any sense of personal responsibility or control.
• people in a psychotic state are not in a position to give fully informed consent about treatment.